arf and ards

Management of Patients With Chest and Lower Respiratory Tract Disorders : 

Management of Patients With Chest and Lower Respiratory Tract Disorders Karen Larson, MBA/TM, MSN

Acute Respiratory Failure Pathophysiology : 

Acute Respiratory Failure Pathophysiology The act of respiration engages in 3 processes: Transfer of oxygen across the alveolus Transport of oxygen to the tissues Removal of carbon dioxide from blood into the alveolus and then into the environment ***Repiratory failure can occur from malfunctioning of any of these processes

Acute Respiratory Failure (ARF) : 

Acute Respiratory Failure (ARF) Respiratory failure is a syndrome in which the respiratory system fails in one or both of it’s gas exchange functions Oxygenation and carbon dioxide elimination Hypoxemic respiratory failure (Pa02 less than 60mmHg) Hypercapnic respiratory failure (PaCo2 greater than 50mmHg with an arterial pH less than 7.35

Acute Respiratory Failure (ARF) : 

Acute Respiratory Failure (ARF) Based on ABG value of PaO2 less than 60 mm Hg, SaO2 less than 90%, or PaCO2 more than 50 mm Hg occurring with pH less than 7.35 Ventilatory failure, oxygenation failure, or a combination of both ventilatory and oxygenation failure The patient is always hypoxemic Not an independent entity….always a consequence of some pathologic process

ARF Management : 

ARF Management Recognize type (hypercapneic, hypoxemic, or both) Treat underlying cause Oxygen (usually the most single useful treatment May need to assist and maintain mechanical ventilation Assess respiratory status, vital signs, LOC Monitor ABGS O2 sat monitoring TCDB Oral and skin care ROM

Acute Respiratory Distress Syndrome : 

Acute Respiratory Distress Syndrome Severe form of acute lung injury Syndrome characterized by sudden, progressive pulmonary edema, increasing bilateral lung infiltrates on CXR, hypoxemia refractory to oxygen therapy, decreased lung compliance Symptoms Rapid onset of severe dyspnea Hypoxemia that does not respond to supplemental oxygen

Management of ARDS : 

Management of ARDS Intubation, mechanical ventilation with PEEP to treat progressive hypoxemia Positioning: frequent position changes, proning Nutritional support Paralytic to perserve oxygen (norcuron, zemuron) Medications for anxiousness (Ativan, versed, diprivan) General supportive care (DVT prophylaxis, Eye care, skin care)