Bc pts who aspirate gastric contents great riskclosely A monitor those on tube

Bc pts who aspirate gastric contents great

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Bc pts who aspirate gastric contents= great risk=closely A- & monitor those on tube feedings & w/problems impair swallowing & gag reflexes Carefully observe pts who are being Txed for any health problems associated w/ARDS 6. A- & Clinical Manifestations A- the breathing of any pt w/a condition that  the risk of ARDS o No abnormal lung sounds are present on auscultation bc the edema of ARDS occurs first in the interstitial spaces & not in the airways o Might usually have diminished lung sounds o  work of breathing? Hyperpnea, grunting respirations, cyanosis, pallor, & retraction intercostally or substernally Document sweating, respiratory effert, & change in mental status Monitor VS at least hrly to A- for hypotension, tachycardia, & dysrhythmias
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7. Dx A- The Dx of ARDS is est. by a  Pao2 value thru ABG measurements . o Pt has a progressive need for higher levels of O2 Due to the shunting of blood o Pt doesn’t respond to  concentrations of O2 (- refractory hypoxemia = Can’t get pt off 100% O 2 but you still have to tx them w/100% O 2 =the only way to tx them initially) & often needs intubation & mechanical ventilation Sputum cultures obtained by the HCP thru bronchoscopy & by transtracheal aspiration are used to determine if a lung infection also is present The chest x-ray usually shows diffused haziness or a “whited-out” (ground-glass) appearance of the lung ECG rules out cardiac problems & usually reveals no specific changes Pulmonary artery (Swan-Ganz) catheter placement & hemodynamic monitoring is a Dx tool o Put these in pt’s a lot that have vol. issues particularly w/pulmonary edema or issues w/their lungs being wet o In Pt w/ARDS, pulmonary capillary wedge pressure (PCWP) is usually  to normal (Normal range=4-12) PCWP differs in ARDS pt from one w/cardiac-induced pulmonary edema (cardio- induced=PCWP is  18 mm Hg) o Wedge=in PA=tells the vol. that exist in lungs o Wedge floats from right side of to left side into PA where it is “wedged” into place by a balloon that’s blown up until normal PCWP is reached (4-12) =After wedging=expect vol. on left side of or to lungs=higher bc there is too much vol. & they aren’t moving it=that means wet lungs HF pt=PCWP= bc they have too much vol. from cardiac system=after wedge= PCWP bc too much vol.=its sitting in lungs from the lack of vol. mvmt or overload of vol. mvmt ARDS pt=will be normal bc they don’t have cardiac involvement= lungs are just wet bc the lungs & alveoli are bad 1. ARDS pt= lungs are wet w/a different type of fluid (it’s interstitial fluid that we are measuring w/cardiac output for CHF; an ARDS lung has protein=vol. is in the lungs but it is not necessarily systemic like we see w/CHF=when wedged &  PCWP, the vol. that exist in the lungs w/somebody w/CHF is going to be =ARDS
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  • Winter '16
  • injury decompromises pt

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