NU 246 (EXAM 3)-RESPIRATORY FAILURE
Terms
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- RESPIRATORY FAILURE
- INSUFFICIENCY OF RESPIRATORY SYSTEM TO EXCHANGE 02 AND CO2 IN AMOUNTS TO MEET BODY'S NEED
- ACUTE RESPIRATORY FAILURE
-
SUDDEN, LIFE-THREATENING
EXP: EMBOLISM,OBSTRUCTION - CHRONIC RESPIRATORY FAILURE
-
SLOWER, GRADUAL DECLINE IN GAS EXCHANGE
-OFTEN DEVELOP TOLERANCE TO HYPOXEMIA OR HYPERCAPNIA
EXP: COPD, NEUROMUSCULAR DISEASE - 4 CAUSES OF RESPIRATORY FAILURE
-
1.DECREASE IN RESP DRIVE
-CNS DEPRESSANTS (MORPHINE)
2.DYSFUNCTION OF RESP MUSCLE
-SPINAL CORD INJURY,GUILLIAN BARRE SYN
3.DYSFUNCTION OF LUNG TISSUE
-PNEUMONIA
4.POST OP
-THE HIGHER THE INCISION ON ABDOMEN
(GALLBLADDER,PANCREATIC CANCER)
COUGH & DB 10 TIMES/HR - S/S OF RESP FAILURE
-
DECREASED PO2 AND INCREASED PCO2
-RESPIRATORY ACIDOSIS - ASSESSMENT FOR RESP FAILURE
-
CHECK LOC
CHECK DYSPNEA
INCREASED PULSE
INCREASED BP
LOW BOWEL SOUNDS
ABG AND EKG-PVC'S MAY BE PRESENT DUE TO HYPOXEMIA-->VENTRICULAR FIBRILLATION=DEATH - IF MORPHINE IS CAUSING DECREASE IN RESPIRATIONS...WHAT SHOULD BE GIVEN?
- NARCAN
- HOW DOES ONE CORRECT UNDERLYING CAUSE OF RESP FAILURE
-
C & DB
LOC
ABG
POX
VS
PT MAY NEED INTUBATION/VENTILATOR -
ACUTE RESPIRATORY DISTRESS SYNDROME
(ARDS) -
COMPLEX FORM OF RESPIRATORY FAILURE
-SUDDEN PROGRESSIVE PULMONARY EDEMA
(NOT ASSOCIATED W/ HEART)
-BILATERAL INFILTRATED ON CXR
***HYPOXEMIA UNRESPONSIVE TO INCREASE IN OXYGENATION**
-DECREASED COMPLIANCE OF LUNGS(STIFF) - CAUSES OF ARDS
-
-ASPIRATION (NEAR DROWNING,FLUID)
-HEMATOLOGIC D/O (DIC,BYPASS)
-INFECTION
-METABOLIC D/O(PANCREATITIS,DRUG OVERDOSE)
-SHOCK,TRAUMA,CANCER,BURNS - TRIGGER OF ARDS LEADS TO
- DECREASED BLD FLOW TO LUNG
- ASSESSMENT OF ARDS
-
S/S 12-24 HR AFTER TRIGGER
-DSYPNEA,HIGH RR,HIGH HEART RATE
-COUGH(FROM FLUID IN LUNGS
-USE OF ACCESSORY MUSCLES
-DECREASED LOC
AVEOLI STIFF/COLLAPSED
CXR-INFILTRATES
**RESP DISTRESS CONTINUES DESPITE AMT OF O2 GIVEN - IMPLEMENTATION
-
MECHANICAL VENTILATION
PEEP-POSITIVE END EXPIRATORY PRESSURE
(LOW TIDAL VOLUME)
WEAN TO O2
MAINTAIN GAS EXCHANGE
ALLOW LUNGS TIME TO HEAL - NSG DIAGNOSIS FOR ARDS
-
-IMPAIRED GAS EXCHANGE
-ANXIETY - GOALS FOR ARDS
-
-INCREASE TISSUE OXYGENATION
-MINIMIZE O2 CONSUMPTION
-PREVENT/TREAT COMPLICATIONS
-ABC'S (AIRWAY,BREATHING,CIRCULATION) - WHATS DONE TO IMPROVE AIRWAY
-
-MECHANICAL VENTILATION
-A/W PATENCY,SUCTION,SIGHING
-NEUROMUSCULAR BLOCKING AGENTS(PARALYZE PT. TO PREVENT PT FROM FIGHTING VENTILATOR) - WHAT SHOULD BE GIVEN TO PT WHILE ON NEUROMUSCULAR BLOCKING AGENT
-
EYE CARE-DROPS
HUMIDITY
CPT/PT - WHAT IS THE POSITION OF CHOICE FOR SOMEONE W/ ARDS
-
PRONE POSITION
-IMPROVES OXYGENATION AND PROTECTS LUNGS
"SWIMMING POSITION" - WHAT SHOULD BE DONE FOR SOMEONE WITH ARDS
-
FLUIDS-DO NOT OVERLOAD
NUTRITION-ENTERAL/TPN (NEEDS 2500-3000 CAL/DAY)
ANTIBIOTICS-MAYBE
STEROIDS-MAYBE - COMPLICATIONS OF ARDS
-
MECHANICAL VENTILATION/ENDOTRACHEAL TUBE
GI=DECREASED MOTILITY->STRESS ULCER
RENAL=DECREASED PERFUSION/MEDS
CV
DIC=DYSRYTHMIAS (PVC'S)
INFECTION - EVALUATION FOR ARDS
-
PREVENTION=PREVENT ASPIRATION
SURFACTANT=IF PT SURVIVES,NORMAL LUNG FCN W/IN 1 YR
NITRIC ACID
ECMO (EXRA CORPOREAL MEMBRAN OXYGENATION)=BYPASS FOR LUNGS,ALLOWS LUNGS TIME TO HEAL