intrapulmonary causes, so very important to know the different between the two you see in that chart, you have things listed in that chart such as sleep apnea, massive obesity, of course those they are going to be extra pulmonary; they occur outside of the lung itself. And then of course examples of intrapulmonary are going to be something such as asthma, a PE can cause vent failure, pulmonary edema and interstitial fibrosis, those are all types of intrapulmonary causes of vent failure. Ok oxygenation failure normal thoracic changes – air moves in and out of the lung without difficulty but does not oxygenate the pulmonary blood sufficiently, so you’ve got adequate movement of air, but poor oxygenation capability. Ventilation is normal but perfusion is decreased. You have impaired diffusion of oxygen at the level of the alveoli, so you have right to left shunting of blood. Venous blood shunt it without being oxygenated, O2 therapy does not correct the mismatch here – this is very important to note that you give, give give, you think ok, their numbers are low, their SPO2, their CO2 is high whatever the case may be, correct it with O2 therapy – this does not correct itself. And so you have a continual low partial pressure of oxygen abnormal hemoglobin, but RBC count may be normal as well as the SPO2. And so what this essentially means is your hemoglobin is going to, when you evaluate their CBC, their H&H is going to look appropriately but what is wrong with this client is their hemoglobin is not adequately saturated with oxygen. Always think of hemoglobin being, basically your boxcars that unload at the level of the tissues. So you’ve got empty boxcars and your boxcars go around to your tissues themselves and they are supposed to unload that oxygen at the level of the tissue, but these boxcars are travelling, they’re cars that are travelling but they are not unloading the oxygen that the tissue needs. Ok, and then of course there can be a combination of both ventilatory and oxygenation failure. It’s often occurs with clients who have abnormal lungs such as those who have a history of chronic bronchitis, emphysema or even can occur during an asthma attack. With these situations or scenarios, you basically have bronchioles and alveoli which causes the oxygenation failure. Now this is because of the increased breathing, the overuse of respiratory muscles become fatigues and ineffective and of course that is going to cause a ventilation issue. Carrying on from that, you have too little O2 reaches the blood, you have hypercapnia where the CO2 levels are too high, there is something called capnography that actually is the measuring of CO2 levels. It’s most serious in those with cardiac failure because they are not able to increase their cardiac output to compensate for this situation that occurs. Many clients, a lot of facilities now are able to monitor CO2 levels and you will see this mainly post-surgical in PACUs or with clients who have a history of high CO2
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- Winter '16
- pulmonary edema, ARDS