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NCM 106 – Acute Pulmonary Failure

Alveoli - an anatomical structure that has the form of a hollow cavity


Carbon dioxide rich blood is pumped from the rest of the body into the alveolar blood vessels where,
through diffusion, it releases its carbon dioxide and absorbs oxygen

Atelectasis
Closure or collapse of an alveoli
Decreased surfactant leading to lung collapse

Risk Factors

Post-op (abdominal Surgeries)- GETA,TIVA, LMA Lung Cancer


Immobilization Excessive Secretions
Chronic Airway Obstruction Newborn (Surfactant – Give dexamethasone)

Clinical Manifestations
Cough Dyspnea
Dimished Bronchial sounds Pleural pain
Increase in Sputum Production Airless Area
Low Grade fever

Prevention
Coughing Exercises Diagnostic Tests
Early Ambulation
Bronchoscopy
Deep breathing
Suctioning CT scan
Nebulization followed by chest physiotherapy
X-ray
Infant Respiratory Distress Syndrome
hyaline membrane disease (HMD)
surfactant deficiency disorder (SDD)

S/S
Tachypnea, Tachycardia, Retractions, grunting, nasal flaring, cyanosis

CPAP- Continuous Positive Airway Pressure


Mix of O2 and compressed air/pressurized air
Aspiration
Breathing in foreign object
Prevention:
Proper positioning before feeding
Turn to the side when vomiting
Prevention of stimulation of gag reflex with suctioning or other procedures
Rehabilitation therapy for swallowing
NCM 106 – Acute Pulmonary Failure

Causes:
Alcohol Intake Running while eating/ activity
Old age Depressed gag reflex - Anesthesia
Medication

Manifestations:
Cyanosis Retractions
Chest pain Fever
Wheezes Fatigue

Management
Remove Causative Factors Prepare for Intubation
Assess breath sounds <85% PO2
Review CXR Assist in Bronchoscopy
Attach Pulse Oximeter

Pleural effusion:
Pleural effusion: accumulation of fluid in the pleural space
Chylothorax: a collection of lymphatic fluid in the pleural space
Empyema: a pyogenic infection of the pleural space
Hemothorax: accumulation of blood in the pleural space
Hydrothorax: accumulation of serous fluid in the pleural space
Pneumothorax: accumulation of air or gas in the pleural space
Oxygen Therapy – Administration of O2 at greater than 21 %
Goals :
To provide adequate transport of O2 in the blood
To decrease the work of Breathing
To reduce stress on the myocardium
Assess:
Hypoxia – pulse oxymetry ( Before Administering O2)
Cyanosis and pallor
Labored breathing
Methods of O2
Cannula – 24-40% or 44% at 2 -6 LPM
Simple face mask – 28 – 50 % at 6-12 LPM
Venturi mask/ air entrainment mask – most accurate
Bulb Valve Mask ( BVM) – 90 %
With reservoir – close 100%
T-piece and tracheostomy collar
Partial Rebreather mask – 40% at 5-15 LMP
Non-Rebreather mask – close to 100% at 10 -15 LPM
Hyperbaric therapy – change in atmospheric pressure 100%
NCM 106 – Acute Pulmonary Failure
Nursing considerations for O2 therapy
Safety = no smoking, away from flames
Flow rate and flow adjustments
Identification of malfunction
Humidification
Ordering of supplies
Activity and travel

Chest Physiotherapy
Used post-op to re-expand the lungs
Principles:
Postural Drainage
Chest percussion and vibration
Breath retraining
Effective coughing
Goal:
Removal of secretions
Improve ventilation
Increase efficiency of respiratory muscles

Chest tube drainage


Used to re-expand the lungs; to remove air, fluid, blood

Management:
Site- check for subcutaneous infection, redness, swelling and foul smelling discharges
Tube – Check for patency
Tube to Bottle – Check for fluctuation, bubbling and absence of fluctuation
Lung expansion – Auscultate or do x-ray
Obstructions – Milk the cord
Kinking of the cord
Problems
Accidental breakage – Clamp, glass or cup of water

Accidental dislodgement – Vaselinized gauze ( petroleum with gauze)

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