ACUTE RESPIRATORY FAILURE
What is the 1st sign of acute hypoxemic failure?
Change in patient's mental status.
Define Acute Respiratory Distress Syndrome (ARDS)
Sudden, progressive form of ARF in which the alveolar-capillary membrane becomes damaged and more permeable to intravascular fluid, allowing fluid to enter the lung
How is ARDS diagnosed?
Development of symptoms within 1 week of a known clinical insult or new or worsening respiratory symptoms, chest xray with new bilateral opacities
O2 is always given to the patient at the lowest possible concentration that results in a PaO2 of greater than 60mm Hg.
In what 2 ways is ARF classified?
Hypoxemic or Hypercapnic
What are 3 disorders that compromise CO2 removal?
Drug overdose, central nervous system damage, COPD, spinal cord injury, acute asthma, neuromusclar disorders
What is the most common cause of ARDS?
Sepsis
What ABG finding are you most likely to see in ARDS
Respiratory alkalosis caused by hyperventilation
Normal PaCO2 levels?
35-45 mm Hg
PNA, Pulmonary edema, PE, HF, Shock
What 2 symptoms often suggest hypercapnia?
What is MODS?
Multiple Organ Dysfunction Syndrome
What mechanical ventilation setting is commonly added to apply positive-end expiratory pressure to help maintain O2 in patients with ARDS
PEEP
Name 3 pharmacological intervention to decrease pulmonary congestion caused by heart failure
Diuretics, nitro, opioids
Hypoxemic Respiratory Failure is defined as?
PaO2 less than or equal to 60mm Hg with normal or slightly suboptimal PaCO2 levels
Provide 3 diagnostic studies done to confirm ARF
ABGs, chest xrays, lab values
A 'white-out'
What position is ideal for treating ARDS patients?
Prone position
Reduction in ventilatory capacity, decreased respiratory muscle strength, and delayed responses in respiratory rate and depth to falls in PaO2 and rises in PaCO2.
Hypercapnic Respiratory Failure is defined as?
Lungs are often normal, the main problem is ventilatory failure (insufficient Co2 removal) PaCO2 over 50
Main goal of nursing case in patients with ARF?
Maintain patent airway, recovery to baseline breathing patterns, effective cough, able to clear secretions, normal ABG values, breath sounds within patient baseline
What is an advanced therapy that involves cannulation of a major blood vessel, removal of the patient's blood through a catheter, adding O2 and removing CO2 and reinfusing the blood back to the patient?
ECMO
What are some clinical manifestations of ARDS as it worsens, name 3
What is something you must prevent as a nurse caring for an intubated patient?
Ventilator associated PNA (VAP)