______________________:
- Usually occurs after an acute traumatic event in those w/no previous pulmonary disease
- 50% mortality rate
- Alveolar capillary membrane becomes damaged & more permeable to intravascular fluid, alveoli fill w/fluid
- Lung Inflammation & injury to the lung itself
Acute Respiratory Distress Syndrome (ARDS)
In terms of Respiratory…
Q = ____________ (Hypoxemic)
V = ____________(Hypercapnic)
Q= O2 exchange failure
V= Ventilator Failure
Mechanical act of breathing failure
What occurs with Hypoxic ARF?
- “Q” is the problem
- Hypoxemia/normocapnia/hypocapnia
- PaO2 <60
- Restlessness, △LOC
- HTN, Tachycardia
- DYSPNEA, TACHYPNEA
- Nasal Flaring/Retractions
- Breaths to finish sentence
- Cool/Clammy/Diaphoretic
- Cyanosis (Late)
_________ is a type of ARF where the O2 being transferred between the alveoli and the capillary bed in the lungs is insufficient for the body’s needs.
Hypoxemic (O2) Failure
__________ is a type of ARF that happens when the actual mechanics of the lungs become insufficient to provide an adequate O2/CO2 exchange.
Hypercapnic (Ventilatory) Failure
What occurs with Hypercapnic (Vent) ARF?
- DYSPNEA, ↘️ RR/Rapid shallow RR
- PaCO2 >48, pH<7.35
- Morning headache/↗️ ICP/bounding pulse
- Muscle weakness, ↘️DTR
- Flushed/warm
- Pursed lip breathing
- Seizures (Late)
___________ is a life-threatening lung condition that prevents enough oxygen from getting to the lungs and into the blood. Characterized by noncardiogenic pulmonary edema; Increased-permeability pulmonary edema
ARDS; Acute Respiratory Distress Syndrome.
Early General Symptoms of ARDS?
- Dyspnea
- Restlessness
- Tachypnea
- Cough
- Crackles
- Hypoxemia
- Resp alkalosis d/t hyperventilation
- Change in LOC
Late General Symptoms of ARDS?
- Noisy respiration
- Sterna retractions
- Bradycardia/↘️ BP
- Oliguria
- Cyanosis
- Hypercapnia; resp/metabolic acidosis
- V-fib/ asystole
_________ _________: Hypoxemia despite increased O2 by mask, cannula, or ET is Hallmark of ARDS, b/c lungs are filled w/water & O2 can’t pass through fluid
Refractory Hypoxemia
4 key elements of ARDS?
- Refractory Hypoxemia
- Dense Pulmonary Infiltrates (Drowning in own fluids) on CXR
- NONcardiogenic pulmonary edema
What occurs in Phase 1 (Exudative Phase) of ARDS?
a. Occurs 1-7 days after injury (Primary Patho △’s)
b. Respiratory alkalosis- hyperventilating (loss of CO2)
c. Increased CO
d. Increased RR
e. Refractory Hypoxemia
f. Decrease tidal volume
g. Atelectasis*
h. Pulmonary edema (not r/t cardiac)- interstitial & alveolar*
i. Decrease in surfactant b/c fluid inactivates it, causing “stiff lungs”
What occurs in Phase 2 (Reparative/Proliferative) of ARDS?
a. occurs 1-2 wks after injury
b. Increased pulmonary vascular resistance & pulmonary HTN
c. Lung compliance continues to decrease d/t interstitial fibrosis & hypoxemia
d. Thickened alveolar membranes cause diffusion limitation & shunting worsening hypoxemia
What occurs in phase 3 (Fibrotic/Chronic) of ARDS?
a. Occurs approx. 3 wks after injury
b. Pulmonary vessels destroyed
c. Tissue is fibrotic & leads to vascular occlusion & pulmonary HTN
d. Decreased lung compliance
e. Surface area for gas exchange significantly reduce & hypoxemia continues
These are all examples of ______ injuries that can cause ARDS?
- Pneumonia**
- Gastric aspiration**
- Lung contusion
- Fat emboli
- Near drowning
- Inhalation injury
- Reperfusion (lung transplant, pulmonary embolectomy)
Direct injuries
These are all examples of _______ injuries that can cause ARDS
- Sepsis*
- Severe trauma w/shock & DIC, multi-transfusions*
- Cardiopulmonary bypass
- Drug overdose
- Acute pancreatitis
- Blood transfusion
- Burns
Indirect injuries
____________?serious condition in which proteins that control blood clotting become abnormally active. Small blood clots form in blood vessels. Can clog up vessels & cut off flow to organs like brain, liver, kidneys. Overtime, clotting proteins are consumed & pt is at high risk for bleeding even without injury.
DIC; Disseminated Intravascular Coagulation
What nutritional support do we offer those with ARF?
a. 35-45 kcal/kg/day: they are in high metabolic demand & need the nutrition
b. High protein
c. Watch milk products- cause high secretions
d. Low carbs (d/t breakdown into CO2)
e. High fluids
Name this equipment:
i. One setting, you have to be able to breathe out at the same pressure as it is blowing in
ii. Good for pt w/MS or problem w/muscle strength, must be able to blow out strongly on your own
CPAP (Cont Pos Airway Pressure)
Name this equipment:
i. Allows you to set level of pressure to blow in at one level & pressure to blow out at another level (usually lower).
ii. Better suited for those w/neuromuscular diseases
BiPAP (Bilevel Pos Airway Pressure)
Drug Therapy for ARF?
- Albuterol, Proventil: relief of bronchospasm
- Steriods: reduction of airway inflammation (watch for infection & high blood sugar)
- Treatment of pulmonary congestion and infections
- Ativan: treat anxiety & ease work of breathing
This organ removes the soluble waste products and access fluid from the blood, helps maintain Ca and phosphate levels, activate vit D to stimulate the intestinal absorption of Ca, helps control BP by secreting renin, helps control acid base balance, and stimulates RBC production.
Kidneys
__________: removal from the body.
Ex: H+ ions if acidodic or K+
Excretion
__________: substances being produced & discharged from a cell, gland, or organ for particular use or function, things the kidneys release.
Ex: Erythropoietin, Calictriol, aldosterone
Secretion
