Define ARDS
The Alveoli in the lungs become very “leaky” due to a SYSTEMIC INFLAMMATORY RESPONSE. Fluids and protein flood into the alveoli and drown them.
Then the Alveoli becomes HARD - This decreases lung flexibility and impaired gas/O2 exchange.
List some Direct causes of ARDS
Anything that directly hurts the lungs
Chest / Lung trauma
Near drowning event
Inhalation injury
Aspiration
Emboli
Contusion
List some Indirect causes of ARDS
1 Sepsis (sepsis shock)
Something that does not occur first in the lungs - but the lungs become effected.
Multiple Blood transfusions
Pancreatitis
Cardio pulmonary bypass
drug overdose
Shock
What are the Hallmark signs of a patient with ARDS
- Refractory Hypoxemia (even with heavy O2 administration, the O2% is not increasing)
- Bilateral infiltrates (found on CXR - white appearance - shows fluid build up)
List the 3 stages of ARDS and briefly summarize them
Exudative Phase “Leaky phase”
- 24-48 hr
- massive fluid shift into the lungs due to systemic inflammatory response”
Proliferative Phase “Heal?… NOPE”
- 14 days
- body tries to heal but doing so rapidly on hurts worse. Dense tissue is made instead of healthy new tissue. Causes the lungs to increase in stiffness.
Fibrotic Stage “Irreversible scarring”
3 weeks
Lungs are filling with dense scar tissue and dying.
poor prognosis and irreversible.
As the nurse you plan to give Dobutamine and Dopamine to your patient who is presenting with ARDS - why would these medications be helpful?
These medications help balance HR and Blood pressure in the body. They basically tell the heart to get moving! increase CO and circulate the body
What are Two possible risks when providing an ARDs patient with PEEP mechanical ventilation?
- Hypotension due to high pressure - blood is harder to get back to heart (decreased CO = low BP)
PEEP can cause hypotension mainly by reducing venous return and cardiac output, even though it may improve oxygenation. - Hyperinfiltration - due to high pressure - can cause subcutaneous emphysema, alveoli rupture and pneumothorax.
What does PEEP stand for
and why would this be helpful for a patient with ARDS
Positive End Expiratory Pressure
high pressurized mechanical ventilation that basically holds the alveoli open and pushes out the fluids.
What is a good PEEP range
(10-20) cm
What is Emphysema?
Progressive lung disease where damage to alveoli causes them to breakdown creating large air pockets trapping air making it hard to breathe due to poor gas exchange.
this is one category of COPD out of two - the other is chronic bronchitis
What two things cause COPD?
Chronic bronchitis and emphysema
Define Chronic bronchitis
affects the small airways with presence of cough and suptum production for at least 3 months in each of 2 consecutive years.
what is ACOS
“asthma-COPD overlap syndrome” describes pts presenting with symptoms of both asthma and COPD.
what is a complication of COPD?
Secondary spontaneous pneumothorax (SSP)
A pneumothorax that occurs spontaneously in pts with underlying lung disease.
Define CHF
What are the main two categories
A progressive myocardial cell dysfunction disease - the heart is either having a hard time pumping out enough blood, or filling with enough blood. Both lead to each other.
Left sided vs Right sided
Explain Left sided HF
The left side of the heart normally is taking the oxygenated blood from the lungs and pumping it out to the body systems. if this is not working… all that blood will be back flowing into the lungs.
LEFT SIDED HF HAS PULMONARY SYMPTOMS
List some symptoms someone may present with who has Left sided HF
Pulmonary congestions
Dyspnea
DROWNING feeling
Rapid weight gain
crackles
increased HR
nagging cough
weak
nocturnal paradoxical dyspnea
Left sided HF backs up to where?
the lungs
What does Ejection Fraction mean (give the range as well)
and explain how this incorporates into HF.
Ejection fraction is defined as the amount of blood pumped out of the heart with each contraction
normal is from 50% and up
this is important to know because if someone has a low EF, this means the heart is not pumping out enough blood to the body … that blood has to go somewhere…. back into the lungs it goes!!
List the Risk factors for CHF from the pneumonic FAILURE
F- faulty heart valves
A- Arrhythmias
I- Infraction (MI)
L- Lineage
U- uncontrolled HTN
R- recreational drug use
E- Evaders (illnesses, viruses, infection)
Additionally other RF may include, smoking, obesity, Diabetes, high sodium intake.
Digoxin Toxicity in relation to CHF - why is this medication used? what does the nurse want to monitor for?
Digoxin is a Inotrppe, it tells the heart to wake up basically. it helps it beat slower but stronger, helping with EF and Cardiac output.
however, Digoxin has a “narrow therapeutic window” (0.5-2.0)
Toxicity is easy - antidote = Digiban
Toxicity s/s
- nausea
- vomiting
- HALOS**
- vision changes.
also monitor pt who has hypokalemia - potassium keeps digoxin in check - if potassium is low… digoxin will elevate.
What would cause a low alarm to go off in a mechanical vent?
Leaking in the tubing or cuff
disconnections or not turning on;
What may cause a ventilator to send off a high alarm.
Obstructions
Biting the tube
Secretions
Kinks in the tubing
List the pneumonic DOPE - there are some interventions for nurses when a patient with a vent O2 starts dropping on a intubated patient.
D- Displacement
O - Obstruction
P - Pneumothorax
E - Equipment
