WEEK 1: CARING FOR CLIENTS REQUIRING COMPLEX RESPIRATORY CARE: LOWERING RESPIRATORY DISORDERS & RESPIRATORY FAILURE Fourth Edition: -Ch30 (p. 623-638 -PDF: pg1846) -Ch40 (p. 930-937 – PDF: pg 2713*) -Ch70 (PDF: pg 5241) –Ch 68 (p.1742-1755 – PDF – 5128*) *Also need to read from Ch 19 about Acid/ Base RESPIRATORY FAILURE & COMPLEX RESPIRATORY CARE Objective: -hypoxemic vs hypercapnic -differentiate between hypoxia + hypoxemia -common pathologies and disorder that contribute to respiratory failure (venous thromboembolism + chest trauma) -differentiate between hypoxia + hypoxemia -ID the following V/G relationships: normal unit; V/Q mismatch; shunt; dead space -Describe ARDs -describe key concepts related to non-invasive + invasive resp support: (Peep, pressure support) + modes of ventilation (volume, pressure) -describe nursing interventions related to resp failure Overview: -primary fxn of lungs is gas exchange -process of effective gas exchange: ventilation, perfusion, diffusion: problems with any of the 3 can result in HYPOXEMIA or HYPERCARBIA -Respiratory Assessment: inspection, ausc, palpation, percussion -Ausc- AS fine crackles (hair rubbing), stridor (whitle), pleural friction rub (rubing together, coarse and rough) -Cheyne strokes – crescendo, goes up and then weans -Kussmul – deep and rapid resps -Palpation – sub cut emphysemia feels like rice krispies -Percussion- check for typamny, dullness etc Hypoxemia- low oxygen in BLOOD Hypoxia – low oxygen in TISSUES Ventilation: air moving in and out Perfusion: movement of blood capillaries Diffusion: movement of gases between the alveoli and RBC -think about: RBC - end organ perfusion, end organ oxygenation -think about adventitious sounds: stridor, pleural friction rub, cheyne-stokes, breathing pattern, kussmal-Palpation: subcutaneous emphysema -tachypnea or bradypnea? 20-10