Respiratory Disorders
What is acute lung failure?
What is the hallmark of lung failure?
Diagnostics for lung failure?
Failure of ventilation or respiration
Hypoxemia, or decreased oxygen in the blood
ABG analysis is best diagnostic tool: ALF is considered present when the Pao2 is less than 60 mm Hg, if the patient is also experiencing hypercapnia the Paco2 will be greater than 45 mm Hg, for patients with chronically elevated Paco2, the criteria is expanded to include a pH less than 7.35
What are the two functions of the respiratory system?
What are ventilation and respiration
Name five medical conditions that could interfere with ventilation/respiration.
COPD, pulmonary fibrosis, cystic fibrosis, asthma, atelectasis, pulmonary edema, scoliosis, lordosis, kyphosis, bronchitis, pneumonia, pectus excavatum, pectus carinatum, barrel chest, etc
pH 7.33; PaCO2 49; HCO3 28; paO2; 85 mm Hg
What is partially compensated respiratory acidosis without hypoxemia
Name three potential causes of respiratory acidosis.
Any condition causing us to retain CO2 (conditions where we are not breathing adequately or slowly)
–COPD
–Acute airway obstruction
–Central nervous system depression
–Sedatives, Opioids, Anesthetics
–Spinal cord, Brain injury
–Chest wall
–Neuromuscular disease, Poliomyelitis, Myasthenia gravis, Guillain-Barre Syndrome
–Hypoventilation with mechanical ventilation (How could we fix this????)
Name at least 3 treatments/medications/nursing interventions for acute lung failure.
Treat underlying cause, promote adequate gas exchange (SPO2 90% or greater), correct acidosis, nutrition support, supplemental oxygen or positive pressure ventilation, bronchodilators, steroids, sedation, analgesics, NMBDs, deep breathing, coughing, incentive spirometry, adequate rest between procedures
In this ventilator mode, the ventilator supports every breath, whether the patient or the ventilator initiates it, is often used to allow the patient to rest, because the ventilator does all the work. This high level of respiratory support is frequently required in patients who have been resuscitated, have ARDS, or are paralyzed/sedated.
In this ventilator mode, not all spontaneous breaths are assisted by the ventilator, leaving the patient to draw some breaths on their own. Ex. if the ventilator is set with a respiratory rate of 10, the ventilator will deliver approximately 1 breath every six seconds.....BUT the patient can also breathe on their own in between ventilator assisted breaths. This mode is often used before extubating a patient.
What is assist control mode? (AC)
What is SIMV mode? (Synchronized Intermittent Mechanical Ventilation)
What is the best position to place your pt if they are diagnosed with right sided pneumonia?
For diffuse disease?
On their right side because the right lung is larger, more vascular
pH 7.44; PaCO2 49; HCO3 30; paO2 90 mm Hg
What is compensated metabolic alkalosis without hypoxemia
Any condition causing us to breathe rapidly, blowing off CO2.
–Hypoxia
–Anxiety
–Pulmonary embolism
–Pregnancy
–Hyperventilation with mechanical ventilation
–Fear, pain
–Stimulants
What is ARDS?
What is the treatment for ARDS?
What does the chest x-ray/CT look like in a pt with ARDS?
What position has been shown to improve outcomes in these patients?
What medication will we avoid in these patients?
A systemic process that is considered the pulmonary manifestation of multiple-organ dysfunction syndrome (MODS), essentially "wet stiff lungs"
Same tx as acute lung injury but these patients require positive pressure ventilation/PEEP
Ground glass appearance
PRONE positioning, the earlier the better!
Since alveoli are already flooded with fluid, fluid administration is not encouraged
The upper airways consist of?
What are there two primary functions?
Oropharynx, Nasopharynx, Pharynx, Larynx
Conducting airways, warm and humidify air, keep foreign particles out
You witness your patient aspirating, what do you do?
What patients are at risk for aspiration?
What can we do to prevent it?
Immediately turn them on their side and suction their airway.
Decreased LOC/use of sedatives: use sparingly
Supine position
Presence of NG tube, vomiting, high gastric residuals, bolus feedings, poor oral health
Mechanical ventilation/artificial airway/inadequate cuff inflation, accumulation of subglottic secretions above endotracheal cuff
Gastric contents and oropharyngeal bacteria are the most common aspirates in critically ill patients
Confirming feeding tube placement
¨Checking for signs/symptoms of feeding intolerance
¨Elevating the HOB 30-45 degrees
¨Feeding the pt via a small-bore feeding tube or gastrostomy tube
¨Avoiding the use of a large-bore NG tube
¨Ensuring proper inflation of artificial airway cuffs
¨Frequent suctioning of the oropharynx of an intubated pt to prevent secretions from pooling above the cuff of the tube
pH 7.48; PaCO2 30; HCO3 23; paO2 65 mm Hg
What is uncompensated respiratory alkalosis with hypoxemia
–Lactic acidosis, ketoacidosis
–Renal failure
–Diarrhea
–Rhabdomyolysis
–Pancreatic fistula, illeostomy
–Ingestion of acids (salicylates, methanol, ethylene glycol)
–Renal tubular acidosis
What are the first two presenting pt signs for PE?
What is the end result of a PE?
What is the tx of PE?
You've just administered medication through a pt's central line when they begin showing signs of a PE? What are your first two nursing interventions, in order?
VQ scan
two tachys: tacycardia and tachypnea
right sided HF
combination heparin and warfarin tx, heparin stopped when therapeutic INR reached
Fibrinolytic agents for massive PEs and pts who are hemodynamically unstable
Pulmonary embolectomy
Clamp the line, place pt in left Trendelenburg to prevent clot from moving into pulmonary system
Where does gas exchange begin in the respiratory system?
What is the respiratory bronchioles and alveoli?
What two things MUST be present for gas exchange to occur in the lungs?
What are ventilation AND perfusion?
pH 7.50; PaCO2 36; HCO3 30; paO2 65 mm Hg
What is uncompensated metabolic alkalosis with hypoxemia
Name three potential causes of metabolic alkalosis.
–Steroid therapy
–Vomiting
–Gastrointestinal suction
–Diuretic therapy
–Hypokalemia
–Hypovolemia
–Hypochloremia
–Sodium bicarbonate intake
What are the three forms of hypoxemia?
Describe all three and how we treat them.
Which is the worst form requiring some form of positive pressure to aid in ventilation/gas exchange?
What are alveolar hypoventilation, ventilation/perfusion mismatch, and intrapulmonary shunting?
alveolar hypoventilation: occurs when the amount of oxygen being brought to the alveoli is insufficient to meet the oxygen demands of the body; this is either from increasing metabolic needs or decreasing ventilation
ventilation/perfusion mismatch: occurs when the ventilation and blood flow are mismatched in various regions of the lung in excess of what is normal, Usually the result of alveoli that are partially collapsed or partially filled with fluid
intrapulmonary shunting: the extreme form of mismatching, occurs when blood reaches the arterial system without participating in gas exchange,
This may be the result of
1. alveolar collapse secondary to atelectasis
2. alveolar flooding with pus, blood, or fluid
If allowed to progress, hypoxemia can result in a deficit of oxygen at the cellular level
What are the functions of type 1 and type 2 alveolar cells?
Alveolar type 1 cells: comprise 90% surface area of lungs, play major role in gas exchange
Alveolar type 2 cells: produce, store, and secrete surfactant (stabilizes alveoli, increases lung compliance, and eases work of breathing)
Where are our respiratory centers located?
What is the brainstem?
medulla- rhythm of respirations
pneumotaxic center in pons- pattern and rate of respirations
apneustic center in pons- depth of inspiration and expiration
pH 7.25; PaCO2 50; HCO3 20; paO2 65 mm Hg
What is mixed acidosis? Both respiratory and metabolic acidosis, uncompensated with hypoxemia
Name at least five components of the VAP bundle.