Respiratory Failure - ICN Lecture Notes - PDF

RESPIRATORY FAILURE ICN LECTURE| 1st SEMESTER | BSN 4-4 Muscular Dystrophy ALS TABLE OF CONTENTS: (amyot...

RESPIRATORY FAILURE ICN LECTURE| 1st SEMESTER | BSN 4-4 Muscular Dystrophy ALS TABLE OF CONTENTS: (amyotrophic lateral sclerosis) - 1. Introduction to Respiratory Failure may weakness ng skeletal ○ Terms muscles ○ Definition ○ Two Main Types Spinal Cord Injuries ○ Two Ways to Acquire 3. Conditions that affect the areas of 2. Five Conditions Causing Respiratory brain that control breathing Failure Stroke ○ Type 1 Respiratory Failure ○ Type 2 Respiratory Failure Drug/alcohol overdose 3. Pathophysiology 4. Conditions that affect the flow of air in ○ Type 1 Respiratory Failure and out of lungs ○ Type 2 Respiratory Failure COPD (chronic obstructive 4. Three Compensatory Mechanism 5. Nursing Care pulmonary disease) ○ Five Assessments Cystic Fibrosis - causes thick ○ Eight Interventions mucus that clogs certain organs ○ Respiration Management such as the lungs, pancreas, and Modalities (ATEM) ○ Evaluation intestines. ○ End of Life Care 5. Conditions that affects gas exchange in alveoli (air sacs) TERMS TO REMEMBER ARDS (acute respiratory disease Hypoxemia - less than 60mmHg (too syndrome) little O2 in blood) Pneumonia - airways fill with Hypercapnia- greater than 55 mmHg ( fluid and pus elevated CO2 levels in blood) TYPE 1 RESPIRATORY FAILURE - PULMONARY WHAT IS RESPIRATORY FAILURE FAILURE (Hypoxemic) Respiratory Failure - serious condition PaO2 - low (less than 60mmHg) in which the respiratory system fails to PaCO2 - balance or low (less than or maintain enough gas exchange. equal to 45 mmHg) WHAT HAPPENS IN THE LUNGS Causes: impair oxygen transfer into The lungs cannot provide enough O2 to the blood the blood (hypoxemia) and or remove ○ Pneumonia CO2 from the blood (hypercapnia) ○ Pulmonary Edema ○ Acute Respiratory Distress RESPIRATORY FAILURE CAN BE: Acute (suddenly) Syndrome (ARDS) Chronic (gradual) ○ Pulmonary embolism TYPE 2 RESPIRATORY FAILURE - VENTILATORY TWO MAIN TYPES OF RESPIRATORY FAILURE (Hypercapnic) FAILURE PaO2 - low Type 1 Respiratory Failure (Hypoxemic PaCO2 - High (greater than 45 mmHg) RF) with or without hypoxemia Type 2 Respiratory Failure Causes: there is an issue with (Hypercapnic RF) ventilation, where the lungs cannot TWO WAYS TO ACQUIRE expel carbon dioxide, leading to its Type 1- Lung failure then gas exchange accumulation. failure manifested by hypoxemia. ○ COPD Type 2- Pump Failure then ventilatory ○ Neuromuscular disorders failure manifested by hypercapnia. ○ Chest wall deformities FIVE (5) CONDITIONS CAUSING RESPIRATORY ○ drug overdose FAILURE 1. Conditions that affects the flow of PATHOPHYSIOLOGY blood into the lungs: Varies depending on whether it is Pulmonary Embolism - blocks primarily hypoxemic or hypercapnic blood flow and causes lung Both types involved a breakdown in the damage normal mechanisms of gas exchange 2. Conditions that affect the nerves and muscles that control breathing Owner: Martinez, Patrisha Pearl B.  RESPIRATORY FAILURE ICN LECTURE| 1st SEMESTER | BSN 4-4 PATHOPHYSIOLOGY - TYPE 1 Central Respiratory V/Q mismatch - one of the most Depression - overdose of common mechanisms, where sedatives or opioids can ventilation (air reaching the alveoli) suppress the brain’s and perfusion (blood reaching the respiratory centers, alveoli) are not properly matched. reducing the drive to ○ Areas of the lung may be breathe. well-perfused but poorly ○ Increased CO2 Production ventilated, leading to inadequate In some cases, increased oxygenation of the blood metabolic activity (e.g. Shunting - blood bypasses the alveoli fever, sepsis) can produce without gas exchange, often due to more CO2 than lungs can alveolar collapse, consolidation , or eliminate, contributing to fluid filling the alveoli (pneumonia or hypercapnia. ARDS) THREE (3) COMPENSATORY MECHANISMS ○ O2 therapy may have limited IN RESPIRATORY FAILURE: effectiveness in cases of Increased RR significant shunting ○ To counteract hypoxemia and Diffusion Impairment - thickening of hypercapnia the alveolar-capillary membrane (e.g. ○ can lead to respiratory muscle in interstitial lung disease) can impair fatigue oxygen transfer from the alveoli to the Hypoxic Pulmonary Vasoconstriction blood, causing hypoxemia. ○ To optimize oxygenation, blood Alveolar Hypoventilation - Although vessels in poorly ventilated areas more commonly associated with Type constrict, diverting blood to 2, hypoventilation can contribute to better-ventilation to lung hypoxemia if the lungs do not receive regions. enough air, reducing overall O2 levels. ○ This can inc. pulmonary arterial pressure and lead to right heart PATHOPHYSIOLOGY - TYPE 2 strain. Two Main Mechanisms Renal Compensation ○ Alveolar Hypoventilation ○ In chronic hypercapnia, the Primary mechanism kidneys retain bicarbonate to Reduced ventilation leads buffer the acid produced by CO2 to the accumulation of retention leading to CO2 compensatory metabolic Due to: alkalosis. Airway Obstruction- like NURSING CARE COPD which can cause air trapping and reduced FIVE (5) ASSESSMENTS alveolar ventilation 1. Respiratory Status: Respiratory Muscle a. Monitor rr, depth, and Fatigue or Weakness- effort Neuromuscular diseases b. Observe for signs of such as myasthenia gravis distress such as or amyotrophic lateral tachypnea, use of sclerosis (ALS), impair accessory muscles, ability to breathe cyanosis, and altered level effectively of consciousness Chest Wall 2. Oxygen Saturation Abnormalities- structural a. Continuously monitor abnormalities like SpO2 using pulse kyphoscoliosis can oximeter restrict lung expansion, b. Aim to maintain SpO2 leading to inadequate above 90%, unless ventilation Owner: Martinez, Patrisha Pearl B.  RESPIRATORY FAILURE ICN LECTURE| 1st SEMESTER | BSN 4-4 otherwise directed by the suctioning healthcare provider. secretions as 3. ABG analysis needed and a. Monitor arterial blood providing gases (ABGs) to assess the humidified patient’s oxygenation, oxygen to ventilation and acid-base prevent drying status. of the mucosa. 4. Breath sounds MEDICATIONS 1. Bronchodilators a. Auscultate lung fields for a. Administer as abnormal sounds like prescribed to crackles, wheezes, or open airways diminished breath and improve sounds. airflow. 5. Mental Status 2. Corticosteroids a. Observe confusion, a. Use to reduce inflammation in restlessness, or lethargy, cases like COPD which can indicate or asthma. hypoxia or hypercapnia. MONITORING 1. Frequent Vital Signs: AND a. Monitor blood EIGHT (8) NURSING INTERVENTIONS DIAGNOSTICS pressure, heart rate, respiratory TERM DEFINITION rate, and temp regularly. OXYGENATION 1. Administer Oxygen 2. Laboratory Tests: Therapy a. CBC a. Deliver O2 via b. Electrolytes nasal cannula, c. Renal Function face mask, or 3. Chest X-Ray or CT Scan high-flow O2 a. Assist with or depending on arrange imaging the severity of studies to assess the failure. lung conditions, 2. Mechanical Ventilation such as a. If indicated , pneumonia or assist with or pulmonary manage edema. mechanical ventilation. FLUID 1. Assess Fluid Balance b. Ensure the MANAGEMENT a. Monitor intake ventilator and output settings are carefully appropriate for b. Overhydration the patient’s can worsen condition. pulmonary 3. Positioning: edema, while a. Position the dehydration can patient in a lead to semi-fowler’s thickened or secretions. high-fowlers’ 2. Diuretics position to a. Administer improve lung diuretics as expansion and prescribed to oxygenation. manage fluid 4. Airway Management overload. a. Maintain a particularly in patent airway by cases of Owner: Martinez, Patrisha Pearl B.  RESPIRATORY FAILURE ICN LECTURE| 1st SEMESTER | BSN 4-4 pulmonary g processes to edema support the patient NUTRITION 1. Nutritional Support: emotionally. a. Provide adequate COMPLICATION 1. VAP Prevention nutrition, often PREVENTION a. Implement through enteral ventilator-asso feeding, to meet ciated the increased pneumonia metabolic (VAP) demands prevention 2. Energy Conservation: strategies if the a. Plan activities to px is avoid fatigue as mechanically respiratory ventilated, failure can including oral increase the care, evaluating work of the head of the breathing and bed, and overall energy subglottic expenditure. suctioning. 2. Deep Vein Thrombosis PATIENT AND 1. Condition Education (DVT) Prophylaxis FAMILY a. Explain the a. Administer EDUCATION patient’s anticoagulants condition, as prescribed treatment plan, and apply and expected compression outcomes to the devices to patient and prevent DVT. their family 2. Infection Prevention a. Teach hand hygiene and NOTES: other infection 1. Oxygenation control 2. Medications measures 3. Monitoring and Diagnostics 3. Smoking Cessation 4. Fluid Management a. Encourage and 5. Nutrition provide 6. Patient and Family Education resources for 7. Psychosocial Support smoking and 8. Complication Prevention cessation PSYCHOSOCIAL 1. Anxiety Management SUPPORT a. Provide RESPIRATION MANAGEMENT MODALITIES reassurance and (ATEM) information to artificial airways reduce anxiety, tracheostomy care which can endotracheal intubation exacerbate mechanical ventilation respiratory EVALUATION distress. Response Treatment 2. Family Involvement ○ Continuously assess the px’s a. Encourage response to interventions and family adjust care plan as needed. involvement in care and Progression or Improvement decision-makin ○ Monitor for signs of improvement or deterioration, Owner: Martinez, Patrisha Pearl B.  RESPIRATORY FAILURE ICN LECTURE| 1st SEMESTER | BSN 4-4 adjusting care as needed to For questions, you may send me a message stabilize or improve the patient’s on twitter (commissio_nurse) or here on tiktok! condition. END OF LIFE CARE SHORTCUTS Advance Directives HEADERS ○ Discuss the patient’s wishes Ctrl + alt + header number regarding life sustaining ○ Ex: ctrl+alt+1 treatments, especially if the BULLETED LIST prognosis is poor. ctrl + shift + 8 Palliative Care ○ Make a bullet then press tab ○ If recovery is not possible, Double press enter to return to bullets involve palliative care to manage NUMBERED LIST symptoms and provide comfort. 1. ctrl + shift + 7 a. Make a numbered list then press tab 2. 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