Pathophysiology
One of the important anatomical alteration with the ARDS is the Alveolar Damage. The damage of the alveoli is due to the fluid build up as well as the compromised respiratory mechanism. The condition is also correlated with the damage of the lung endothedlium. The ARDS occurs in three phases where the damage for both alveoli as well as the endothelium. The three phases are Exudative, Proliferative, and Fibrotic.
Exudative Phase
Occurs approximately during the first week, usually start within 24 to 48 hours after the direct lung injury. In this phase, the injury of alveolar capillary endothelial cells and type I pneumocytes lead interstitial alveolar edema (non cardiogenic pulmonary edema) and atelectasis. Fluid that contains protein accumulates in the interstitial and alveolar spaces. In this acute phase, massive concentration of cytokines and lipid mediators are present in the lung. In response to proinflammatory mediators, leukocytes move into interstitial and alveoli. In addition, plasma protein accumulates in the air spaces with cellular debris and dysfunctional pulmonary surfactant to form hyaline membrane. Refractory hypoxemia occurs due to Severe V/Q mismatch and shunting of pulmonary capillaries. Respiratory alkalosis and an increase in cardiac output occurs in result of increased respiratory rate and heart rate as compensatory mechanism of Hypoxemia (Levy & Choi., 2012).
Proliferative Phase
This phase of ARDS usually lasts from day 7 to day 21. Some patients recover rapidly and are disconnected from mechanical ventilation during this phase. Regardless the improvement, many patients still suffering from shortness of breathe, tachypnea, and hypoxemia. There are some patients developed lung inj...
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...respiratory distress syndrome after pulmonary resection. General Thoracic and Cardiovascular Surgery, 61(9), 504-512. Doi: 10.1007/s11748-013-0276-7
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Many interventions are already in place to improve patient outcomes while on a ventilator. For example, elevating the head of the bed to 30 degrees, preventing venous thrombus via sequential compression devices or anticoagulant drugs, initiating early mobilization and practicing good hand hygiene were among the interventions listed by Fields, L.B., 2008. However, oral care was n...
Acute respiratory distress syndrome (ARDS) is a condition where there is a low oxygen level in the blood this mostly affects the lungs, people who have sepsis will be affected by ARDS as there breathing rate will decrease. Another reason for a multi-organ dysfunctions is that there is a lack of blood being given to the organs this causes low blood pressure or as it’s called hypotension this mostly affects diabetic people which leads them to having sepsis. Also hypoxia which is a lack of oxygen is another pathological physiological outcome of sepsis as less oxygen is reaching the tissue this is due to the fact that there is less oxygen in the blood. This causes confusion and change in heart and breathing rate which can lead to
Ascertaining the adequacy of gaseous exchange is the major purpose of the respiratory assessment. The components of respiratory assessment comprises of rate, rhythm, quality of breathing, degree of effort, cough, skin colour, deformities and mental status (Moore, 2007). RR is a primary indicator among other components that assists health professionals to record the baseline findings of current ventilatory functions and to identify physiological respiratory deterioration. For instance, increased RR (tachypnoea) and tidal volume indicate the body’s attempt to correct hypoxaemia and hypercapnia (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). The inclusive use of a respiratory assessment on a patient could lead to numerous potential benefits. Firstly, initial findings of respiratory assessment reveals baseline data of patient’s respiratory functions. Secondly, if the patient is on respiratory medication such as salbutamol and ipratropium bromide, the respiratory assessment enables nurses to measure the effectiveness of medications and patient’s compliance towards those medications (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). Thirdly, it facilitates early identification of respiratory complications and it has the potential to reduce the risk of significant clinical
Previous research used noninvasive ventilation to help those with COPD improve their altered level of consciousness by allowing the alveoli to be ventilated and move the trapped carbon dioxide out of the lungs. When too much carbon dioxide is in the blood, the gas moves through the blood-brain barrier and causes an acidosis within the body, because not enough carbon dioxide is being blown off through ventilation. The BiPAP machine allows positive pressure to enter the lungs, expand all the way to the alveoli, and create the movement of air and blood. Within the study, two different machines were used; a regular BiPAP ventilator and a bilevel positive airway pressure – spontaneous/timed with average volume assured pressure support, or AVAPS. The latter machine uses a setting for a set tidal volume and adjusts based on inspiratory pressure.
As mentioned above, emphysema affects the alveoli. When you develop emphysema the symptoms may go unnoticed for many years. With emphysema, your alveoli lose their elasticity and that makes it harder for the body to dispel the carbon dioxide. Also, the alveoli will eventually rupture and develop into one larger air sac. (Mayo Clinic)
MADGE, S and ESMOND, G (2001) Respiratory Nursing. Edinburgh: Harcourt Publishers Limited. London: Taylor & Francis.
An electrocardiogram (ECG) is one of the primary assessments concluded on patients who are believed to be suffering from cardiac complications. It involves a series of leads attached to the patient which measure the electrical activity of the heart and can be used to detect abnormalities in the heart function. The ECG is virtually always permanently abnormal after an acute myocardial infarction (Julian, Cowan & Mclenachan, 2005). Julies ECG showed an ST segment elevation which is the earliest indication that a myocardial infarction had in fact taken place. The Resuscitation Council (2006) recommends that clinical staff use a systematic approach when assessing and treating an acutely ill patient. Therefore the ABCDE framework would be used to assess Julie. This stands for airways, breathing, circulation, disability and elimination. On admission to A&E staff introduced themselves to Julie and asked her a series of questions about what had happened to which she responded. As she was able to communicate effectively this indicates that her airways are patent. Julie looked extremely pale and short of breath and frequently complained about a feeling of heaviness which radiated from her chest to her left arm. The nurses sat Julie in an upright in order to assess her breathing. The rate of respiration will vary with age and gender. For a healthy adult, respiratory rate of 12-18 breaths per minute is considered to be normal (Blows, 2001). High rates, and especially increasing rates, are markers of illness and a warning that the patient may suddenly deteriorate. Julie’s respiratory rates were recorded to be 21 breaths per minute and regular which can be described as tachypnoea. Julies chest wall appeared to expand equally and symmetrical on each side with each breath taken. Julies SP02 levels which are an estimation of oxygen
Medical technology today has achieved remarkable feats in prolonging the lives of human beings. Respirators can support a patient's failin...
Person, A. & Mintz, M., (2006), Anatomy and Physiology of the Respiratory Tract, Disorders of the Respiratory Tract, pp. 11-17, New Jersey: Human Press Inc.
Alveolar hyperventilation causes a decreased partial pressure of arterial carbon dioxide (PaCO2). The decrease in PaCO2 increases the ratio of bicarbonate concentration to PaCO2 which increases the pH level. The decrease in PaCO2 develops when a strong respiratory stimulus causes the respiratory system to remove more carbon dioxide than is produced. Respiratory alkalosis can be acute or chronic. Acute respiratory alkalosis is when the PaCO2 level is below the lower limit of normal and the serum pH is alkalemic. Chronic respiratory alkalosis is when the PaCO2 level is below the lower limit of normal, but the pH level is relatively normal or near normal. Respiratory alkalosis is the most common acid-base abnormality observed in patients who are critically ill. It is associated with numerous illnesses and is a common finding in patients on mechanical ventilation. Many cardiac and pulmonary disorders can occur with respiratory alkalosis. When respiratory alkalosis is present, the cause may be a minor or non–life-threatening disorder. However, more serious disease processes should also be considered in the differential diagnosis (Byrd, 2017). Hyperventilation is most likely the underlying cause of respiratory alkalosis. Hyperventilation is also known as over breathing (O’Connell, 2017).
Hess Dean R., M. N. (2012). Respiratory Care: Principles and Practice 12th Edition. Sudbury, MA: Jones and Bartlett Learning.
Chronic bronchitis is a disorder that causes inflammation to the airway, mainly the bronchial tubules. It produces a chronic cough that lasts three consecutive months for more than two successive years (Vijayan,2013). Chronic Bronchitis is a member of the COPD family and is prominently seen in cigarette smokers. Other factors such as air pollutants, Asbestos, and working in coal mines contributes to inflammation. Once the irritant comes in contact with the mucosa of the bronchi it alters the composition causing hyperplasia of the glands and producing excessive sputum (Viayan,2013). Goblet cells also enlarge to contribute to the excessive secretion of sputum. This effects the cilia that carry out the mechanism of trapping foreign bodies to allow it to be expelled in the sputum, which are now damaged by the irritant making it impossible for the person to clear their airway. Since the mechanism of airway clearance is ineffective, the secretion builds up a thickened wall of the bronchioles causing constriction and increasing the work of breathing. The excessive build up of mucous could set up pneumonia. The alveoli are also damaged enabling the macrophages to eliminate bacteria putting the patient at risk for acquiring an infection.
...o Pneumonia, it causes respiratory failure. The treatment for this would most likely be ventilator breathing for the patient with supplemental oxygen. (Boothby, L. A. (2004)
World Health Organization “Frequently Asked Questions on Severe Acute Respiratory Syndrome (SARS),” Communicable Disease Surveillance & Response (CSR), March 24. (2003). World Health Organization . Retrieved March 29, 2004.
How exactly does this condition pose a danger to life? A major effect of ARDS is build up of thick sputum in the lungs. Sputum has an adverse effect of greatly reducing lung elasticity. This hinders the lungs from expanding to allow enough volume of oxygen to flow in and mix with blood for circulation to the rest of the body. The curtailed amount of oxygen in the lungs causes a domino effect in the bloodstreams and, ultimately, in the rest of the body systems. In other words, the effects of an attack on the lungs resounds in all the organ systems. This easily takes the life of the pa...