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Nursing Management: Respiratory Failure and Acute Respiratory Distress Syndrome
Chapter 68 Overview
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2. Acute Respiratory Failure
Fig Normal gas exchange unit in the lung.
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3. Acute Respiratory Failure
Fig Classification of respiratory failure.
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4. Acute Respiratory Failure
Etiology and Pathophysiology
Hypoxemic respiratory failure
Ventilation-perfusion mismatch
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5. Acute Respiratory Failure
Fig Regional V/Q differences in the normal lung. At the lung apex, the V/Q ratio is 3.3, at the
midpoint 1.0, and at the base This difference causes the PaO2 to be higher at the apex of the
lung and lower at the base. Values for PaCO2 are the opposite (i.e., lower at the apex and higher at
the base). Blood that exits the lung is a mixture of these values.
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6. Acute Respiratory Failure
Fig Range of ventilation to perfusion (V/Q) relationships. A, Absolute shunt, no ventilation due
to fluid filling the alveoli. B, V/Q mismatch, ventilation partially compromised by secretions in the
airway. C, Normal lung unit. D, V/Q mismatch, perfusion partially compromised by emboli obstructing
blood flow. E, Dead space, no perfusion due to obstruction of the pulmonary capillary.
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7. Acute Respiratory Failure
Etiology and Pathophysiology
Hypoxemic respiratory failure, continued
Shunt
Diffusion limitation
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8. Acute Respiratory Failure
Fig Diffusion limitation. Exchange of CO2 and O2 cannot occur because
of the thickened alveolar-capillary membrane.
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9. Acute Respiratory Failure
Etiology and Pathophysiology
Hypoxemic respiratory failure, continued
Alveolar hypoventilation
Interrelationship of mechanisms
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10. Acute Respiratory Failure
Etiology and Pathophysiology, continued
Hypercapnic respiratory failure
Airways and alveoli
Central nervous system
Chest wall
Neuromuscular conditions
Tissue oxygen needs
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11. Acute Respiratory Failure
Clinical Manifestations
Consequences of hypoxemia and hypoxia
Specific clinical manifestations
Diagnostic Studies
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12. Nursing and Collaborative Management: Acute Respiratory Failure
Nursing Assessment
Nursing Diagnoses
Planning
Prevention
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13. Nursing and Collaborative Management: Acute Respiratory Failure
Respiratory Therapy
Oxygen therapy
Mobilization of secretions
Effective coughing and positioning
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14. Nursing and Collaborative Management: Acute Respiratory Failure
Fig Augmented coughing is performed by placing the palm of the hand on the abdominal
musculature below the xiphoid process. As the patient ends a deep inspiration and begins the
expiration, the hand should be moved forcefully downward, increasing abdominal pressure,
resulting in a forceful cough.
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15. Nursing and Collaborative Management: Acute Respiratory Failure
Respiratory Therapy
Mobilization of secretions, continued
Hydration and humidification
Chest physical therapy
Airway suctioning
Positive pressure ventilation
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16. Nursing and Collaborative Management: Acute Respiratory Failure
Fig Noninvasive bilevel positive pressure ventilation. A mask is placed over the nose or nose
and mouth. Positive pressure from a mechanical ventilator assists the patient’s breathing efforts,
decreasing the work of breathing.
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17. Nursing and Collaborative Management: Acute Respiratory Failure
Drug Therapy
Relief of bronchospasm
Reduction of airway inflammation
Reduction of pulmonary congestion
Treatment of pulmonary infections
Reduction of severe anxiety, pain, and agitation
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18. Nursing and Collaborative Management: Acute Respiratory Failure
Medical Supportive Therapy
Treating the underlying cause
Maintaining adequate cardiac output
Maintaining adequate hemoglobin concentration
Nutritional Therapy
Evaluation
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19. Gerontologic Considerations: Respiratory Failure
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20. Acute Respiratory Distress Syndrome
Fig Stages of edema formation in acute respiratory distress syndrome. A, Normal alveolus
and pulmonary capillary. B, Interstitial edema occurs with increased flow of fluid into the interstitial
space. C, Alveolar edema occurs when the fluid crosses the blood-gas barrier.
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21. Acute Respiratory Distress Syndrome
Etiology and Pathophysiology
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22. Acute Respiratory Distress Syndrome
Fig Pathophysiology of acute lung injury (ALI)/acute respiratory distress syndrome (ARDS).
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23. Acute Respiratory Distress Syndrome
Etiology and Pathophysiology, continued
Injury or exudative phase
Reparative or proliferative phase
Fibrotic phase
Clinical Progression
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24. Acute Respiratory Distress Syndrome
Clinical Manifestations and Diagnostic Studies
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25. Acute Respiratory Distress Syndrome
Fig Chest x-ray of a patient with acute respiratory distress syndrome (ARDS). The x-ray
shows new, bilateral, diffuse, homogeneous pulmonary infiltrates without cardiac failure, fluid
overload, chest infection, or chronic lung disease.
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26. Acute Respiratory Distress Syndrome
Table Diagnostic Findings in Acute Lung Injury/Acute Respiratory Distress
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27. Acute Respiratory Distress Syndrome
Complications
Ventilator-associated pneumonia
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28. Acute Respiratory Distress Syndrome
Table Key Components of Ventilator Bundle
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29. Acute Respiratory Distress Syndrome
Complications, continued
Barotrauma
Volutrauma
Stress ulcers
Renal failure
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Nursing and Collaborative Management: Acute Respiratory Distress Syndrome
Nursing Assessment
Nursing Diagnoses
Planning
Oxygen administration
Positive pressure ventilation
Positioning strategies
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Nursing and Collaborative Management: Acute Respiratory Distress Syndrome
Fig A, Turning patient prone on Vollman Prone Positioner.
B, Patient lying prone on Vollman Prone Positioner.
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Nursing and Collaborative Management: Acute Respiratory Distress Syndrome
Fig TotalCare SpO2RT® Bed System offers continuous lateral rotation therapy and
percussion and vibration therapies. Patients can easily and quickly be repositioned.
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Nursing and Collaborative Management: Acute Respiratory Distress Syndrome
Medical Supportive Therapy
Maintenance of cardiac output and tissue perfusion
Maintenance of nutrition and fluid balance
Evaluation
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