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This chapter is from the book

This chapter is from the book

Acute Respiratory Failure

Acute respiratory failure can be defined as the lungs’ failure to meet the body’s oxygen requirements. One acute respiratory condition you need to be familiar with is acute respiratory distress syndrome, commonly known as ARDS.

Acute Respiratory Distress Syndrome

Acute respiratory distress syndrome, commonly known as ARDS or noncardiogenic pulmonary edema, occurs mostly in otherwise healthy persons. ARDS can be the result of anaphylaxis, aspiration, pulmonary emboli, inhalation burn injury, or complications from abdominal or thoracic surgery. ARDS may be diagnosed by a chest x-ray that will reveal emphysematous changes and infiltrates that give the lungs a characteristic appearance described as ground glass. Assessment of the client with ARDS reveals

  • Hypoxia
  • Sternal and costal retractions
  • Presence of rales or rhonchi
  • Diminished breath sounds
  • Refractory hypoxemia

Care of the client with ARDS involves

  • Use of assisted ventilation
  • Monitoring of arterial blood gases
  • Attention to nutritional needs
  • Frequent change in position, placement in high Fowler’s position, prone position, or use of specialized beds to minimize consolidation of infiltrates in large airways
  • Investigational therapies, including the use of vitamins C and E, aspirin, interleukin, and surfactant replacements

Pulmonary Embolus

Pulmonary embolus refers to the obstruction of the pulmonary artery or one of its branches by a clot or some other undissolved matter, such as fat or a gaseous substance. Clots can originate anywhere in the body but are most likely to migrate from a vein deep in the legs, pelvis, kidney, or arms. Fat emboli are associated with fractures of the long bones, particularly the femur. Air emboli, which are less common, can occur during the insertion or removal of a central line. Common risk factors for the development of pulmonary embolus include immobilization, fractures, trauma, cigarette smoking, use of oral contraceptives, and history of clot formation.

Fat emboli are associated with fracture of long bones (such as a fractured femur); most fractured femurs occur in young men 18–25, the age of most football players.

Symptoms of a pulmonary embolus depend on the size and location of the clot or undissolved matter. Symptoms include

  • Chest pain
  • Dyspnea
  • Syncope
  • Hemoptysis
  • Tachycardia
  • Hypotension
  • Sense of apprehension
  • Petechiae over the chest and axilla
  • Distended neck veins

Diagnostic tests to confirm the presence of pulmonary embolus include chest x-ray, pulmonary angiography, lung scan, and ECG to rule out myocardial infarction. Management of the client with a pulmonary embolus includes

  • Placing the client in high Fowler’s position
  • Administering oxygen via mask
  • Giving medication for chest pain
  • Using thrombolytics/anticoagulants

Antibiotics are indicated for those with septic emboli. Surgical management using umbrella-type filters is indicated for those who cannot take anticoagulants, as well as for the client who has recurrent emboli while taking anticoagulants. Clients receiving anticoagulant therapy should be observed for signs of bleeding. PT, INR, and PTT are three tests used to track the client’s clotting time. You can refer to Chapter 13, “Caring for the Client with Disorders of the Cardiovascular System,” for a more complete discussion of these tests.

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