Advanced Clinical Concepts

Exchange of oxygen for CO2 in the lungs is inadequate for oxygen consumption and CO2 production within the body's cells.

1. Hypoxemia that persists even when 100% O2 is given 2. Decreased pulmonary compliance 3. Dyspnea 4. Bilateral pulmonary edema, not r/t the heart 5. Dense pulmonary infiltrates on x-ray

It is an unexpected catastrophic pulmonary complication. Pt. has no previous pulmonary problems High mortality rate of 50%

No abnormal lungs sounds because the associated edema first occurs in the interstitial spaces not the airways

Lowered PaCO2

PEEP: Positive End-expiratory pressure- the instillation and maintenance of small amounts of air into alveoli to prevent collapsing during expiration. Pressure set at 5 to 10cm of water

COPD Pneumonia TB Contusion Aspiration Inhaled Toxins Emboli Drug Overdose Fluid Overload Disseminated intravascular coagulation Shock

Dyspnea, hyperpnea Intercostal retractions Cyanosis, pallor Hypoxemia PO2 <50mmHg Diffuse pulmonary infiltrates seen on chest radiograph as "white-out" appearance Verbalized anxiety, restlessness

Impaired gas exchange Risk for deficient fluid volume Ineffective breathing pattern Risk for injury Risk for infection

Position client for maximal lung expasion Monitor for signs of hypoxemia and O2 toxicity Suction ONLY when secretions present Auscultate for pneumothorax Emotional support to decrease anxiety Monitor blood gases (first do Allen's test), vitals, & cardiac monitor Monitor vital organ status: CNS , LOC, Renal output, apical pulse and B/P Monitor fluid & electrolyte balance