ADHF vs Pneumonia
HF (frothy blood tinged) vs. pneumonia (rust colored, green, yellow)
What are some early signs of ARF?
tachycardia, mild HTN, AMS,
What are the cardinal signs of ARDS?
Dyspnea, cough, restlessness
Tachypnea: ABG w/ mild hypoxemia &
respiratory alkalosis
definition of COPD exacerbation? what is it commonly caused by?
acute worsening of resp. symptoms that results in additional therapy
Commonly precipitated by resp. tract
infections/pneumonia
What will an initial assessment show with an acute asthma exacerbation?
Breathlessness
chest tightness, increased work of
breathing
Increased resp. rate, increased HR & BP, decreased lung function, hypoxemia, hypercapnia, anxiety, restlessness, fear, agitation, fatigue Accessory muscle use & ability to talk in sentences/phrases
How do chest x-rays differ between pneumonia and ADHF
CXR will look different in HF & pneumonia (consolidation)
What is a late sign of ARF?
inability to speak full sentences, paradoxical breahting
What are some other common signs of ARDS once it progresses
Diffuse crackles & rhonchi
Ø Tachycardia, tachypnea, diaphoresis, cyanosis,
pallor, mental status change
Ø CXR progresses to “white out”
Ø Signs of organ failure
Ø Hypotension from leaky capillaries
What are the cardinal symptoms of COPD?
Increased dyspnea,
sputum volume, sputum production
What are a few causes of an asthma exacerbation?
Viral/illness/↑inallergenexposure
Ø Emotionalstress
Ø BB,Aspirin,NSAIDS
Ø Discontinuationofdrugtherapy
Ø Mayreportahistorypoorly-control&
progression over days or weeks
What do pneumonia labs look like
CBC w/ elevated WBC & neutrophils
What tests do you do for ABG?
• ABG (may insert arterial line for BP monitoring & ABG draws
• Pulse Ox (measure oxygenation only, need ABG to measure ventilation &
acid base status)
• CXR/EKG
• CBC (checking if anemic or ↑ WBC for infection), electrolytes, UA
• Cultures (blood, sputum)
• PE studies (CT angiogram or VQ scan)
• If concerned about cardiac output, may insert pulmonary artery catheter
• PFT (not usually helpful during acute event, but may be used to trend care)
What is the O2 treatment for ARDS (equipment, setting, procedure, etc)?
mechanical intubation, ECMO,
lowest oxygen to maintain PaO2 > 60, SpO2 > 90%
Other common symptoms?
confusion, fatigue, insomnia, malaise, Wheezing during auscultation, Hyperinflation (barrel chest), Pursed-lip breathing, Pulmonary HTN,
Retraction of intercostal spaces
What are complications of an acute asthma exacerbation?
Pneumothorax, acute cor pulmonale, resp. failure, death
What does ADHF frequently present as?
Pulmonary edema: sx of fluid overload, bilateral crackles
What is the difference between CPAP and BiPAP? And why is it used (besides for oxygen)
BiPAP:provides different pressures for insp. & exp
CPAP: same pressure for inspiration and expiration
to prevent hypercapnia
Would you run IV fluids? why or why not?
IV Fluids: balance b/w maintaining perfusion & not worsening pulmonary edema
Pharm treatment for COPD?
Bronchodilators
Ø Corticosteroids (systemic, not inhaled)
Ø Abx (if change in sputum)
Pharm tx for acute asthma exacerbation
Inhaled B2 agonist (short-acting, quick relief albuterol) Ø Systemic corticosteroids
Ø Adjunct Therapy: IV MgSO4
What is the treatment for ADHF vs pneumonia?
Drugs: diuretics, vasodilators, BB, inotropic agents
• Other: Nutrition (low Na), fluid restriction, med
compliance, Edu, ↑ exercise tolerance, rest
pneumonia:
Nursing care focuses on prevention of pneumonia
• Pulse ox reading on room/initiate IV saline lock
• O2 at2LNC
• Respiratory therapist referral: ABG & breathing treatment
• Abx ASAP (w/in 6hrs, after blood cultures)
• Supportive care: analgesics, cough suppressants, expectorants, fluids
What is the inspiratory-expiratory ratio? what is it in ARF?
normal 2:1, arf 1:3 or 1:4
Hallmark sign of ARDS?
hypoxemia refractory to oxygen
Smoking cessation
• Avoidance of indoor & outdoor pollutants
• Vaccinations: ↓ incidence of serious illness & resp. infections. Influenza for all
COPD & Pneumococcal for COPD >65 y/o.
• Optimize nutrition
• Pulmonary rehab: improves symptoms, QoL, & physical & emotional
participation in everyday activities
• O2 therapy for hypoxemia (PaO2<55 or O2 Sat<88%)
• Surgical options: Bullectomy & Lung-volume reduction surgery, Lung transplant
What are the warning signs that require URGENT care?
HR>120, RR>20, SaO2<90%, PaO2<60, PaCO2>45,
PEFR<100L/min
Ø Pulsus Paradoxus (chest rises & doesn’t look right)
Ø Wheezing on auscultation that turns silent (decreased breath
sounds)
Ø Agitation
Ø Speaking in words, not sentences