Respiratory Problems

• • A condition in which there is severe, diffuse injury of the alveolar-capillary membrane, resulting in increased stiffness of the lungs and non cardiogenic pulmonary edema.
• •Occurs more frequently in clients without history of respiratory problems.
• •Onset is usually insidious/abrupt and appears within one hour-96 hours post injury

• •Direct Pulmonary Injury
• Aspiration of gastric contents or other toxic substances, Near drowning,Inhalation of toxic substances,pneumonia thoracic trauma, drugs-heroin, methadone,and embolus-fat, air, amniotic fluid.

• •Indirect Pulmonary Injury
• Sepsis,Severe pancreatitis, Multiple trauma DIC (disseminated intravascular coagulation), Shock, Head trauma, ICP, Postcardiopulmonary bypass, and anaphylaxis

• occurs 1-7 days (usually 24-48 hours) after the initial lung trauma. Characterized by alveolar capillary and endothelial cell injury, increases vascular permeabililty, edema and accumulation of alveolar fluid.
• •Reparative or Proliferation Phase
• Begins 1-3 week after initial lung trauma. There is an influx of granulocytes, mononuclear cells, and fibroblast proliferation as part of the inflammatory response. Lung compliance continue to decrease. Hypoxemia worsen with fibrous tissue formation beginning.
• •Fibrotic Phase
• Occurs 3-4 weeks. Lung tissue replaced with fibrotic tissue.

• •Early Assessment
• tachypnea
• restlessness
• hyperventilation
• change in LOC
• tachycardia
• fine crackles
• dyspnea
• cough
• fatigue

• •Later Assessment
• diffuse crackles, gurgles
• cyanosis/pallor
• decrease urine output
• grunt sounds with respirations
• PaCO2 decreases without O2
• improvement (respiratory alkalosis)

• •Definition-a state of altered gas exchange resulting in an arterial blood gas (ABG) a partial pressure of oxygen (PaO2) of less than 60/50 mm Hg and a partial pressure of Co2 (PaCO2) greater than 50 mmHg with a pH of less than 7.30
• •Can be either failure to ventilate,failure to oxygenate, or both but hypoxemia is always the underlying cause.

• - Exacerbation of COPD, Asthma, ARDS, Pneumonia, Cardiogenic Shock,CHF and Post Operative surgery due to increased pain.
• - Sepsis, Drug overdose, Decreased LOC, Head Injury, Airway Obstruction, Guillain Barre Syndrome and Chronic neuromuscular diseases.

• - Asthma is a chronic inflammatory disorder of the airways characterized by hyper-responsiveness of the airways and episodic periods of bronchospasm (prolonged contraction of the bronchial smooth muscles).
• - Allergies,Genetic disposition,Environmental factor(air pollution/exposure to compounds),Respiratory viruses, Emotional stress and Exercises can trigger an attack.

• - the primary process involves chronic inflamation, which leads to airway hyperresponsiveness and acute aiway limitations.
• - Edema, mucus, muscle spasms,resistance to airflow,Impaired expiration,Air trapping, Alveolar hyperinflation ,Uneven ventilation/perfusion,Increased work of breathing, Hypoxemia, Hypercapnia and Respiratory Failure
• - Complications: Status Asthmaticus-severe prolonged asthma that does not respond to treatment. Condition leads to respiratory failure, hypoxemia, acidosis. Use of endotracheal intubation, mechanical ventilation may be needed to sustain life.

- S/S: Wheezing, air hunger, Cough, apprehension, Dyspnea, prolonged expiration, Chest tightness, speaking 1-2 words, tachypnea, tachycardia and anxiety.

- Test: History and signs and symptoms, Skin Test, ABGs,Pulmonary Function Tests (PFTs) and Challenge or bronchial provocation testing.

• Prevention: Avoiding allergens and environmental triggers, modifying home environment, eliminating all tobacco smoke in home, use of mask in cold weather and early treatment of upper respiratory infections.
• Medications:
• -Corticosteroids for severe exacerbations,
• -Cromolyn, leukotriene modifier, sustained release theophylline (mild) ,
• -Inhaled corticosteroids (mod. Persistent)
• -Systemic corticosteroids, high dose inhaled corticosteroids and long acting inhaled beta 2 agonist (Severe Persistent)

• -Clients with chronic airflow obstruction due to chronic bronchitis, emphysema, and/or asthma are said to have COPD.
• -Affects middle age and older adults and cigarette smoking is clearly implicated as primary cause.

• - Disease is characterized by slowly progressive obstruction of the airways and has periodic exacerbation often due to URIs. Breakdown of elastin in connective tissue of lungs, and continual bronchial irritation.
• - Tobacco smoke, air pollution and deficiency of antitrypsin
• - Chronic Bronchitis is caused by bronchial edema, hypersecretion of mucus, chronic cough and bronchospasms.
• - Emphysema is caused by destruction of alveolar septa leading to airway instability.
• - S/S: Airway obstruction, Air trapping, Dyspnea, Frequent infections, Changes in ventilation/perfusion, Hypoxemia, Hypoventilation and Cor pulmonale

• - Refrain from smoking, avoid irritants and allergens, pulmonary hygiene, exercise if no cardiac problems (limit),Breathing exercises, Oxygen therapy and treat infections.
• - Diagnostic Tests: Pulse oximetry, CBC, Chest X-ray, ABGs and Exhaled CO2 (capnogram, ETCO2) (normal 35-45mmHg).