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Acute Respiratory Failure PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Acute Respiratory Failure".

This medical PowerPoint presentation talks about acute respiratory failure (ARF), a condition where the lungs are unable to provide enough oxygen to the body and/or remove enough carbon dioxide from the body. This can result in a range of symptoms, such as shortness of breath, rapid breathing, confusion, and blue skin or lips.

There are two main types of ARF, i.e., Hypoxemic respiratory failure and Hypercapnic respiratory failure.

Tags : Acute Respiratory Failure, Hypoxemic respiratory failure, Hypercapnic respiratory failure, critical care medicine, critical care medicine PowerPoint presentation

Published on : Mar 28, 2023 | Views : 2420 | Downloads : 1

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Slide 2-

Acute Respiratory Failure (ARF) Failure Oxygenation Ventilation Both of the above Altered gas exchange (room air) PaO2 < 60 mm Hg PaCO2 > 50 mm Hg pH ≤ 7.30 Copyright © 2017 Elsevier Inc. All rights reserved. 2
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Failure of Oxygenation Hypoventilation Intrapulmonary shunting Ventilation-perfusion mismatch Diffusion defects Decreased barometric pressure Low cardiac output (nonpulmonary hypoxemia) Low hemoglobin level (nonpulmonary hypoxemia) Copyright © 2017 Elsevier Inc. All rights reserved. 3
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Intrapulmonary Shunting Blood shunted from right to left side of heart without oxygenation Qs/Qt disturbance Causes: atrial or ventricular septal defect, atelectasis, pneumonia, pulmonary edema Why does administration of higher levels of oxygen not help in shunt disorders? Copyright © 2017 Elsevier Inc. All rights reserved. 6
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V/Q Mismatch Most common cause of low O2 Normal ventilation (V) is 4 L/min Normal perfusion (Q) is 5 L/min Normal V/Q ratio is 4/5 or 0.8 A mismatch occurs if either V is decreased or Q is decreased What are causes of this condition? Copyright © 2017 Elsevier Inc. All rights reserved. 8
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Tissue Hypoxia Some conditions prevent tissues from using oxygen despite availability Cyanide poisoning Tissue hypoxia results in anaerobic metabolism and lactic acidosis Copyright © 2017 Elsevier Inc. All rights reserved. 12
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Quick Quiz The nurse suspects respiratory failure secondary to hypoventilation in a patient with: Anxiety Neuromuscular disease Pulmonary embolism Volume A/C ventilation at rate of 20 breaths/min Copyright © 2017 Elsevier Inc. All rights reserved. 13
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Assessment of Respiratory Failure Neurological—shows earliest signs of hypoxemia and hypercapnia Respiratory Cardiovascular Nutrition Psychosocial Chest x-ray Pulmonary function tests Laboratory studies Arterial blood gases (ABGs) Pulse oximetry and end-tidal CO2 Copyright © 2017 Elsevier Inc. All rights reserved. 16
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Interventions Maintain a patent airway Optimize O2 delivery Minimize O2 demand Identify and treat the cause of ARF Prevent complications Copyright © 2017 Elsevier Inc. All rights reserved. 17
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Nursing Diagnoses (Cont.) Ineffective breathing pattern Impaired gas exchange Impaired breathing pattern Fluid volume excess Altered nutrition Copyright © 2017 Elsevier Inc. All rights reserved. 20
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Medical Management Oxygen Bronchodilators Corticosteroids Sedation Transfusions Therapeutic paralysis Nutritional support Hemodynamic monitoring Copyright © 2017 Elsevier Inc. All rights reserved. 21
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Quick Quiz A nursing intervention to maximize airway clearance is which of the following? Administer supplemental oxygen. Elevate the head of bed. Provide oral care every 4 hours. Reposition patient every 2 hours. Copyright © 2017 Elsevier Inc. All rights reserved. 23
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ARDS Noncardiogenic pulmonary edema Diagnostic criteria PaO2/FiO2 ratio of less than 200 Bilateral infiltrates Pulmonary capillary wedge pressure < 18 mm Hg Acute lung injury scoring Copyright © 2017 Elsevier Inc. All rights reserved. 25
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Case Study Mrs. J. is a 31-year-old female admitted to the critical care unit with respiratory distress after getting the “flu.” Her condition worsens; SpO2 is 85% on Venturi mask at 0.50. ABGs show a PaO2 of 50 mm Hg. Her chest x-ray is showing infiltrates. Calculate Mrs. J.’s PaO2/FiO2 ratio, and interpret the findings. Copyright © 2017 Elsevier Inc. All rights reserved. 26
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Case Study(Cont.) Within 2 hours of NPPV, Mrs. J. is getting worse. Her SpO2 remains at 85%, and the oxygen via NPPV was 80%. Her chest x-ray shows bilateral “white out.” What treatment is indicated? Copyright © 2017 Elsevier Inc. All rights reserved. 28
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ARDS Pathophysiology Insult—systemic inflammatory response syndrome (SIRS) Release of inflammatory mediators Damage to alveolar-capillary membrane Increased capillary permeability Pulmonary edema (noncardiogenic) Copyright © 2017 Elsevier Inc. All rights reserved. 30
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ARDS Pathophysiology(Cont.) Microatelectasis Decreased compliance (stiff lungs) Decreased surfactant (damage to type II pneumocytes) Impaired gas exchange V/Q mismatch Copyright © 2017 Elsevier Inc. All rights reserved. 31
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ARDS Pathophysiology (Cont.) Copyright © 2017 Elsevier Inc. All rights reserved. 32 Figure 15-2. Pathogenesis of acute respiratory distress syndrome (ARDS). TNF, Tumor necrosis factor; IL-1, interleukin-1; PAF, platelet-activating factor; RBCs, red blood cells. (From McCance KL, Huether SE. Pathophysiology: The Biologic Basis for Diseases in Adults and Children. 6th ed. St. Louis: Mosby; 2014.)
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Critical Thinking Challenge What patients would you identify as having a high risk of developing ARDS? Why is hyperventilation an early sign seen in patients developing ARDS? What related ABG abnormality will be seen? Copyright © 2017 Elsevier Inc. All rights reserved. 33
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Symptoms of ARDS Dyspnea and tachypnea Hyperventilation with normal breath sounds Respiratory alkalosis Increased temperature and pulse Worsening chest x-rays that progress to “white out” Increased PIP on ventilation Eventual severe hypoxemia Copyright © 2017 Elsevier Inc. All rights reserved. 35
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Treatment of ARDS Treat the cause Oxygenation and ventilation Positive end-expiratory pressure (PEEP) Possible nontraditional modes of ventilation: high-frequency, pressure-control, and inverse-ratio Copyright © 2017 Elsevier Inc. All rights reserved. 36
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Case Study(Cont.) Mrs. J. is placed on volume assist/control (V-A/C) ventilation: rate 16 breaths/min, VT 8 mL/kg, FiO2 0.80, and PEEP 10 cm. What is the rationale for these settings, including PEEP? Copyright © 2017 Elsevier Inc. All rights reserved. 37
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Treatment of ARDS Comfort Sedation Pain relief Neuromuscular blockade Decrease O2 consumption Positioning Prone positioning Continuous lateral rotation therapy Copyright © 2017 Elsevier Inc. All rights reserved. 38
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Case Study (Cont.) Mrs. J.’s condition does not improve. SpO2 is 85%, and the FiO2 is increased to 0.90 to maintain this. A decision is made to increase the PEEP to 20 cm H2O. About 10 minutes after the PEEP is increased, Mrs. J.’s blood pressure drops to 80/50 mm Hg. Breath sounds are equal bilaterally. Copyright © 2017 Elsevier Inc. All rights reserved. 39
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Question What is the likely rationale for the drop in Mrs. J.’s blood pressure? What is the significance of the bilateral breath sounds? Copyright © 2017 Elsevier Inc. All rights reserved. 40
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ARDS Be alert for complications: Multiple organ dysfunction syndrome Renal failure Disseminated intravascular coagulation Long-term pulmonary effects associated with high oxygen and other therapies Copyright © 2017 Elsevier Inc. All rights reserved. 42
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Case Study(Cont.) Mrs. J.’s condition continues to worsen. A decision is made to try the oscillator ventilator. Why is this decision made? What is the related nursing care? As Mrs. J. gets worse, what other complications can occur with ARDS? Copyright © 2017 Elsevier Inc. All rights reserved. 43
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Case Study(Cont.) Despite the oscillator, Mrs. J.’s condition worsens. The physicians discuss her grave condition with her husband. They mutually agree to make her a DNR. The husband and her parents are encouraged to spend time with her in the room and are supported by the staff. Mrs. J. dies about 4 hours after the DNR decision. Copyright © 2017 Elsevier Inc. All rights reserved. 44
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ARF in Chronic Obstructive Pulmonary Disease (COPD) Worsening V/Q mismatch (e.g., secretions and bronchoconstriction can lead to ARF) Causes: acute exacerbations, CHF/ pulmonary edema, dysrhythmias, pneumonia, dehydration, and electrolyte imbalances Copyright © 2017 Elsevier Inc. All rights reserved. 48
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Assessment Dyspnea Chronic cough Sputum production Postbronchodilator spirometry limitations Pulmonary function studies Chest wall changes (barrel chest) Accessory muscles used for breathing Clubbing of the fingers Wheezing and crackles ABG (hypoxemia and hypercapnia) Copyright © 2017 Elsevier Inc. All rights reserved. 49
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Medical Management of ARF in COPD Correct hypoxemia Cautious administration of O2 Noninvasive positive-pressure ventilation Ventilatory assistance Medications Beta2 agonists (bronchodilators) Corticosteroids Antibiotics (depends on cause) Cautious administration of sedatives Copyright © 2017 Elsevier Inc. All rights reserved. 50
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Oxygen Guidelines in COPD Exacerbation Figure 15-4 General guidelines for titration of oxygen therapy in COPD exacerbation. (Modified from Brill, SE, & Wedzicha, JA. Oxygen therapy for acute exacerbations of COPD. International Journal of Chronic Obstructive Pulmonary Disease.;9:1241-1252, 2014.) Copyright © 2017 Elsevier Inc. All rights reserved. 51
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Exacerbation of Asthma Wheezing Dyspnea Chest tightness Use of accessory muscles Nonproductive cough Hyperventilation initially Peak expiratory flow reading is less than 50% of normal values What are some triggers? Copyright © 2017 Elsevier Inc. All rights reserved. 56
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Exacerbation of Asthma(Cont.) Causes Bronchodilators no longer working Noncompliance with medications Effects Hyperventilation with air trapping results in respiratory acidosis Severe hypoxemia Copyright © 2017 Elsevier Inc. All rights reserved. 57
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Medical Management Oxygen; ventilation in severe cases IV corticosteroids Inhaled bronchodilators; rapid-acting beta2-agonists Teaching Copyright © 2017 Elsevier Inc. All rights reserved. 58
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Critical Thinking Challenge How can you alleviate anxiety in the patient with status asthmaticus? What positioning will facilitate gas exchange? What discharge teaching is essential to prevent future episodes? Copyright © 2017 Elsevier Inc. All rights reserved. 59
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Pneumonia Types Community-acquired Health care–acquired Hospital-acquired Ventilator-associated Increased risk: elderly, alcoholic, smokers, chronic diseases, head injury, immunosuppression Copyright © 2017 Elsevier Inc. All rights reserved. 60
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Pathophysiology Pneumonia Organisms in lower respiratory tract to overwhelm defense mechanisms Causes Aspiration Inhalation Spread from another infected area Impaired mucociliary clearance Copyright © 2017 Elsevier Inc. All rights reserved. 61
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Prevention of Pneumonia Influenza vaccine All persons over 6 months People at high risk for complications of influenza People in contact with those at high risk Health care providers At age 65, pneumococcal vaccination to prevent Streptococcus or pneumococcus Conjugate dose Polysaccharide dose Copyright © 2017 Elsevier Inc. All rights reserved. 62
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Presentation of Pneumonia Fever Cough Purulent sputum Hemoptysis Dyspnea/tachypnea Chest pain (pleuritic) Adventitious breath sounds Copyright © 2017 Elsevier Inc. All rights reserved. 63
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Quick Quiz Arterial blood gas alterations in pneumonia include which of the following? Hypoxemia and respiratory alkalosis Normal oxygen and respiratory acidosis Hypoxemia and metabolic acidosis Normal values Copyright © 2017 Elsevier Inc. All rights reserved. 64
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Ventilator-Associated Pneumonia (VAP) Aspiration of bacteria from oropharynx or gastrointestinal tract Many potential causes Controversies about best way to diagnose—no “gold standard” Copyright © 2017 Elsevier Inc. All rights reserved. 65
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Ventilator-Associated Pneumonia (Cont.) Copyright © 2017 Elsevier Inc. All rights reserved. 66 Figure 15-6. Role of airway management in the pathogenesis of ventilator-associated pneumonia.
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VAP Bundle Elevate head of bed 30 to 45 degrees Awaken daily and assess readiness to wean and extubate Stress ulcer disease prophylaxis Venous thromboembolism (VTE) prophylaxis Oral care Copyright © 2017 Elsevier Inc. All rights reserved. 67
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Prevention of VAP Hand washing and standard precautions Surveillance Ventilator bundle Prevent transmission Sterile water in circuit Drain condensate AWAY from patient Avoid normal saline during suctioning Copyright © 2017 Elsevier Inc. All rights reserved. 69
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Prevention of VAP(Cont.) Prevent infection and aspiration Avoid reintubation Oral intubation ETT with continuous aspiration of subglottic secretions Sedation and weaning protocols Aseptic suctioning of endotracheal tube (ETT) Nutrition Mobilization Copyright © 2017 Elsevier Inc. All rights reserved. 70
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Quick Quiz To prevent VAP, it is recommended that the head of bed be elevated to at least: 15 degrees 20 degrees 30 degrees 45 degrees Copyright © 2017 Elsevier Inc. All rights reserved. 72
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ARF: Pulmonary Embolus (PE) Virchow’s triad Venous stasis Altered coagulability Damage to vessel wall Embolus results in a lack of perfusion to ventilated alveoli (V/Q mismatch) Copyright © 2017 Elsevier Inc. All rights reserved. 73
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PE Assessment Symptoms of deep venous thrombosis Chest pain (worse on inspiration) Dyspnea Tachycardia Tachypnea Cough; hemoptysis Crackles, wheezes Hypoxemia Copyright © 2017 Elsevier Inc. All rights reserved. 74
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Diagnosis of PE Clinical signs and symptoms d-dimer assay (positive) V/Q scan with high probability of PE Duplex ultrasound (DVT) High-resolution multidetector computed tomography angiography (MDCTA; spiral CT) Pulmonary angiogram Copyright © 2017 Elsevier Inc. All rights reserved. 75
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Prevention of PE Medications Heparin, low–molecular weight heparin Mechanical Sequential compression devices Foot pumps Compression stockings Position changes Treatment of atrial dysrhythmias Prophylactic anticoagulant therapy Warfarin; long-term prevention Copyright © 2017 Elsevier Inc. All rights reserved. 76
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Treatment for PE ABCs; oxygen Thrombolytics (dissolve the clots) Heparin Monitor laboratory results for Bleeding Thrombocytopenia Surgical procedures Embolectomy Vena cava umbrella (prevention) Copyright © 2017 Elsevier Inc. All rights reserved. 78
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Cystic Fibrosis Genetic disorder Mutation in chloride transport results in “sticky” mucus that obstructs glands: Lungs (greatest effect) Pancreas Liver Salivary glands Testes Thick mucus in lungs is medium for infection, chronic bronchitis, and ARF Copyright © 2017 Elsevier Inc. All rights reserved. 79
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Cystic Fibrosis(Cont.) Cornerstones of care for a patient with CF Antibiotic therapy Airway clearance Nutritional support Ventilatory support Pseudomonas aeruginosa is the most common pathogen found in adult patients with CF Copyright © 2017 Elsevier Inc. All rights reserved. 81