nursing management: respiratory failure and acute respiratory distress syndrome chapter 68 overview...

Nursing Management: Respiratory Failure

and Acute Respiratory Distress Syndrome

Chapter 68 Overview

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

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Acute Respiratory Failure


Fig. 68-1. Normal gas exchange unit in the lung.

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Fig. 68-2. Classification of respiratory failure.

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Etiology and Pathophysiology Hypoxemic respiratory

failure Ventilation-perfusion mismatch


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Fig. 68-3. Regional V/Q differences in the normal lung. At the lung apex, the V/Q ratio is 3.3, at themidpoint 1.0, and at the base 0.63. This difference causes the PaO2 to be higher at the apex of thelung and lower at the base. Values for PaCO2 are the opposite (i.e., lower at the apex and higher atthe base). Blood that exits the lung is a mixture of these values.

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Fig. 68-4. Range of ventilation to perfusion (V/Q) relationships. A, Absolute shunt, no ventilation dueto fluid filling the alveoli. B, V/Q mismatch, ventilation partially compromised by secretions in theairway. C, Normal lung unit. D, V/Q mismatch, perfusion partially compromised by emboli obstructingblood flow. E, Dead space, no perfusion due to obstruction of the pulmonary capillary.

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failure, continued Shunt Diffusion limitation


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Fig. 68-5. Diffusion limitation. Exchange of CO2 and O2 cannot occur becauseof the thickened alveolar-capillary membrane.

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failure, continued Alveolar hypoventilation Interrelationship of mechanisms


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Etiology and Pathophysiology, continued Hypercapnic respiratory

failure Airways and alveoli Central nervous system Chest wall Neuromuscular conditions

Tissue oxygen needs


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Clinical Manifestations Consequences of hypoxemia

and hypoxia Specific clinical

manifestations Diagnostic Studies


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Nursing and Collaborative Management:

Acute Respiratory Failure Nursing Assessment Nursing Diagnoses Planning Prevention


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Acute Respiratory Failure Respiratory Therapy

Oxygen therapy Mobilization of secretions

Effective coughing and positioning


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Fig. 68-6. Augmented coughing is performed by placing the palm of the hand on the abdominalmusculature below the xiphoid process. As the patient ends a deep inspiration and begins theexpiration, the hand should be moved forcefully downward, increasing abdominal pressure,resulting in a forceful cough.

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Acute Respiratory Failure Respiratory Therapy

Mobilization of secretions, continued

Hydration and humidification Chest physical therapy Airway suctioning

Positive pressure ventilation


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Fig. 68-7. Noninvasive bilevel positive pressure ventilation. A mask is placed over the nose or noseand mouth. Positive pressure from a mechanical ventilator assists the patient’s breathing efforts,decreasing the work of breathing.

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Acute Respiratory Failure Drug Therapy

Relief of bronchospasm Reduction of airway

inflammation Reduction of pulmonary

congestion Treatment of pulmonary

infections Reduction of severe anxiety,

pain, and agitationCopyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

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Acute Respiratory Failure Medical Supportive Therapy

Treating the underlying cause

Maintaining adequate cardiac output

Maintaining adequate hemoglobin concentration

Nutritional Therapy Evaluation


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Gerontologic Considerations:Respiratory Failure


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Acute Respiratory Distress Syndrome


Fig. 68-8. Stages of edema formation in acute respiratory distress syndrome. A, Normal alveolusand pulmonary capillary. B, Interstitial edema occurs with increased flow of fluid into the interstitialspace. C, Alveolar edema occurs when the fluid crosses the blood-gas barrier.

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Etiology and Pathophysiology


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Fig. 68-9. Pathophysiology of acute lung injury (ALI)/acute respiratory distress syndrome (ARDS).

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Etiology and Pathophysiology, continued Injury or exudative phase Reparative or proliferative

phase Fibrotic phase

Clinical Progression


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Clinical Manifestations and Diagnostic Studies


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Fig. 68-10. Chest x-ray of a patient with acute respiratory distress syndrome (ARDS). The x-rayshows new, bilateral, diffuse, homogeneous pulmonary infiltrates without cardiac failure, fluidoverload, chest infection, or chronic lung disease.

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Table 68-7. Diagnostic Findings in Acute Lung Injury/Acute Respiratory Distress

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Complications Ventilator-associated

pneumonia


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Table 68-8. Key Components of Ventilator Bundle

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Complications, continued Barotrauma Volutrauma Stress ulcers Renal failure


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Acute Respiratory Distress Syndrome Nursing Assessment

Nursing Diagnoses Planning

Oxygen administration Positive pressure ventilation

Positioning strategies


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Fig. 68-11. A, Turning patient prone on Vollman Prone Positioner. B, Patient lying prone on Vollman Prone Positioner.

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Fig. 68-12. TotalCare SpO2RT® Bed System offers continuous lateral rotation therapy andpercussion and vibration therapies. Patients can easily and quickly be repositioned.

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Acute Respiratory Distress Syndrome Medical Supportive Therapy

Maintenance of cardiac output and tissue perfusion

Maintenance of nutrition and fluid balance

Evaluation


nursing management: respiratory failure and acute respiratory distress syndrome chapter 68 overview...

Documents

affiliate of elsevier

lung apex

vq mismatch

perfusion vq relationships

normal lung unit

vq ratio

regional vq differences

range of ventilation