Critical Care Pulmonary Problems PDF

Critical Care Pulmonary Problems Karen LaNasa MSN, RN Revised 6/20/2024 A. Hernandez, FNP-BC  Pulmonary Edema Abnormal accumulation of fluid in the alveoli and interstitial spaces in the lungs A complication of various heart and lung diseases Acute decompensated HF  Hear...

Critical Care Pulmonary Problems Karen LaNasa MSN, RN Revised 6/20/2024 A. Hernandez, FNP-BC  Pulmonary Edema Abnormal accumulation of fluid in the alveoli and interstitial spaces in the lungs A complication of various heart and lung diseases Acute decompensated HF  Heart failure: most common is Left-sided heart failure secondary to CAD Overhydration Low albumin, nephrotic syndrome, hepatic disease Respiratory distress syndrome Causes Etiology: Cardiac & Non- Cardiac Near drowning Oxygen and post intubation Trauma and Transfusion CNS (neurogenic) Allergic alveolitis Renal failure Drugs Inhaled toxins Altitude & ARDS Contusion Clinical Appearance: SOB, cough, Pink Frothy Sputum, Hypoxia, orthopnea, anxiety Fluid overload: Auscultation of adventitious sounds(crackles, rales, wheezing), peripheral edema, hepatomegaly, tachypnea  · Increased pulmonary venous pressures · RR, pO2, HR, / BP · Anxious/pale/dusky · Cold & clammy Clinical · Severe dyspnea, use of accessory muscles Manifestations · Frothy, blood-tinged sputum · Crackles/wheezes/rhonchi · JVD · BNP > 500 · Dysrhythmias Unilateral Pulmonary Edema Interventions Critical Care interventions BiPAP, mechanical ventilation Funds and Med Surg1 1 Hemodynamic monitoring interventions Morphine, Nitroglycerine, Inotropic support, anticoagulation (Afib) Ventricular assist device or intraaortic balloon pump Diagnostic testing: Management: Hypoxemia via ABG ABCDE (sit up patient, o2 w/ face CXR shows pulmonary veins, mask, reassurance) increase in heart size, opacities IV diuretic IV opioid IV antiemetic Dialysis CPAP/IPPV for resp support Fluid Balance Pulmonary Embolism Clinical Manifestations DIAGNOSTIC TESTING: US to look for blood clots in your legs. CT scan to look for blood clots in LUNGS and LEGS. VQ Scan uses radioactive substance to show how well O2 and blood are flowing to lungs. Pulmonary angiography Pulmonary Embolism - LABS: Causes, Signs & D-Dimer Symptoms, Diagnosis, Treatment TREATMENT: (healthjade.com) Blood thinners (heparin) Thrombolytics Clot removal IVC filter  Patho: Vasoconstriction and increasing vascular resistance of pulmonary blood vessels leading to poor perfusion, hypoxemia and right sided heart failure. Pulmonary Hypertensions https://www.webmd.com/lung/pah-help-16/video-pulmonary- hypertension-symptoms-treatments  All symptoms are related to the inability of the CO to adequately respond to the increased oxygen demands; eventually, as the disease progresses, pt suffers dyspnea at rest Clinical Increases workload of RV – Cor pulmonale= DYSPENIA AT REST Manifestations Clear lung fields Cxray: shows enlarged Enlarged right central pulmonary arteries ventricle Diagnosis of Pulmonary Hypertension Vital signs – a loud pulmonic 2nd heart sound upon auscultation, which is usually a murmur or a gallop; tachycardia Blood tests – B-type Natriuretic Peptide (BNP), Basic Metabolic Panel (BMP), Complete Metabolic Panel (CMP), Liver Function Tests (LFTs) are all useful in diagnosing pulmonary hypertension Electrocardiogram (ECG) – to check for any irregularity in heartbeat Exercise stress test – use of ECG while the patient is on a treadmill or a stationary bike Chest X-ray – to check for any enlargement of the heart’s right ventricle Echocardiogram – utilizes sound waves to create images of the heart Cardiac catheterization (right-sided) and angiogram – to directly measure the pressure in the right ventricle and the pulmonary arteries Cardiac CT scan / MRI Pulmonary function test -a non-invasive test using a spirometer to measure how much air the lungs can hold Genetic test – if there is a suspected hereditary or genetic involvement Pulmonary Hypertension Nursing Diagnosis and Nursing Care Plan - NurseStudy.Net Interventions 1 2 3 4 Key is early Oxygen Meds: Lung Transplant recognition!!!!! Diuretics Anticoagulants Vasodilators/ Ca+ Channel Blockers  Karen LaNasa MSN, RN Acute Respiratory Failure and Acute Respiratory Distress Revised 6/20/2024 Syndrome A. Hernandez, FNP-BC Respiratory Failure and Critical Care  Ventilation: Movement of air from the atmosphere to the alveoli Components Diffusion: Exchange of oxygen of and carbon dioxide at the Respiratory alveolar–capillary membrane) Function Perfusion: Blood flow  Acute Respiratory Failure Results from inadequate gas Classification exchange Hypoxemic respiratory Insufficient O2 transferred failure to blood Hypercapnic respiratory Hypoxemia failure Inadequate CO2 removal Hypercapnia Hypoxemic vs Hypercapnic  Major threat is inability of Respiratory lungs to meet the O2 needs of tissues Failure & Inadequate O2 delivery to Oxygen tissues or Needs of Tissues cannot use O2 delivered to them Tissues Septic shock Acid-base alterations  Hypoxic Respiratory Failure Clinical Manifestations Tachycardia, HTN, Confusion, cool & clammy, HYPOXIC: irritability, dysrhythmias & combative, in LOC hypotension (late) Dyspnea, prolonged Fatigue, unable to expiration, talk in full accessory muscle sentences use, cyanosis (late)  Hypercapnic Respiratory Failure Clinical Manifestations HA, Dysrhythmias, disorientation, Shallow Hypercapnic HTN, tachycardia, somnolence, coma respirations bounding pulse (late) Pursed lip Tendon reflexes, V-tach Muscle weakness breathing, tripod seizures (late) position Diagnostics ABG CXR Pulse oximetry CBC EKG Cultures V/Q scan or Spiral CT  ARF Interventions Hydrate and Oxygen Therapy Mobilize Secretions Chest physiotherapy humidify Drugs Bronchodilators, Suctioning Ventilation corticosteroids, diuretics, antibiotics, antianxiety  Audience Response Question A patient’s ABG results include pH 7.31, PaCO2 50 mm Hg, PaO2 51 mm Hg, and HCO3 24 mEq/L. Oxygen is administered at 2 L/min, and the patient is placed in high-Fowler’s position. An hour later, the ABGs are repeated with results of pH 7.36, PaCO2 40 mm Hg, PaO2 60 mm Hg, and HCO3 24 mEq/L. What is most important for the nurse to do? Increase the oxygen flow rate to 4 L/min. Document the findings in the patient’s record. Reposition the patient in a semi-Fowler’s position. Prepare the patient for endotracheal intubation and mechanical ventilation. abgs tic tac toe - Search (bing.com)  Audience Response Question A patient with severe chronic lung disease is hospitalized with respiratory distress. Which finding would suggest to the nurse that the patient has developed rapid decompensation? An SpO2 of 86% A blood pH of 7.33 Agitation or confusion PaCO2 increases from 48 to 55 mm Hg  Audience Response Question Which patient is at highest risk for hypoxemic respiratory failure? A patient who has respiratory muscle paralysis A patient who has fractured ribs and a flail chest A patient who has a massive pulmonary embolism A patient who has slow breathing from a drug overdose  Acute Respiratory Distress Syndrome (ARDS) Sudden progressive form of acute respiratory failure Alveolar capillary membrane becomes damaged and more permeable to intravascular fluid Alveoli fill with fluid Bing Videos  Stages of Edema Formation in ARDS Copyright © 2017, Elsevier Inc. All Rights Reserved.  Clinical Manifestations Chest x-ray termed whiteout or white lung As ARDS progresses, because of consolidation profound respiratory distress and widespread infiltrates requires endotracheal throughout lungs intubation and PPV Leaves few recognizable air spaces Copyright © 2017, Elsevier Inc. All Rights Reserved. Diagnostics Pulmonary function tests Repeat chest x-ray ABGs PaO2 < 50 on FiO2 > 40%  Treatment GOAL is to improve the levels of oxygen in your blood. Oxygen Supplemental oxygen Mechanical ventilation Fluids Carefully managing the number of intravenous fluids is crucial. Medication Antibiotics Pain meds Anticoagulants DVT prophylaxis GI prophylaxis Sedation  All Respiratory Failure Nursing and Interprofessional Management Planning: Overall Goals Independent maintenance of airway Effective cough and ability to clear secretions Normal ABG values or values within patient's baseline Absence of dyspnea or recovery to baseline breathing patterns for patient Breath sounds within patient's baseline When this fails…. MECHANICALLY VENTILATE Noninvasive Ventilation Options CPAP BiPAP  Respiratory Therapy Modest to severe ARDS and refractory hypoxemia Need intubation with mechanical ventilation to maintain the PaO2 at acceptable levels Copyright © 2017, Elsevier Inc. All Rights Reserved.  Endotracheal Intubation and Mechanical Ventilation Artificial airway bypassing upper airway and laryngeal structures through nose or mouth used to provide mechanical respiration Goals – improve oxygenation & ventilation, decrease workload of breathing, maintain airway, facilitate removal of secretions Once inserted… what do we do???  Respiratory assessment Monitor oxygenation and ventilation Maintain tube patency Interventions Oral care and hygiene Comfort Communicate  Ventilator Alarms High Pressure = Too much Low Pressure= Leaks pressure Disconnection Increased secretions Cuff leak Broncospasm Tube displacement ET tube displacement Ventilator tube is obstructed Client coughs or bites on the tube Fighting the ventilator  Mechanical Ventilator Settings f= # of breaths per minute Tidal Volume (Vt)= volume of air that the client receives each breath FiO2= Fraction of inspired oxygen. O2 concentration of the air that is being delivered to the patient PEEP: Positive end expiratory pressure  PEEP What does it do? Indications Cautions  Complications of Treatment Ventilator-associated pneumonia Increased Intrathoracic pressure Decreased cardiac output High risk for stress ulcers Renal failure  W.W.B.G.D. ? Blood Gas Results pH 7.31, PaCO2 50 mm Hg, PaO2 51 mm Hg, and HCO3 24 mEq/L f Vt FiO2. abgs tic tac toe - Search (bing.com)  How Do I? Increase Oxygen Decrease Oxygen Increase CO2 Decrease CO2 Increase pH Decrease pH