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Problems of RespiratoryFunction

NUR 222

Cookie Little

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Objectives

*Compare and contrast pathophysiology ofclients with:Pulmonary edema, ARF, ARDS

*Describe client care in pulmonaryhypertension and pulmonary heart disease

*Describe nursing process of caring forpatient on mechanical ventilation

*Describe therapeutic management of theclient with chest trauma

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Respiratory System

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Pulmonary Edema

Etiology

Diagnosis

Flash

Reexpansion

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Acute Respiratory Failure

PaO2< 50 mm Hg and a rise in PaCO2

to > 50 with a pH of < 7.35

ACUTE vs Chronic

http://emedicine.medscape.com/article/

167981-overview

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ARDS

Sudden and progressive pulmonaryedema (absense of left heart failure)

Increasing bilateral infiltrates

Hypoxemia- even with oxygensupplementation

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ARDS

Pathophysiology Inflammatory

process Decreased

compliance Gas exchange

impaired

ClinicalManifestations

12-48 hrs afterinitiating event Dyspnea Tachypnea

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ARDS

Medical Management Intubation and ventilation

Supplemental oxygen PEEP

Goal is a PaO2>60 and saturation level >90

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ARF and ARDS

Ventilator Considerations

Peep is unnatural breathing patternProvide paralysis WITH sedation

Communicate with patient and explain drug effects

Explain to family members the purpose and effectsof these drugs

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Smoke InhalationLocal injury Flames in a closed space

Systemic Injury

CO

Management http://www.emedicinehealth.com/smoke_inhalation/arti

http://www.emedicinehealth.com/smoke_inhalation/article_em.htmanagementhttp://www.emedicinehealth.com/smoke_inhalation/article_em.htmanagement

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Pulmonary Hypertension

Systolic pulmonary artery pressureexceeds 30 mm Hg

Mean pulmonary artery pressureexceeds 25 mm HG

http://www.mayoclinic.com/health/pulmonary

http://www.mayoclinic.com/health/pulmonary-hypertension/DS00430http://www.mayoclinic.com/health/pulmonary-hypertension/DS00430

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Pulmonary Hypertension

Primary orIdiopathic

Secondary

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Pulmonary Hypertension

Diagnosis History, chest X-Ray, pulmonary

function, ECG

Treat underlying cause

Manage hypoxemia

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Cor Pulmonale

Condition in which the rightventricle of the heart enlarges as a

result of diseases that effect thestructure or function of the lung.

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Pulmonary Embolus

The obstruction of the pulmonaryartery of one of its branches by a

thrombus

Diminished blood flow to

obstructed area

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Pulmonary Embolus

ClinicalManifestations

Dyspnea Tachypnea Pain ..

Assessment andDiagnostics

DVT? V-P perfusion scan Pulmonary

angiography

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Mechanical Ventilation

ET intubation DOPE

-pressure

+pressure

PEEP/CPAP

http://www.ccmtutorials.com/rs/mv/index.htm

http://www.ccmtutorials.com/rs/mv/index.htmhttp://www.ccmtutorials.com/rs/mv/index.htm

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Pulmonary Embolus

Emergency Management

Prevention

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Chest Trauma

Hemothorax

Pneumothorax

Chest tubes

http://www.calgaryhealthregion.ca/programs/respiratory/pdf/edday_200 http://www.icufaqs.org/ChestTubes.doc

Blunt trauma

PenetratingTrauma

http://www.calgaryhealthregion.ca/programs/respiratory/pdf/edday_2005nov/chest_tubes_etc.pdfhttp://www.icufaqs.org/ChestTubes.dochttp://www.icufaqs.org/ChestTubes.dochttp://www.calgaryhealthregion.ca/programs/respiratory/pdf/edday_2005nov/chest_tubes_etc.pdf

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Aspiration

Submersion

Swallow Studies

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Additional Referenceshttp://www.ards.org/

http://www.ards.org/learnaboutards/whatisards/brochure/

http://www.lungusa.org/diseases/ards_factsheet.html

http://www.nlm.nih.gov/medlineplus/ency/article/000103.ht

http://www.vh.org/adult/provider/emergencymedicine/ARF/

http://www.ards.org/http://www.ards.org/learnaboutards/whatisards/brochure/http://www.lungusa.org/diseases/ards_factsheet.htmlhttp://www.nlm.nih.gov/medlineplus/ency/article/000103.htmhttp://www.vh.org/adult/provider/emergencymedicine/ARF/AcuteRespiratoryFailure.htmhttp://www.vh.org/adult/provider/emergencymedicine/ARF/AcuteRespiratoryFailure.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000103.htmhttp://www.lungusa.org/diseases/ards_factsheet.htmlhttp://www.ards.org/learnaboutards/whatisards/brochure/http://www.ards.org/