7. Respiratory Failure - ARDS.doc - Clients with Complex...

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Clients with Complex Respiratory Alterations RESPIRATORY CLINICAL EXAMPLES: Acute Respiratory Failure; Acute Respiratory Distress Syndrome (ARDS) PRIOR TO CLASS REVIEW : Lewis Chapter 26 – previous foundational information regarding: a. Normal respiratory system functioning – A & P of respiratory system b. Respiratory assessment parameters – history and physical exam c. Respiratory diagnostic studies (blood, sputum, radiology, endoscopic) Also review: a. Hypoxemia, hypercapnia, ventilation-perfusion mismatching (shunting, dead space – Fig. 68-4) b. Pathophysiology of respiratory failure (Fig. 68-2) and ARDS (Fig. 68-9) READINGS : Lewis, et al., (8 th ed.) Pages 1744-1762 (acute respiratory failure, ARDS) OBJECTIVES : 1. Describe risk factors and key assessment findings associated with acute respiratory failure. 2. Discuss interventions to support individuals who have experienced acute respiratory failure. 3. Discuss nursing responsibilities when caring for pt who is receiving noninvasive or invasive methods of mechanical ventilation. 4. Discuss complications associated with ventilator support options and describe appropriate nursing interventions. 5. Develop a teaching plan for an individual who has experienced acute respiratory distress. 6. Relate the pathophysiologic changes to the clinical changes occurring with ARDS. 7. Describe the management of the client with ARDS. 8. Discuss complications associated with ARDS and appropriate management. I. Acute Respiratory Failure Table 68-1 A. Hypoxemic respiratory failure ( Oxygenation failure ) - occurs when gas exchange (O2 and CO2) between the atmosphere and the blood is inadequate - Fig. 68-4 1. Definition: PaO2 < 60 mm Hg with FiO2 > 60% - Fig. 68-2 2. Causes – often more than one/combination of cause(s) a. V/Q Mismatch – inadequate ventilation &/or perfusion from the lungs b. Intrapulmonary shunt - Alveoli not oxygenated but with adequate blood flow c. Diffusion limitation - Compromised alveolar gas exchange - thickened, damaged, or destroyed alveolar membranes i. Classic sign hypoxemia present with exercise but not rest because blood moves too quickly to make the exchange d. Alveolar hypoventilation increased PaCO2 with a decreased PaO2 e. Low cardiac output states B. Hypercapnic respiratory failure ( Ventilatory failure ) 1. PaCO2 > 45 mm Hg with acidemia (pH <7.35) 2. Causes a. Airways and alveoli – obstruction or air trapping b. CNS abnormalities - suppresses the drive to breathe c. Chest Wall abnormalities (kyphosis, ex) d. Neuromuscular Conditions (guillian-barre, ex) C. Nursing Assessment – Tables 68-3, 68-4 ***Always interpret data with the patient’s baseline in mind*** ***Major threat to respiratory failure is the inability of the lungs to meet oxygen demands of tissues OR the inability of tissues to utilize the oxygen that is delivered (as in septic shock) *** ***Tissue oxygen delivery is dependent on hemoglobin and CO 2 *** 1. Symptoms dependent on: a. The cause of the respiratory failure (TREAT THE CAUSE) Pulmonary: COPD; emphysema; etc Non-pulmonary: Flail chest b. The severity of the change in PaO2 or the PaCO2 c. Acute vs. chronic
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