1. Respiratory Respiratory Failure and ARDS

2. Normal Respirations

3. Respiratory Failure Not a disease process, sign of severe dysfunction Lungs unable to oxygenate blood & remove CO2 Alveolar ventilation is inadequate to meet the body’s need Commonly defined in terms of ABG’s PO2 of less than 50 mmHg PCO2 greater than 50 mmHg Arterial pH of less than 7.35

4. Respiratory failure & affect on acid-base balance 1. Hypoxemia resp failure is failure of oxygenation. PO2 significantly reduced and PCO2 is at or below normal Metabolic acidosis results from tissue hypoxia 2. Hypercapnia resp failure results from hypoventilation. PCO2 rises rapidly and resp acidosis develops PO2 drops more slowly

5. Causes of respiratory failure (p.1157) Impaired ventilation Impaired diffusion Ventilation-perfusion mismatch (VQ) COPD most common cause of resp failure

7. Common manifestations/complications of respiratory failure Hypoxemia Hypercapnia Underlying disease process symptoms (p. 1157)

8. Cyanosis

10. Therapeutic interventions for Resp Failure Diagnostic tests- ABG’s; ETCO2; chest X-ray Main treatment- correct underlying cause & restore adequate gas exchange in lung Elevate HOB Medications Oxygen therapy (O2 sat 90%; PaO2 60 mmHg) Airway management

11. Tracheotomy

12. Endotracheal tube

14. Make sure airway attached to lungs

15. Therapeutic interventions cont. Mechanical ventilation Adeq gas exchange & tissue perfusion Criteria to put on RR > 35-45 pCO2 >45 pO2 <50

16. Mechanical ventilation cont Types Modes PEEP; CPAP Ventilator settings- including alarms Complications Ventilate one lung Nosocomial pneumonia Barotraumas Cardiovascular Gastrointestinal

17. Nursing assessment specific to respiratory failure Health history Physical exam

18. Pertinent nursing problems and interventions specific to respiratory failure Impaired spontaneous ventilation Ineffective airway clearance Anxiety Home care

19. Acute respiratory distress syndrome- ARDS Syndrome, sudden & progressive acute resp failure- not primary Alveolar capillary membranes damaged more permeable> noncardiac pulmonary edema & progressive refractory hypoxemia

20. Pathophysiology of ARDS- Stages Refer to BB course documents Module 2 for video Page 1170-1 illustrations of stages Initiation of ARDS; onset pulmonary edema; alveolar collapse; end-stage ARDS

21. surfactant keeping alveoli open

23. Common manifestations/complications of ARDS Symptoms develop 24-48 hrs after initial insult Early symptoms Later symptoms Hallmark sign- progressive refractory hypoxemia Noncardiac pulmonary edema

24. Therapeutic interventions for ARDS Diagnostic tests ABG’s- hypoxemia Chest X-ray- snow storm effect Pulmonary function tests Hemodynamic monitoring

25. Therapeutic intervention for ARDS cont. Medications Mainstay of treatment---Mechanical ventilation with intubation Correct underlying condition Fluid replacement keep vascular volume Nutrition positive protein balance Heparin prevent thrombothebitis ‘Proning’

26. Independent Lung Ventilation

27. Prone Device

28. Benefits to Proning >

29. Nursing assessment specific to ARDS Health history Physical exam

30. Pertinent Nursing problems and interventions for ARDS Decreased cardiac output Ineffective airway clearance; impaired tissue perfusion; imbalance nutrition: less than body requirements; risk for infection Dysfunctional ventilatory weaning response Home care