Respiratory Part 2 PDF

Pulmonary Disorders Acute Lung Failure AKA Acute Respiratory Failure Two Types>Type 1-Hypoxemic ItPaO2 Normocapnic i Normal PaCOL...

Pulmonary Disorders Acute Lung Failure AKA Acute Respiratory Failure Two Types>Type 1-Hypoxemic ItPaO2 Normocapnic i Normal PaCOL Type 2-Hypoxemic Hypercapnic (uPaO2iTPaCOz 2 Etiology disorder that effects Secondarytoanyon of the respiratory sysis - Extrapulmonary Neuro system ; Brain Spinal , cord , neuromuscular disease Pleuralinjury/infection issue w/ upper airway Intrapulmonary the The airways within lungs Problems with pulmonary circulation Atelectasis-Alveolar/capillary exchange IDE also impaired  Normacapnic) pt2 Etiology Type 1 - (Hypoxemic Ventilation Perfusion Mismatch (v/Q) - - through the blood vessel Blood passes to Alveoli - oxygen is not geting (Examples) Pneumonia · · Atelectasis · Fluid Overload · Airway Obstruction that blocks the tubes to the Alveoli Anything · Intrapulmonary Shunting Blood does not participate in gas exchange - Mixes blood wol unoxygenated oxygenated blood clowers the overall PaOz - be alveolar issue or vessel issue can Etiology Typell(Hypoxemic Hypercapnic) Alveolar Hypoventilation · Wor clo VQ Mismatch or Shunting to meet the necessary receiving Oxygen the · Not - metabolic needs Decreased ventilation of the body - Increased metabolic needs(sepsis,feer) · Most extrapulmonary Diseases/ Injuries Respiratory Failure Assessment and Diagnosis p+ 3 Clinical Findings - Hypoxemia - (Hallmark) Hypercapnia (Respiratory) - - Acidosis ? Bronchoscopy · · ABE's Ultrasound/CTScan-Chest CXR11tthing) · · j black-air Medical Management white-shid · Ventilation · Medications ooxygen - Albuterol - Atrovent - steriods - ABX Nursing Management Fowlera Deep cough , if rent the suction (PVC)  ARDS : Acute Respiratory Distress System known by many names : · Adult Respiratory Distress Syndrome Disease Wet Lung · Stiff · Lung Disease /so much fluid lungs can't more) Vietnam War · Nam Lung-first identified during  what is it ? Icapillarymembranethat a suron form of An acute, diffuse, inflammatory a · luin;inglungs Life-threatening condition · infiltrates · Poor Oxygenation and pulmonary · Acute Onset What causes ARDS ? to the lungs that causes injury Anything · Intrapulmonary > Infectionon - · (source is lungs) · Extrapulmonary - > Sepsis IsourceO 5)Lung - Trauma - Drowning - Fluid Overload - Toxic Fomes  Who develops ARDs ? Estimates of 721100 , 000 per year · mild - approx 25% are considered L /3 develop more severe disease % mod to severe approx 75 are considered - The · more severe the ARD -higher mortality rate Previously Healthy lungs · How is ARDs Defined ? · Defined based on the Berlin Criteria -TimingfrominsultSeek are ChestXraberal opacities that - cannotbe explained -decimal 0 %0 Oxygenaltered PaO/FiO ratio - , Uberlin score Score-ARDs criteria Berlin => ey - Moderate  Post ARDs Impact term disabilities Long · Problems wol mobility-unable to walkfar Difficultybreathinis Issues rIt poor oxygenation · Memory - Difficulty prolongedatrach swallowingit · · Anxiety/Depression /PTSD  Everything happens 3 Phases of ARDs Bilaterally Exudative/AcutePhase ~ -he first 7 days after insult to lungs Unchecked inflammation to alveolar epithelial cells 1) Damage to capillary endothelium 2)Platelet activation intravascular - > thrombillotsto 3) Activation of Meutophils - more more inflammation 4) Increased permability leakage damage of fluid into the alveoli 5)Pulmonary Edema-> V/Q mismatch ~ Hung compliance (Refractory Hypoxemia) Proliferative Phase · insult --I days after Pulmonary · edema starts to slowly improve to stop the leaks- Influx of Lungs are trying Fibrin c-Fibroblasts Matrix The damaged tissue is replaced wo/ fibrics · decreased lung elasticity is compliance Hypoxia is the result Atelectasis · Refractory hypoxemia compliance Decrease lung Surfactant sell damage pharsesind 3 Fibrotic Phase -21 days after injury · Increased Fibrosis in intra-alveolar , and capillar a lymphatic interstitialfunction , o decreased lung and hypoxemia shunting NarrowingDay · on and edema to resistance to airflow leads atelectasis and increased also leads to decid space Elsewhere Body (uncontrolled inflammation a( in fails maygintmorgan patien  Pictures CXR Progression outthe white  What Assessment ? are our findings Respiratory Distress Respiratory · Distress with : Dysphed - Tachypnea - Refractory Hypoxemia ; Oxygen does not improve - other findings to note hypoxemia - Breath sounds changing-crackles in base of -restlessness (neuro needs oxygen) lungs I may betachycardic fluid in - Winga - may have fever alveolip pota go  What are we to do about it? (Intervention going Give supplemental Oxygen % · Goal to keep SpOz>92 ↳start vol least invasive - Masal cannula , mask LCPAP/BiPAP · Intubation wol mechanical ventilation into lungs of air going wants to protectlungwith mount Low tidal volume increased rate keep pressures in lung low slow LPEEP as needed low and - FiOz to maintain PaOz and Spo Ladjust What medications to get? steroids for Inflammation or may not help ; no real data may - Sedation - decrease anxiety - promotes relaxation and rest - prevents desynchrony with the ventilator supportive Be maintence ; Fluids , Vasopressors  What if they're on Ventilator? Paralytic neuromuscuar blocking the agents of ~ Decrease or eliminates working < Improves oxygenation breathing C try to use for 148 his decrease mortality -EBP shows that it may ? What about positioning · Fowlers CHOB up to 30-45 Prone · - promotesOxygenatoraposterior long fields of lungs - reduces weight/compression Repositioning · g2hrstunifabsab Millers prone r tolerated every 24tirs - as supine - Pulmonary Embolism  What is it ? groin is dangerous its to A thromboemboli- be easy - within the vasculature of the lung break off pulmonary artery fat I can be blood or through - moves starts in lower extremity pulmonary artery - to venous system - block u/o exchange PE ? What causes - Venous Stasis Atrial Fibrillation Immobility cardiac as out - Injury or Infection of Vascular Endothelium clocalized vessel injury -cuts Latherosdenosis (cot easy) HypercoagulabilityRB4 - Calo + Polycythemia -  What conditions increase risk ? Previous PE Cardiovascular Disease - HE /mainly fill a IbitsgeightSideahy - pighat-cor pulmonale Surgery - Orthopedic - Vascular Abdominal BCP/birth control · pills) Others trepancy/Post · · Ovarian Cancer Estrogen Replacement · pancreatic lancer · Stomach Cancer · therapy · Bile ductCancer Trauma below waist ·  PE's ? How do you classify · AHA Classification - > not to important - Massive PE Lacute PE mesmo ctility hypotensive PE - Submassive LAute PE, co/tV dysfunction or necrosis - LOW Risk conditions uno underlying  What is the Pathophysiology? & A massive PE blocka ulmonary can Pulmonary large Artery · Increased alveolar dead Reduces gas exchange · Bronchoconstriction Space lobar area compensatory · throughout a - - shunting Patho I Emodynamic Vascular Resistance Increased Pulmonary · ventricular workload · Increased right bit's blocked  Why Bronchoconstrictions ?mediators >Releaseof Alveolar Hypocarbia Hypoxia · - (near the clot Increased > constriction of local - · airway · Airway Resistance Redistribution of · ventilation to the perfused lung areas > compensatory Shunting - What is compensatory Shunting ? · The unaffected area must pick up the slack Limist accommodate of the blocked long for Cardiac Output operfusion will exceed ventilation ↓ side of heart that blood returning to right in did not participate gas exchange t Hypoxemia  What are SiS of PE ? Most Common Others Dyspnea - - Tachycardia - Anxiety Tachypnea - - Feuer - Cracktes Pleuritic ChestPain - Cough - How Are PE's diagnosed ? Labs · EIG ABG T RBBB Low PaUz-Hypoxia Atrial Fib Low Paliz-Hypocaphia Twave Inversion High pH-Resp Alkalosis. Chest x ray Echocardiogram cardiomegaly Visualize PEsize loc Elevated Hemidiaphragm D-dimer Prevention - LMWH Anticoagulatio - - Pneumatic Compression Treatment - Prevent Recurrence - Plot dissolution (TPA dissolves co +s) Hin - Reverse pulmonary - Promote Gas Exchange - Prevent complications  Nursing Management Box 19. 17 Pneumatic compression devices · of motion exercises Active/passive range · foot extension involving Adequate Hydration · Ambulation Progressive ·