HESI Critical Care Cardiac Pulmonary.pdf

Second stage damage leads to onset of pulmonary edema

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Second Stage : damage leads to onset of pulmonary edema. Because membrane is damage, cells & fluid leak into alveoli Third Stage : alveolar collapse. Surfactant is destroyed & alveoli become damaged & collapse. Lungs start to become less compliant. End Stage : entire lung becomes fibrotic causing major gas exchange impairment Treatment of ARDS 1. Treat the cause Sepsis & pneumonia: antibiotics 2. O2 and ventilation PEEP: high levels. 12, 15, 18 mm water Possible non-traditional modes of ventilation Decrease O2 consumption 3. Comfort: sedation, pain relief, neuromuscular blockade 4. Positioning: prone positioning or continues lateral rotation therapy Anterior part of lungs get highest amt of ventilation. Help pt oxygenate anterior portion of lungs & getting weight of heart off of lungs. 2 concerns of prone position: airway (special beds have space for tube to go or pts heads will go to side on regular bed). Skin integrity (facial edema, issues with eyes/corneas, different pressure points on stomach like shoulders, hips, feet) 5. Fluid & electrolyte balance 6. Adequate nutrition 7. Psychosocial support : family 8. Prevent complications : organ failure, DIC (disseminated intravascular coagulation), long-term pulmonary effects, death ARF (Acute respiratory Failure) of underlying disease Several conditions both acute and chronic can result in Acute Respiratory Failure 1. COPD 2. Asthma Exacerbation 3. Pneumonia: all types 4. Pulmonary Embolism Treatment of ARF in chronic disease Treat underlying cause: 1. COPD: bronchodilators, corticosteroids, antibiotics (infection) 2. Asthma: IV corticosteroids, bronchodilators 3. Pneumonia: antibiotics, fluids 4. Pulmonary Embolism: DVT prophylaxis, thrombolytics, heparin, vena cava filter Maintain O2: administer O2, ventilate if needed, minimize demands
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