respiratory failure s/t hcap

7/25/2019 Respiratory Failure s/t HCAP

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CASE PRESENTATION:

RESPIRATORYFAILURE

2 TO HCAP


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PRESENTED BY: GROUP 2

Aramburo, Cristina

Binag, La! "i

Caba#o, $%an%tt%

Diron, Ann%

Es%o, &ir' I(an

&it, A#!ssa

Lai, &i%rst%in

Largo, Ni)o#%

L%a, Ri)*an

Samuio, $o*n Car#o

Toma)ru+, Samant*a

Traba#, T*omas C*ar#%s

Ua!an, E#ain% $%an


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INTRODUCTION:

D%g%n%rati(% is) is%as% in t*% #umbar sin%, or #o-%r ba)' arti)u#ar#! in t*% L.

/L0 r%1%rs to a s!nrom% in -*i)* a )omromis% is) )aus%s #o- ba)' ain r%1%rr%

to as #umbago3 or irritation o1 a sina# n%r(% to )aus% ain raiating o-n t*% #%g

s)iati)a3, numbn%ss in %rmatom%s istribution an ositi(% straig*t #%g raising t%st

S)iati) ain aggra(at%s on staning, -a#'ing, b%ning, straining an )oug*ing4 Ot*%

s!mtoms o1 #umbar is) %g%n%ration ar% s%nsor! isturban)%s in #%gs, )#aui)ation

r%#i%1 o1 ain -*%n b%ning 1or-ar an -%a'n%ss4

As -% ag%, t*% -at%r an rot%in )ont%nt o1 t*% )arti#ag% o1 t*% bo! )*ang%s4 T*is

)*ang% r%su#ts in -%a'%r, mor% 1ragi#%, an t*in )arti#ag%4 B%)aus% bot* t*% is)s an

t*% 5oints t*at sta)' t*% (%rt%bra% 1a)%t 5oints3 ar% art#! )omos% o1 )arti#ag%, t*%s

ar%as ar% sub5%)t to -%ar an t%ar o(%r tim% %g%n%rati(% )*ang%s34


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T*% is) its%#1 o%s not *a(% a b#oo su#!, so i1 it sustains an in5

)annot r%air its%#1 t*% -a! ot*%r tissu%s in t*% bo! )an4 An ot*%rinsigni1i)ant in5ur! to t*% is) )an start a %g%n%rati(% )as)a% -*

is) -%ars out t*us )aus%s (arious )om#i)ations su)* as immobi#i

to r%sirator! )om#i)ations as #ungs ar% unab#% to %6an ro%r#

T*% #ungs )an b% a11%)t% a1t%r (%r! s*ort %rios o1 immobi#it! #%

r%sirator! )om#i)ations4 E(%n a a! or t-o t*% )*%st mus)#%s b%-%a'%n% r%su#ting in %)r%as% #ung %6ansion an s*a##o- br%at

Coug*ing an imortant rot%)ti(% 1un)tion to )#%ar t*% air-a!s, b%

-%a'%r an #%ss %11%)ti(%4


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S%)r%tions bui# u in t*% #ungs, in)r%asing t*% ris' o1 n%umonia an #at%r on -i## #%a

r%sirator! 1ai#ur% -*i)* r%su#ts 1rom ina%7uat% gas %6)*ang% b! t*% r%sirator! s!st%mt*at t*% art%ria# o6!g%n, )arbon io6i% or bot* )annot b% '%t at norma# #%(%#s4 A ro

)arri% in b#oo is 'no-n as *!o6%mia8 a ris% in art%ria# )arbon io6i% #%(%#s is )a##%


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T*% r%(a#%n)% o1 D%g%n%rati(% Dis' is%as% r%#at% r%sirator! )om#i)ations is *ig*%

t*% %r)%ntag% o1 99 an 9; in -om%n ag%s 1rom 0< !%ars o# an abo(%4 T*% *ig*

r%(a#%n)% o1 an int%r(%rt%bra# sa)% -it* %g%n%rati(% is) is%as% is in L. = L0 abouan ob%sit! -%r% asso)iat% -it* t*% r%s%n)% o1 %g%n%rati(% is) is%as% in a## r%gion

In t*% )as% o1 t*% ati%nt D4A, 9. !%ars o#, ma#%, )*i%1 )om#ain i11i)u#t! o1 br%at*ing

uration an amitt% u% to s%sis s%)onar! to *osita# a)7uir% n%umonia an )om


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Pati%nt -as iagnos% -it* %g%n%rati(% is) is%as% arti)u#ar#! in L. an L0 an

%6%ri%n)% s!mtoms su)* as bi#at%ra# 'n%% ain, an g%n%ra# bo! -%a'n%ss,

#%aing to immobi#i+ation4 Du% to immobi#i+ation, t*% ati%nt *a a )ommunit!

a)7uir% n%umonia t*%n -as amitt% to UER@ *osita# an it -as r%so#(%4 Lat%r

on, t*% ati%nt *a *osita# a)7uir% n%umonia at t*% sam% tim% -it* )om#i)at%

UTI4 rom )om#i)at% UTI, an t*% %stru)tion o1 L. an L0 it r%su#ts to as)%ning

in1%)tion #%aing to t*% a)ut% 'in%! in5ur! t*%n going to s!st%mi) )ir)u#ation -*i)*

r%su#ts to s%sis4


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DE@OGRAPIC DATA

Name: D4A

Gender: @a#%

Age: 9. !%ars o#

Status: Sing#%

Occuat!"n: R%tir% @@DA O11i)%r

Nat!"na#!t$: i#iino

Address: Cubao, u%+on Cit!

Re#!g!"n: Cat*o#i)

%ate "& '!rt(:


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DE@OGRAPIC DATA

Adm!tt!ng %!agn"s!s: S%sis s%)onar! to *osita# a)7uir% n%umonia an )om#i)at%

UTI4

Past Hea#t( H!st"r$:

Status ost r%na# ston%s ;


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ANATO@Y AND PYSIOLOGY

T(e Res!rat"r$ S$stemT*% r%sirator! s!st%m is ma% u o1 organs an tissu%s t*at *%# !ou br%at*%4 T*% mai

s!st%m ar% t*% air-a!s, t*% #ungs an #in'% b#oo (%ss%#s, an t*% mus)#%s t*at %nab#%


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Figure A shows the location of the respiratory structures in the body. Figure Benlarged view of the airways, alveoli (air sacs), and capillaries (tiny blood veC is a closeup view of gas exchange between the capillaries and alveoli. COdioxide, and O is oxygen.


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Airways

The airways are pipes that carry oxygen-rich air to your lungs. They also carry cara waste gas, out of your lungs. The airways include your:

Nose and linked air passages (called nasal cavities)

outh

!arynx (!"#-ingks), or voice box

Trachea (T#"-ke-ah), or windpipe Tubes called bronchial tubes or bronchi, and their branches

"ir $rst enters your body through your nose or %outh, which wets and war%s the air can irritate your lungs.) The air then travels through your voice box and down ywindpipe. The windpipe splits into two bronchial tubes that enter your lungs.

" thin 'ap of tissue called the epiglottis (ep-ih-!T-is) covers your windpipe wheswallow. This prevents food and drink fro% entering the air passages that lead to


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*xcept for the %outh and so%e parts of the nose, all of the airways have special hairs callecilia (+!-e-ah) that are coated with sticky %ucus. The cilia trap ger%s and other foreignparticles that enter your airways when you breathe in air.

These $ne hairs then sweep the particles up to the nose or %outh. ro% there, theyreswallowed, coughed, or snee/ed out of the body. Nose hairs and %outh saliva also trapparticles and ger%s.

Lungs and Blood Vessels

0our lungs and linked blood vessels deliver oxygen to your body and re%ove carbon dioxid

fro% your body. 0our lungs lie on either side of your breastbone and $ll the inside of yourchest cavity. 0our left lung is slightly s%aller than your right lung to allow roo% for yourheart.

1ithin the lungs, your bronchi branch into thousands of s%aller, thinner tubes calledbronchioles. These tubes end in bunches of tiny round air sacs called alveoli (al-2**-uhl-eye).

*ach of these air sacs is covered in a %esh of tiny blood vessels called capillaries. The

capillaries connect to a network of arteries and veins that %ove blood through your body.


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The pul%onary (34!!-%un-ary) artery and its branches deliverblood rich in carbon dioxide (and lacking in oxygen) to thecapillaries that surround the air sacs. nside the air sacs, carbondioxide %oves fro% the blood into the air. "t the sa%e ti%e, oxyge%oves fro% the air into the blood in the capillaries.

The oxygen-rich blood then travels to the heart through the

pul%onary vein and its branches. The heart pu%ps the oxygen-richblood out to the body.

The lungs are divided into $ve %ain sections called lobes. +o%epeople need to have a diseased lung lobe re%oved. 5owever, theycan still breathe well using the rest of their lung lobes.


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Muscles Used for Breathing

uscles near the lungs help expand and contract (tighten) the lungto allow breathing. These %uscles include the:

6iaphrag% (6-ah-fra%)

ntercostal %uscles

"bdo%inal %uscles uscles in the neck and collarbone area

The diaphrag% is a do%e-shaped %uscle located below your lungst separates the chest cavity fro% the abdo%inal cavity. Thediaphrag% is the %ain %uscle used for breathing.


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The intercostal %uscles are located between your ribs. They alsoplay a %a7or role in helping you breathe.

8eneath your diaphrag% are abdo%inal %uscles. They help youbreathe out when youre breathing fast (for exa%ple, duringphysical activity).

uscles in your neck and collarbone area help you breathe in when

other %uscles involved in breathing dont work well, or when lungdisease i%pairs your breathing.


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What are the kidneys and what do they do?

The kidneys are two bean-shaped organs, each about the si/e of a$st. They are located 7ust below the rib cage, one on each side ofthe spine. *very day, the two kidneys $lter about 9; to 9


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The urinary tract


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Why are the kidneys important?

The kidneys are i%portant because they keep the co%position, or%akeup, of the blood stable, which lets the body function. They

prevent the buildup of wastes and extra 'uid in the body

keep levels of electrolytes stable, such as sodiu%, potassiu%,and phosphate

%ake hor%ones that help

regulate blood pressure

%ake red blood cells

bones stay strong


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How do the kidneys work?

The kidney is not one large $lter. *ach kidney is %ade up ofabout a %illion $ltering units called nephrons. *ach nephron$lters a s%all a%ount of blood. The nephron includes a $ltercalled the glo%erulus, and a tubule. The nephrons workthrough a two-step process. The glo%erulus lets 'uid and

waste products pass through it> however, it prevents bloodcells and large %olecules, %ostly proteins, fro% passing. The$ltered 'uid then passes through the tubule, which sendsneeded %inerals back to the bloodstrea% and re%oveswastes. The $nal product beco%es urine.


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*ach kidney is %ade up of about

%illion $ltering units called

nephrons.


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Points to emem!er *very day, the two kidneys $lter about 9; to 9 however, itprevents blood cells and large %olecules, %ostly proteins, fro%

passing. The $ltered 'uid then passes through the tubule, whichsends needed %inerals back to the bloodstrea% and re%oves


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PYSICAL ASSESS@ENTA##$##M$%& A%A

+?N and

N"!+

*venly colored skin tone, dry and war% to

touch. There is presence of peeling of the

skin on both upper and lower extre%ities

with poor skin tugor, presence of grade four

pitting ede%a, both upper and lower

extre%ities. There are four pressure sores

that are present. 3ressure sore @9 is on

sacral %edial> grade A with %easure%ent of

grade with %easure%ent of 9.< x

;.B c%. 3ressure sore @A on %alleolus

(right)> necrotic and dry with %easure%ent

of 9.< x 9 c% and pressure sore @D on

%alleolus (left)> grade with %easure%ent

of x c%. Nails are clean and intact.

" dry ski

pressure

present d

prolonge

i%%obilit

&apilliary

%ore tha

seconds

skin tugo

decrease

oxygena

body sys

3resence

four pitti

is due to


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PYSICAL ASSESS@ENT

A##$##M$%& A%AL'#

5*"6 "N6N*&? 5ead is round with s%ooth skullcontour. 5ard and s%ooth, no

tenderness upon palpation. No

bleeding and lesions noted.

3resence of white hair. ree fro%

lice. acial features are

sy%%etrical. No swelling of ly%ph

nodes below the angle of the 7aw

and along the sternocleido%astoid

%uscle. No bruits heard upon

auscultation. &lient has li%ited

range of %otion of the neck.

!i%ited range oof neck is due to

atrophy and pro

i%%obility.


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PYSICAL ASSESS@ENT

A##$##M$%& A%AL'#

*0*+ "N6 *"#+ *yebrows are sy%%etrical in shape

and eyelashes are si%ilar in

=uantity and distribution. *ye has

no redness, and tenderness

*yeballs are feels $r%. No ede%a

or tearing of the lacri%al sac.

&on7unctiva is %oist and clear. *ars

are sy%%etrical in shape> externalauditory %eatus is patent with no

drainage. &olor of ear %atches the

surrounding area and face, no

redness, nodules, swelling and

lesions noted. 5earing is intact and

able to recogni/ed voices and

N#"!


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PYSICAL ASSESS@ENT

A##$##M$%& A%AL'

N+* "N6 +N4+*+ Nose is straight, nares are

e=ual in si/e, and skin is

intact. No tenderness,

swelling upon palpation.

NT is intact.

N#"!

4T5 !ips are sy%%etrical, nolesions, dry but %oist

buccal %ucosa. 3atientEs

teeth are loose. +urface

of the tongue is s%ooth

and %oist.

" dry lip is dueopening of the

because of the

endotracheal t

3ositive for de


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PYSICAL ASSESS@ENT

A##$##M$%& A%AL'#

#*+3#"T#0 &lientEs chest color is consistent

with the rest of the body. +ternu%is in %idline. 5as tachypnea,

positive labored breathing and used

of accessory %uscles. &rackles are

heard on lower left lung upon

auscultation. "ssisted with

%echanical ventilator with whiningtherapy every after %orning care

%aintained with oxygen tank at one

liter per %inute. #espiratory rate of

F bp%. 3resence of purulent

sputu% greenish in color upon

suctioning thick in consistency.

"ssess%ent sho

client has been with 5&"3.


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PYSICAL ASSESS@ENT

A##$##M$%& A%AL'

&"#62"+&4!"# ood heart tone with noabnor%al sounds heard.

No %ur%urs or bruits

heard during auscultation

83: 9;GC; %%5g

3#: FB bp%

N#"!

"+T#NT*+TN"! No lesions, scars

observed on the

abdo%en. "bdo%en is

sy%%etric and 'at.

Nor%o active bowel

sounds. *%pty bladder is

not palpable or

N#"!


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PYSICAL ASSESS@ENT

A##$##M$%& A%AL'#

#*+3#"T#0 &lientEs chest color is consistent

with the rest of the body. +ternu%is in %idline. 5as tachypnea,

positive labored breathing and used

of accessory %uscles. &rackles are

heard on lower left lung upon

auscultation. "ssisted with

%echanical ventilator with whiningtherapy every after %orning care

%aintained with oxygen tank at one

liter per %inute. #espiratory rate of

F bp%. 3resence of purulent

sputu% greenish in color upon


"ssess%ent sho

client has been with 5&"3.


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PYSICAL ASSESS@ENT

A##$##M$%& A%AL'#(

4#N"#0 oley catheter inserted and

attached to a oley catheterbag. Nor%al yellow urine color

passes through the bag in

%ini%al a%ounts

onitor urinary ou

evaluate hydrationand collection of u

sa%ples for diagno

procedures.*IT#*T*+ *xtre%ities are sy%%etrical in

si/e and shape with li%ited

range of %otion. 3resence ofgrade pitting ede%a on shin

and ankle. No presence of

pedal pulses. &apillary re$ll

seru% returns to nor%al less

than two seconds. No signs of

cyanosis noted

3itting ede%a is as

with acute kidney


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PYSICAL ASSESS@ENTA##$##M$%& A%AL'#(

N*#24+ +0+T* No di//iness, tre%or or sei/ure.

5ard to awaken. !i%ited %otor

function. Nu%bness and

weakness in the lower

extre%ities

Nu%bness and we

the legs is one of

of herniated disc

4+&4!+?*!*T

"!

&lient has 9G< %uscle strength

of 'exion and extension on bothupper and lower extre%ities.

&anEt do the cross over hand

grip. +tiJness in trape/ius, ar%

and hand %uscles. orward

shoulder, downward scapular

rotation and increased kyphosis.

1eak %uscle tone

strength


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PATOPYSIOLOGY


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LABORATORY RESULTS

)H$M(#&' *MA)H +,- +./01

&$#& $#UL& $2$$%)$ (%&$P$&

A%AL)reatinine C< u%olG! DD K 9;B u%olG! N#Al!min Mass ) gG! AF K


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LABORATORY RESULTS

BL334 )H$M(#&' *AP(L +- +./01

&$#& $#UL& $2$$%)$ (%&$P% A%4 A

#odium 9AB %%olG! 9A< K 9


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LABORATORY RESULTS

)3MPL$&$ BL334 )3U%& *AP(L /6- +./01

&$#& $#UL& $2$$%

)$

(%&$P$&A&(3% A%4 A%AL

Hemoglo!

in Mass )

9;< 9D;-9B; !ow 5b indicates anemia, rec

he%orrhage, or 'uid retention, can cause he%odilution

Hematocri

t

A; D;-


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)3MPL$&$ BL334 )3U%& *AP(L /6- +./01

&$#& $#UL& $2$$%)$ (%&$P

A%4 A%WB) 99.;


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DRUG ANALYSIS

4rug M3A (ndication8 )(9 #ide

$7ects

%ursing esponsi!i

&lexane

&lassi$ca

tion:

"nticoag

ulants

" low %oleculer

weight heparin

derivative that

acceleratesfor%at

ion of anti-

thro%bin -

thro%bin co%plex

and deactivates

thro%bin,preventing

conversion of

$brinogen to

$brin. 5as higher

anti-factor Ia

toantifactor a

activity ratio.

:

patients with

acute illness

who are at

increased risk

because of

decreased

%obility.

&:

&onditions with

high risk of

uncontrolled

he%orrhage

including %a7or

bleeding

-ede%a

-ane%ia

- onitor 2+ and asses

of bleeding

-ive only by deep +&

down

-6o not give

-"ssess for 5eparin pr

hypersensitivity

-6ocu%ent baseline h

para%eters, liver funccoagulation studies

-#eport unusual bleed

weakness

-"void T& agents con

aspirin

-4se an electronic ra/o

-4se a bandage to pre-

4rugs M3A ( and )( #$ %(l l l i ki k i l l


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etropolol

&lassi$catio

n:

8eta

8locker

" selective

beta blocker

that

selectively

blocks beta9

receptors>decreases

cardiac

output,

peripheral

resistance,

and cardiac

oxygenconsu%ption>

and

depresses

rennin

secretion.

:

-hypertension

&:

-right

ventricularfailure

secondary to

pul%onary

hypertension.

6ry skin,

pruritus, skin

eruptions.

+pecial

+enses: 6ry

%outh and%ucous

%e%branes.

Take apical puls

ad%inistering dr

physician signi$c

rate, rhyth%, or

or variations in 8

ad%inistration.

onitor 83, 5#,

carefully during

ad%inistration..

!ab tests: btai

periodic evaluat

cell counts, blooand kidney func

onitor M, da

auscultate daily

rales.

1ithdraw drug i

presents sy%pto

4U5# M3A )3%&A(%: #(4$ %U#


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(%4()A&(3%

#

4()A&(3%# $22$) $#P3

&linda%y

cin

&lassi$cation:

"nti

neJectiv

e

nhibits

protein

synthesis in

susceptiblebacteria at the

level of

hinders or kills

susceptiblebacteria

/ To treat

serious

respirator

y tractinfection

caused by

pneu%on

ococci

/ nfection

in skin

and soft

tissuein7ury

/ &ontraindi

cated to

patient

hypersensitive to

drugs

/ 4se

cautiously

in patient

with renal

or hepatic

dse.

+evere skin

reaction

that causes

blisteringand

peeling.

/ "ss

pat

con

appthe

spu

/ bt

for

sen

to i

the

/ onand

ant

trea

/ "ss

for

hyp

4U5# M3A )3%&A(% #(4$ %U#(


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4U5# M3A

(%4()A&(3

%#

)3%&A(%

:

4()A&(3%#

#(4$

$22$)

%U#(

$#P3

'!ansopra

/ole

&lassi$ca

tion:

33

8ind en/y%e

in presence

of acidicgastric 35

3reventing

$nal

transport of

hydrogenions to

gastric

lu%en

/ "ctive

benign

hastriculcer

/ 3rolonge

d *T and

NT

tube

5ypersens

itivity to

the drug

6ry %outh

3eripheral

ede%a

/ "sse

rout

epigabdo

pain

/ "d%

drug

%ea

/ #epo

headwors

sy%

/ ral

ice c

prev

dryn

%U#(%5 )A$ PLA%


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%U#(%5 )A$ PLA%P(3(&' ;/

Assessment

4iagnosi

s

Planni

ng

(nter


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%U#(%5 )A$ PLA%P(3(&' ;/

(nter


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Assessment 4iagnosis Planb7ective:

&lientEs chest color is consistent with the rest

of the body. +ternu% is in %idline. 5astachypnea, positive labored breathing and

used of accessory %uscles. &rackles are

heard on lower left lung upon auscultation.

"ssisted with %echanical ventilator with

whining therapy every after %orning care

%aintained with oxygen tank at one liter per

%inute. #espiratory rate of F bp%. 3resence

of purulent sputu% greenish in color upon


neJective

breathing pattern

related tohypoventilation as

%anifested by ##

of F bp% and

crackles upon

auscultation

+hort ter%:

"fter -A hour

intervention tbe able to i%p

pul%onary ve

oxygenation.

!ong ter%:

"fter -Adays

intervention t

breathing pat

%aintain as n

respiratory ra

%U#(%5 )A$ PLA% P(3(&'


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(nter


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$


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=3U%AL9 $#P(A&3'2A(LU$

#espiratory failure occurs due %ainly either to lung failure resulting inhypoxe%ia or pu%p failure resulting in alveolar hypoventilation andhypercapnia. 5ypercapnic respiratory failure %ay be the result of%echanical defects, central nervous syste% depression, i%balance ofenergy de%ands and supplies andGor adaptation of central controllers.

5ypercapnic respiratory failure %ay occur either acutely, insidiously oracutely upon chronic carbon dioxide retention. n all these conditions,pathophyisiogically, the co%%on deno%inator is reduced alveolarventilation for a given carbon dioxide production.

"cute hypercapnic respiratory failure is usually caused by defects in thcentral nervous syste%, i%pair%ent of neuro%uscular trans%ission,%echanical defect of the ribcage and fatigue of the respiratory %uscle

=3U%AL9 $#P(A&3'


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=3U%AL9 $#P(A&3'2A(LU$

The pathophysiological %echanis%s responsible for chronic carbon dioxide retention are no

yet clear. The %ost attractive hypothesis for this disorder is the theory of Onatural wisdo%P3atients facing a load have two options, either to push hard in order to %aintain nor%al

arterial carbon dioxide and oxygen tensions at the cost of eventually beco%ing fatigued anexhausted or to breathe at lower %inute ventilation, avoiding dyspnea, fatigue andexhaustion but at the expense of reduced alveolar ventilation. 8ased on %ost recent work,the favored hypothesis is that a threshold inspiratory load %ay exist, which, when exceederesults in in7ury to the %uscles and, conse=uently, an adaptive response is elicited toprevent andGor reduced this da%age. This consists of cytokine production, which, in turn,

%odulates the respiratory the respiratory controllers, either directly through the blood or

probably the s%all aJerents or via the hypothala%ic-pituitary-adrenal axis. odulation of thpattern of breathing, however, ulti%ately results in alveolar hypoventilation and carbondioxide retention.

#**#*N&*:

#oussos, &., M ?outsoukou, ". (;;A). #espiratory failure Q"bstractR. *uropean #espiratorySournal, A-9D. #etrieved ay ;, ;9B.

respiratory failure s/t hcap

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