Acute Respiratory Failure (ARF)

Submitted By nursemel
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Acute Respiratory Failure (ARF)

Causes:
Failure to remove CO2, Pneumonia, COPD, Asthma, MS, sedatives, hypothyroidism, ALS, Guillian-Barre, myasthenia gravis, muscular dystrophy, PE, pleural effusions, hemothorax/pneumothorax, lung trauma

Patho:
Decreased respiratory drive. Impaired normal respiratory stimulation. Can progress into ARDS

Assessment:
Initially:
Restlessness
Fatigue
Anxiety
Dyspnea (fast and shallow)
Tachycardia
Increased BP
Labored breathing
Progression:
Confusion (decreased LOC)
Lethargy
Tachycardia
Tachypnea
Cyanosis (low O2)
Respiratory arrest
Interventions:
Admin O2 via NRB 100% O2
Elevate HOB
Digoxin/CCB (decrease workload of heart)
Antianxiety meds
Monitor fluids
Assess lung sounds for crackles
CXR
Steroid therapy (decrease inflammation)
RRT
PFT (asked to blow)
Cough & Deep breathe
Incentive spirometer
Intubation
Charcoal (if sedative cause)
Narcan (has short half-life)
TX underlying cause
Monitor pulse ox
BVM if pt can’t breathe on NRB mask until RRT intubates pt

SIADH

Causes:

Pulmonary cancer, drugs, neuro dz/changes, hypothyroid

Patho:
Excessive circulating ADH. Water is being retained. The patient is not urinating.

Assessment:
Edema
Weight gain
Increase BP
Increase HR
Pulmonary Edema
Decrease urine output
Frothy pink sputum, adventitious breath sounds, increase RR
Elevated CVP, PAP, PCWP
Serum Na+ <120
Serum Osmo <250
Urine Osmo increased
Urine SG >1.030
Interventions:
Want to diurese (lasix/bumex) do not use hydrochlorathiazide!
Restrict fluids
Restore normal fluid volume
Increase serum osmolality
Admin Declomycin (abx)-impairs action of ADH.

DI

Causes:

Damage to posterior pituitary lobe (tumor). Anything that can cause increase ICP. Head injury, tumors, major trauma, inflammation

Patho:
Decreased ADH. Water is not being retained. Patient is urinating a lot.

Assessment:
Low BP
High HR
Dry skin
Confusion, restlessness, lethargy, irritability
Thirsty
Dry mucous membranes
Hypomotility
Weight loss
Serum Na+ >145
Serum Osmo >300
Urine Osmo <300
Urine SG <1.005
Interventions:
Replace fluids (isotonic). Be careful administering NS
Blood more viscous= increase risk for clots
Vasopressin/Diabinase
Admin Desmopressin (DDAVP). 1-4mcg SubQ/IM/IV. Side effects: h/a, nausea, abd cramps. NI: watch for water intoxication, I&O, weight

DKA

Causes:
Not taking insulin, pt gets sick, medication compliance.

Patho:
NO INSULIN! DM Type 1. Body turns to breaking down fat and proteins as glucose sources for starving cells leading to ketone formation.

Assessment:
Dehydrated
Poor skin turgor
BP variable
Orthostatic hypotension
Increased HR
Serum pH <7.2
Positive urine glucose and serum ketones
Serum Osmolality 300-350
Lethargy/coma
Fruity/acetone breath
Cold/clammy skin
Kussmaul breathing BS 300-800
*Correlation between pH and K+. More acidic, higher K+
Interventions:
1st: Short-acting Insulin IV bolus
2nd: Insulin drip of 1-2 u/hr
Watch respiratory changes
Watch BS levels as well (don’t want to over correct with too much insulin)
Admin Sodium Bicarbonate to TX acidosis. Only utilize to bring pH >7.0
Once BS falls to 250, dextrose added to IV sol’n

HHNS

Causes:
Exacerbation of a chronic illness, trauma, infection, medication compliance

Patho:

Produces some insulin, poorly utilized insulin. Insulin production enough to prevent DKA but not enough to prevent severe hyperglycemia.

Assessment:
Similar to DKA
NO Kussmaul respirations
NO fruity odor to breath
Tachypnea/shallow breathing
BS 300-2000
High urine output pH normal or slightly acidic
Serum osmolality >350
Interventions:
Similar to DKA

Pulmonary Hypertension
Causes:
Right sided heart failure
Patho:

MAP sustained >25, primary is idiopathic, secondary r/t other causes
Assessment:

Decrease cardiac output increase ventilation hypoxemia pink frothy sputum dizziness later: tachypnea, dypsnea, generalized edema, cyanosis
Interventions:
Oxygen
Diuretics
Vasodilators
Anticoagulants d/t PE (heparin or angiomax).