(ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS
اسلاید 1: 1/17/2018LBS1ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS)_
اسلاید 2: 1/17/2018LBS2DefinitionNoncardiac pulmonary edemaA form of respiratory failure Complication of hospitalized patientsSerious med-surg problemMay not be lung relatedMortality remains 50-60%
اسلاید 3: 1/17/2018LBS3PathophysiologyFrequently associated Low perfusion Single organMulti-organ (MODS)Total body system (shock)Etiology: Severe CNS Disorder, Trauma, CVA, Inc. CSF. Hallmark of ARDSHypoxia
اسلاید 4: 1/17/2018LBS4PathophysiologyOther characteristicsSevere dyspneaDiffuse bilateral infiltrates
اسلاید 5: 1/17/2018LBS5PathophysiologyInjury to lungs (Scoring)Abnormal gas exchangeIntrapulmonary shuntingReduced lung complianceDecreased surfactant activityAmt. of Infiltrates on CXR.Degree of Hypoxemia.Amount of PEEP.Static Lung Compliance.
اسلاید 6: 1/17/2018LBS6PathophysiologyPhysiologic alterationsInjury to pulmonary endothelium and alveolar epithelium causes increase in lung permeability. Fluid leaks into interstitial spaces causing pulmonary edema.INCIDENCE AND PREVALENCE
اسلاید 7: 1/17/2018LBS7PathophysiologyPhysiologic alterationsInjury to Type II pneumocytes, causes increase in surface tension and atelectasisAlveolar-capillary membrane damage, inflammation occurs, substances gather at site of injury decreasing gas exchange
اسلاید 8: 1/17/2018LBS8PathophysiologyAmerican-European Consensus Conference (1994) Defines ARDS as:PaO2/FiO2 <200;Bilat. Infiltrates;PCWP <18mm Hg (or more easily understood, no clinical evidence of L Atrial HTN).
اسلاید 9: 1/17/2018LBS9PathophysiologyResults of physiologic alterationsVentilation-perfusion anomaliesDecreased lung complianceIncrease work of breathing
اسلاید 10: 1/17/2018LBS10EtiologyNo single exogenous or endogenous precipitating factor Multiple causes.Exact causative mechanism is unknownDirect and Indirect Causes
اسلاید 11: 1/17/2018LBS11EtiologyMany conditions associatedMost commonNon pulmonaryGram (-) sepsisTraumaPulmonary relatedAspirationAIDS/PCPNear drowningPulmonary embolism
اسلاید 12: 1/17/2018LBS12EtiologyOther conditionsAmniotic fluid embolismBowel infarctionDrug abuseMultiple fracturesHeat strokePeritonitisMultiple blood transfusions
اسلاید 13: 1/17/2018LBS13Clinical manifestationsAcute respiratory failureChange in Personality, disorientation, dec. LOC.Initial Dyspnea w/ Hyperventilation (Tachypnea)Grunting respirationsCyanosisPallorRetractions
اسلاید 14: 1/17/2018LBS14Clinical manifestationsDry coughDiaphoresis Crackles, Rhonchi, and Bronchial Sounds.Vitals SignsFeverHypotensionTachycardia (dysrhythmias)Altered sensorium PaCO2 dec. Resp. Alkalosis (initial); Lactic Acid Met. Acidosis (later)
اسلاید 15: 1/17/2018LBS15Diagnostic studiesRadiologicCXR Diffuse, bilateral infiltratesLaboratoryABGs HypoxemiaRespiratory alkalosis
اسلاید 16: 1/17/2018LBS16Phases of ARDSPhase IClient exhibits dyspnea and tachypneaSupport client with oxygenationPhase 2Increasing pulmonary edemaMechanical ventilation support
اسلاید 17: 1/17/2018LBS17Phases of ARDSPhase 3Progressive refractory hypoxemiaMaintain oxygenationPrevent complicationsPhase 4Pulmonary fibrosis pneumoniaChronic problemMaybe ventilator dependent
اسلاید 18: 1/17/2018LBS18ManagementVent. Settings should be Lung-Protective.Unconventional Modes (High Frequency Ventilation, Pressure-Controlled Ventilation, and Inverse-Ratio Ventilation) have failed to demonstrate efficacy and are not standard acceptable Tx.
اسلاید 19: 1/17/2018LBS19Nursing diagnosisAnxietyImpaired gas exchangeAltered nutritionDepressionDecreased cardiac outputKnowledge deficit
اسلاید 20: 1/17/2018LBS20InterventionsAssessSputum productionOxygenationHeart soundsLung soundsUrinary outputCardiac rhythm
اسلاید 21: 1/17/2018LBS21InterventionsMonitorABGsPulse oximetryVentilator settingsFluid maintenanceTeachVentilatorLines
اسلاید 22: 1/17/2018LBS22Medical managementVentilatorIMVPEEPFluid controlSwan Ganz line
اسلاید 23: 1/17/2018LBS23Medical managementMedicationsDiureticsAnti anxietyNeuromuscular blocking agentsAnalgesicsAntibioticsDopamineCorticosteroids
اسلاید 24: 1/17/2018LBS24ManagementPossible Prone Positioning (Vollman, 1997).F/E Balancing: Monitor R Arterial Pressure (RAP) and Pulmonary Artery Diastolic (PAD) Pressure.Nutrition: ARDS increases nutritional requirements by 1.5 to 2 times.
اسلاید 25: 1/17/2018LBS25ManagementPsychosocial SupportComplications of ARDS:1. Heart failure2. Acidosis3. Hyper- hypo- kalemia4. De- over- hydration5. Pulmonary embolism
اسلاید 26: 1/17/2018LBS26ManagementCardiac arrestDICGI bleedRenal failurePrognosis: Pts. Who recover typically return to relatively normal lung function. Studies of ARDS survivors from 9 months- 4 years after lung injury show a mild restrictive pulmonary function.
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