Class notes
NUR 203 Unit 7 Lecture Notes
- Course
- NUR 203
- Institution
- Nassau Community College
This is a comprehensive and detailed note on;Unit 7 Respiratory Oxygenation, ARDS, PE, Chest Trauma.
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Respiratory OxygenationObstructive Sleep Apnea: Cessation of breathing (apnea) during sleep usually caused by repetitive upper airway
obstruction
o Obstructive:
More common type, respiratory drive remains intact
But airflow ceases due to occlusion of oropharyngeal airway
Clinical Manifestations
o Loud, cyclic snoring
o Periods of apnea lasting 10 – 120seconds during sleep, for at least 5
episodes /hour-up to 100s/night
o Gasping/Choking during sleep/Nocturnal wakening
o Restlessness, thrashing during sleep
o Daytime fatigue & sleepiness
o Morning headache
o Personality changes (depression)
o Intellectual impairment
o Impotence/Enuresis
o Hypertension/Pulmonary HTN/ Cor Pulmonale
o Significant- other reports episodes of sleep apnea
Contributing Factors:
o Male gender / Post-menopausal status
o Increasing age, OBESITY
o Large neck circumference ( >17 inches in men and >16 inches in
women) also is a known risk factor for obstructive sleep apnea
o Use of alcohol and other central
o Nervous system depressants may contribute to sleep apnea.
Diagnosis:
o Polysomnography: an overnight sleep study
o Electroencephalogram and measurements of ocular activity and
muscle tone
o Recordings of ventilatory activity and airflow
o Continuous arterial oxygen saturation
o Heart rate using a single lead ECG
o Transcutaneous arterial PCO2
Interventions
o Weight reduction
o Alcohol Abstinence
o Improving nasal patency
o Avoiding the supine position for sleep
o Oral appliances MADS mandibular advancement devices
o Nasal continuous positive airway pressure (CPAP, BIPAP)
o Surgery (Tonsillectomy, Adenoidectomy)
o MEDS: Provigil(day) Triptal(Given HS to increase resp. drive)
Central (Sleep Apnea): rare neurologic disorder that involves transient impairment of
neurologic drive to respiratory muscles
, Acute Respiratory Distress Syndrome (ARDS)
- Respiratory failure characterized by: nonspecific pulmonary response to a variety of pulmonary response
to a variety of pulmonary and
o Pathophysiology:
Damage develops rapidly
Inflammatory trigger injures alveolar capillary membrane
Fluid & protein move into the alveoli, inactivating surfactant
Alveoli collapse & lungs become difficult to inflate
Fibrotic changes occur; intra-alveolar septa thicken; gas exchange is reduced
Alveolar collapse; atelectasis
Blood returning to the lungs for gas exchange is pumped through the non-functioning,
non-ventilated area of the lung causing shunting
o Conditions Associated with ARDS:
Shock
Inhalation Injuries
Infections/Sepsis
Drug Overdose
Trauma
Hematologic / Metabolic Disorders
o Clinical Manifestations: (develop less than 72 hours after precipitation event)
HALLMARK: Hypoxemia (refractory) does not improve with supplemental O2
Dyspnea
Restlessness/Anxiety/Change in mental status
Tachypnea
Intercostal retractions
Use of accessory muscles (lungs are stiff difficult to ventilate)
Cyanosis
Adventitious breath sounds (Crackles due to the fluid leaking into alveolar space)
o Diagnostic Tests:
*Refractory Hypoxemia*
*ABG’s*
BNP
Chest x-ray
Perfusion poor
Bilateral infiltrates that worsen
“white out” pattern
PFT’s
*Chest CT Scan
Pulmonary Artery Pressure Monitoring
o ARDS Interventions:
Identify & treat cause
Goal: Maintain pO2>60 & 02sat >90% @ lowest possible FIO2
o *CAUTION TO PREVENT OXYGEN TOXICITY*
Prevent injury during CMV:
LOC, Orientation, awareness
Condition of mucosa
Lung auscultation; sputum C&S
V/S, skin color, cap refill, peripheral pulses
, Bowel sounds
Urine output, daily weights
Progressive Respiratory Support
Provide o2; nebulizer, CPT, suctioning, ABGs
Positioning ( prone)
Rest; assist with ADL
Proper management of ventilator (keep alveoli open)
Intubation & CMV
PEEP: Positive end expiratory pressure
CPAP: continuous positive air pressure
Low dose glucocorticoid steroids
T&P: prone positioning
Daily weights
Enteral/Parenteral feedings
Hemodynamic monitoring – Swan Ganz
Fluid replacements; strict I&O
Antibiotic Therapy
Low molecular weight heparin
o Diagnosis:
Ineffective Breathing Pattern
Impaired Gas Exchange
Anxiety
Decreased Cardiac Output / Ineffective Tissue Perfusion (cardiac)
Risk for Injury
Dysfunctional Ventilatory Weaning Response
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