Respiratory Failure - effectiveness.lahc.edu IV... · Acute Respiratory Failure Nursing and...
Transcript of Respiratory Failure - effectiveness.lahc.edu IV... · Acute Respiratory Failure Nursing and...
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
RespiratoryFailure
Revised1.5.17Chapter68
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
AcuteRespiratoryFailure• Resultsfrominadequategasexchange
• InsufficientO2transferredtotheblood• Hypoxemia
• InadequateCO2removal• Hypercapnia
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
GasExchangeUnit
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
AcuteRespiratoryFailure• NotadiseasebutacondiFon• oneormorediseasesinvolvingthelungsorotherbodysystems
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Classi9icationofRespiratoryFailure
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
CaseStudy
• J.D.,a75-year-oldmalewithalong-standinghistoryofCOPD,developsarespiratoryinfecFonthatisunresponsivetotreatment.• HeisadmiMedtotheEDinmoderaterespiratorydistress.• RR32andshallow,andheisanxious.
• WhattypeofrespiratorydistressJ.D.isexperiencing.• Whatinforma7onandassessmentdatawillhelpindiagnosisandtreatment?
iStockphoto/Thinkstock
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
HypoxemicRespiratoryFailureEtiologyandPathophysiology• Causes• Ven7la7on-perfusion(V/Q)mismatch• COPD• Pneumonia• Asthma• Atelectasis• Resultofpain• Pulmonaryembolus
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
RegionalDifferencesinV/QMismatch
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
RangeofV/QRelationships
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
HypoxemicRespiratoryFailureEtiologyandPathophysiology
• Causes• Shunt• Anatomicshunt• Intrapulmonaryshunt
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
HypoxemicRespiratoryFailureEtiologyandPathophysiology
• Causes• Diffusionlimita7on• SevereCOPD• Recurrentpulmonaryemboli• Pulmonaryfibrosis• ARDS• IntersFFallungdisease• Hypoxemiapresentduringexercise
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
DiffusionLimitation
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
HypoxemicRespiratoryFailureEtiologyandPathophysiology• Causes• Alveolarhypoven7la7on• RestricFvelungdisease• CNSdisease• ChestwalldysfuncFon• Neuromusculardisease
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
HypoxemicRespiratoryFailureEtiologyandPathophysiology• Interrela7onshipofmechanisms• CombinaFonoftwoormorephysiologicmechanisms• V/Qmismatch• Shunt• DiffusionlimitaFon• AlveolarhypovenFlaFon
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
CaseStudy• J.D.’schestx-rayshowsbilateralinfiltrates.ABGresults:• pH7.18• PaO258mmHg• PaCO260mmHg• O2saturaFon85%
• Hiswifeisyellingatthehealthcareteamto“dosomethingorhewilldie.”
• WhatdohisABGresultsindicate?• Whatisthecauseofhisrespiratoryfailure?• Howwouldyouaddresshiswife’sconcern?• Howissheaffec7nghisresponsesandanxiety?
iStockphoto/Thinkstock
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
HypercapnicRespiratoryFailureEtiologyandPathophysiology
• ImbalancebetweenvenFlatorysupplyandvenFlatorydemand
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
HypercapnicRespiratoryFailureEtiologyandPathophysiology• Airwaysandalveoliabnormali7es• Asthma• COPD• CysFcfibrosis
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
HypercapnicRespiratoryFailureEtiologyandPathophysiology• Centralnervoussystemabnormali7es• Drugoverdose• BrainsteminfarcFon• Spinalchordinjuries
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
HypercapnicRespiratoryFailureEtiologyandPathophysiology• Chestwallabnormali7es• Flailchest• Kyphoscoliosis• Severeobesity• Fractures• MechanicalrestricFon• Musclespasm
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
HypercapnicRespiratoryFailureEtiologyandPathophysiology• Neuromuscularcondi7ons• Musculardystrophy• Guillain-Barrésyndrome• MulFplesclerosis• Exposuretotoxins• MusclewasFng
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
RespiratoryFailureClinicalManifestations
• Suddenorgradualonset• AsuddendecreaseinPaO2orrapidincreaseinPaCO2indicatesaseriouscondiFon
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
CaseStudy• J.D.’swifereportsthathehashadincreaseddifficultysleeping.• HehasbeenconfusedatFmesoverthepastweek.• Heappearsrestlessnowandinsistsonleaningontheoverbedtable.
• Howdothesemanifesta/onsrelatetorespiratoryfailure?• Whatotherclinicalmanifesta/onswouldyouassessfor?
iStockphoto/Thinkstock
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
RespiratoryFailureClinicalManifestations
• SpecificclinicalmanifestaFons• Rapid,shallowbreathingpaMern• Orthopnea• TripodposiFon• Dyspnea• Pursed-lipbreathing• RetracFons• ChangeinI:EraFo
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
CaseStudy
• J.D.’swifestatesthathehasahistoryofMI,hypertension,andGERD.• Asputumcultureisorderedforhim.
• Whatotherdiagnos/cstudieswouldbeorderedforhim?
iStockphoto/Thinkstock
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
RespiratoryFailureDiagnosticStudies• Historyandphysicalassessment• ABGanalysis• Chestx-ray• CBC,sputum/bloodcultures,electrolytes• ECG• Urinalysis• V/Qlungscan• Pulmonaryarterycatheter(severecases)
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
CaseStudy• J.D.’swifesharesthatheisareFredteacher.• Hehasenjoyedwoodworkingbutstrugglestoworkonprojectsnow.• J.D.walksshortdistancesinhisneighborhoodwhenheiswell.• Hetoleratessmallfrequentmealsbest.
• Discussthesefindingsandotherques/onstheymightaskhimorhiswiferelatedtofunc/onalhealthpa>erns.• Discusshead-to-toeassessmentfocus.
iStockphoto/Thinkstock
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
CaseStudy• J.D.isplacedonoxygenviafacemask.
• Whatothercollaborativecareareappropriate?
iStockphoto/Thinkstock
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
AugmentedCough
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
AcuteRespiratoryFailureNursingandCollaborativeManagement
• Huffcoughing• Seriesofcoughsperformedwhilesaying“huff”• EffecFveinclearingcentralairways
• Stagedcough• Sitleaningforward• Takethreedeepbreathsthroughmouthandcough
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
AcuteRespiratoryFailureNursingandCollaborativeManagement
• HydraFonandhumidificaFon• Adequatefluidintake• IVhydraFon• HumidificaFondevices• O2viaaerosolmask
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
AcuteRespiratoryFailureNursingandCollaborativeManagement
• Chestphysicaltherapy• Posturaldrainage• Percussion• VibraFon
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
AcuteRespiratoryFailureNursingandCollaborativeManagement
• AirwaysucFoning• Nasopharyngeal• Oropharyngeal• Nasotracheal
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
AcuteRespiratoryFailureNursingandCollaborativeManagement
• Respiratorytherapy• PosiFvepressurevenFlaFon(PPV)• NoninvasivePPV• BiPAP• CPAP
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
NoninvasivePPV
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
CaseStudy
• Thesputumcultureisobtainedandsenttothelab.• Hissputumisthickandtanincolor.
• Whatdrugtherapywouldbeusedforhim?
iStockphoto/Thinkstock
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
AcuteRespiratoryFailureNursingandCollaborativeManagement
• Drugtherapy• Reliefofbronchospasm• Bronchodilators
• ReducFonofairwayinflammaFon• CorFcosteroids
• ReducFonofpulmonarycongesFon• DiureFcs,nitratesifheartfailurepresent
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
AcuteRespiratoryFailureNursingandCollaborativeManagement
• Drugtherapy• TreatmentofpulmonaryinfecFons• IVanFbioFcs
• ReducFonofsevereanxiety,pain,andagitaFon• Benzodiazepines• Opioids
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
AcuteRespiratoryFailureNursingandCollaborativeManagement
• MedicalsupporFvetherapy• Treattheunderlyingcause• MaintainadequatecardiacoutputandhemoglobinconcentraFon
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
AcuteRespiratoryFailureNursingandCollaborativeManagement
• NutriFonaltherapy• Maintainproteinandenergystores• EnteralorparenteralnutriFon• NutriFonalsupplements
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Evaluation• Expectedoutcomes• MaintainapatentairwaywitheffecFveremovalofsecreFons• NormalorbaselineRR,breathsounds,oxygenaFon• Normalhemodynamicstatus
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
CaseStudy
• J.D.wasadmiMedtoamedicalunitandisslowlyrecoveringfromhisrespiratoryinfecFon.• Heandhiswifeaskabouthowthismightbepreventedinthefuture.
• Whatwillbeyourteachingplanfordischarge?
iStockphoto/Thinkstock
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
ApaFent’sABGresultsincludepH7.31,PaCO250mmHg,PaO251mmHg,andHCO324mEq/L.Oxygenisadministeredat2L/min,andthepaFentisplacedinhigh-Fowler’sposiFon.Anhourlater,theABGsarerepeatedwithresultsofpH7.36,PaCO240mmHg,PaO260mmHg,andHCO324mEq/L.Whatismostimportantforthenursetodo?a. Increasetheoxygenflowrateto4L/min.b. DocumentthefindingsinthepaFent’srecord.c. ReposiFonthepaFentinasemi-Fowler’sposiFon.d. PreparethepaFentforendotrachealintubaFonandmechanical
venFlaFon.
AudienceResponseQuestion
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
ApaFentwithseverechroniclungdiseaseishospitalizedwithrespiratorydistress.WhichfindingwouldsuggesttothenursethatthepaFenthasdevelopedrapiddecompensaFon?a. AnSpO2of86%b. AbloodpHof7.33c. AgitaFonorconfusiond. PaCO2increasesfrom48to55mmHg
AudienceResponseQuestion
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
WhichpaFentisathighestriskforhypoxemicrespiratoryfailure?a. ApaFentwhohasrespiratorymuscleparalysisb. ApaFentwhohasfracturedribsandaflailchestc. ApaFentwhohasamassivepulmonaryembolismd. ApaFentwhohasslowbreathingfromadrug
overdose
AudienceResponseQuestion