med surg ch 15 - resiptory failure

assessement of respirotry failure

neurological - early signs hypercapnia/hypoexima

resiporty

cardiovasular

nutrition

psychosoical

chest xray

ABG

Pulmonary function test

pulse ox / end tidal CO2

ARDS

noncardigenic pulmonary edema

diagnostic criteria

• bilateral breathing

• PAco2/FiO less than 200

• pulmonary cap wedge pressure less than 18mm Hg

Acute lung injury scoring

Symptoms of ARDS

dyspnea/tachypnea

hyperventiation with normal breath sounds

increased temp/pulse

respiratory alkalosis

worsening chest x-ray that white out

increase PIP on vent

eventual severe hypoxemia

treatment of ARDS

treat the cause

O2 and vent

• (PEEP) positive end-expiratory pressure

• possible nontraditional modes of ventilation - high frequency , pressure control and inverse ratio

Fluid/ eletrotyles balance

adequate nutrition

pharmacologic intervention

psychosocial support

what should u be alert for complication in ARDS

MODS

DIC

renal failure

long-term pulmonary effects associated with high oxgyen and other therapies

AFR in COPD

worsening V/Q mismatch

• ex secretions and bronchoconstrictions can lead to ARF

Causes of AFR in COPD pt

acute exacrebation ,

CHF/pulomary edema

dysrthymias

eletrolyte imbalance

dehydration

pneumoina

assessement in COPD pt

barrel chest

accessory muscles to breath

Dyspnea

chronic cough

sputum production

clubbing of fingers

pulmonary function studies

postbronchodilator spirometry limitations

medical management in COPD pt

correct hypoexmia

• caution giving O2

• nonivasives postive pressure vent

• ventilatory assistance

Medication

• Beta 2 agonist- broncdilators

• long acting/short acting

• antibioitcs

• corticostreiods

ARF in with asthma

wheezzing

dyspnea

chest tightness

accessory muscle

nonproductive cough

hypereventilation initially

peak flow is low—less than 50

cause of AFR in asthma pt

bronchodilaotrs dont work no more

not sticking to meds

what the effects of ARF in asthma pt

hyperventilation - air trapping results in resiporty acidosis

severe hypoxemia

different types of Pneumonia

CAP - communicty acquired

HCAP- healthcare assoicated

HAP - hosptial acquired

VAP - ventilator assoicated

increased risk for pnemonia pt

old ppl

alcoholics

smokers

immunosuppression

chronic disease

head injury

prevent of pnenomia

influenza vaccines

• all person over 6 month

• high risk of getting influenza

• heathcare providers

At age 65 get pneumoococcal vaccination to prevent Streptococcus or pneumococcus

presentation of pnueomona

fever

cough

blood in suptum

hemoplysis

purluelrnt suptum

dyspnea/tachypnea

chest pain

adventitious breath sounds

oral care

assess the pt

do it 2x a day

assess intubated pt every 2 hours

brush gums, tongue, teeth

use a soft toothbursh

what are things u need for oral care

oral suction

toothbrush

mouth lube

mouth wash

ARF in Pulmonary Embolus

virchow triad

• veous stasis

• altered coagulatiblity

• damage to vessel wall

embolus results in a lack of perfusion to ventilated alveoli ( v/Q mism,atch )

assessement PE

S/S of DVT

chest pain

dsypena

tachycardia/pnea

cough/hemoptysis

crackles/whezzing

hypoxemia

prevention of PE

meds -heperain

mechecial - Compression socks, foot pumps, sequential compression devices

postion change - no pillow under knees

encough fluids

treatment of PE

abc, o2

thrombolysitcs

heparin

monitor bleeding

surgucal procedures - embolectomy

vena cava umbrella

risk facotrs in PE

recent surgery

prolonged immobility

acute MI/infectious disease

lower extremity fracture

herediatry PE risk factors

Protein C/S deficiency - clotting is not happening in the body

antithrombin deficiency

prothrombin mutation