Severe form of respiratory failure which follows direct or indirect lung injury, usually in 24-48 hours  Patho massive inflammatory response damages lungs, alvvoelar-capillary membrane allows plasma & blood cell to leak into lung tissue & alveoli, surfactant does not work & is not replaced, alveoli collapes, o2 down, co2 rises

• Causes Massive Trauma
• Severe Respiratory Disorder
• Prolonged Mechanical Ventilation
• Hemorrhagic Shock
• Fat Emboli
• Septic Condition

S/S

first dyspnea & tachypnea, Cyanosis, falling bp

INCREASING REPIRATORY DISTRESS

refractory hypoxemia (desn't respind to 02)

may recover, but if develop sepisis & mulitple organ dysfunction syndrome(MODS) prognosis is poor, retractions tachycardia and crackles

Treatment

ventilator support, treat cause, bronchodilators, ABX, corticosteroids, lasix, dopamine for falling BP, treated in an intensive care setting

• Pulmonary Bronchial Constriction
• Possiblie Foreign Body
• Pulmonary Embous
• Pneumonia
• Pump Failure
• Pneumo-Thorax

A: adrenergics (Albuterol)

S: steroids                       

T: Theophylline              

H: hydration (IV)            

M: Mask 02                     

A: antibiotics             

hypersensitivity, higher occurrence in males, onset before age 12, retractions, hypoxemia: tachycardia Restlessness tachypnea, Familial Tendanceis, cough, mucus, sortness of air, epiratory wheezeing, co2 retention, prolonged expiration, if symptoms do responed in 30 min seek medical help can be life threating         

Def: Chronic inflammatory disorder characterized by airway constriction, secretion of excess mucus, and edema of airway mucosa.

Types: Allergic asthma (extrinsic) External stimulants: allergens (pollen, dander, dust, tobacco smoke. Idiopathic asthma: (intrinsic) internal stimulants URI, exercise or physical stress, emotional stress, drugs. Mixed asthma: most common, element of both.

Pathophysioloy: inlannation of airways causes constriction, secretion of excess mucus, and edema of airway mucosa air enters and is trapped

bronchospasms lead to increase airway resistance, obstrution & airway resistance

S/S: SOA, labored respiration's, expiratory wheezing, diaphoresis, use of accessory muscles & flaring nostrils, increased heart rate & bp, after acute attack thick tenacious sputum, dyspnea, may see signs of cyanosis, anxiety or feeling of suffocation and impending doom, sleep apnea & sudden death may occur within minutes of severe attack

DX: H&P, ABG's, PFT's, allergy testing

Treatment:  removal of cause, low-flow humidified 02, bronchodilators, corticosteroid's, sedatives, mucoytic agents

• remove cause
• provide o2 & continuous humidity as ordered
• encourage fluids as ordered
• position for comfort (high-fowler with arms supported on table tripod)
• prevent 2nd infections,
• no staff or visitors with URI
• schedule rest periods
• teach relaxation

• Asthma
• Chronic Obstructive Pulmonary Disease
• Cystic Fibrosis
• Atelectasisi

usually reesults from  other process -- infections (pneumonia), lung abscess, trauma, fungus, TB, CA, CHF, ascites

• sharp or stabbing  pain on inspiration, 
• dyspnea & cough (painful),  anxiety, decreased breath sounds
• shallow  breathing, pleural rub

• Dx: H&P with auscultation,  CXR
• Trmt:  according to cause—ABX, analgesics, NSAIDS, cough suppressant, O2 for severe dyspnea
• Nursing:  turn to affected side to alleviate pain, alleviate anxiety, diet—high PRO, calories, minerals, vitamins

• collection of excess fluid in pleural sac
• causes resp disorders (pneumonia, CA, trauma)  or systemic disease (heart failure or kidney disease)
• examination of pleural fluid via thoracentesis

• Purulent exudate
• Follows chest trauma, pneumonia or TB
• May do thoracentesis

• local lung destruction or necrosis , usually caused by aspiration pneumonia
• S/S of both—about 2 weeks, chills, fever, pleuritic chest pain, wt loss
• IV ABX & postural drainage, diet high PRO & high calories

chronic, recurrent infectious disease that usually affects the lungs but not always

• Mycobacterium tuberculosis organism,  worldwide
• generally disadvantaged populations (homeless or crowded, immigrants, altered immune, HIV, elderly, health care workers)

• M. tuberculosis transmitted by droplet nuclei (airborne droplets in cough, sneeze, talking, singing)
• breathed in by susceptible host and gets into bronchiole or alveoli (usually upper lobe)
• Immune response causes WBCs to attack & isolate the pathogen but can’t destroy it
• tubercule become fibrous & calcified sealed off tubercule forms small nodule called primary tubecule

• rod shaped, slender, acid-fast bacillus (AFB)    
• screening test  is TB skin test (Mantoux), immune response within 3-10 weeks after exposure
• H&P, CXR, sputum for AFB (3 positive specimens on 3 consecutive days)

develop gradually—fatigue, weight loss, anorexia, low grade afternoon fever, night sweats 

cough dry at first then purulent or blood tinged—generally here that they seek medical attention

• active disease always treated with at least 2 antibacterial meds—3 during 1st 4 months then 2 drugs
• isoniazid, rifampin, pyrazinamide—now in one tablet for 4 months
• isoniazid, rifampin—for additional 2 months
• prophylactic—isoniazid for 6-12 monthstoxic to liver
• surgical resection of tissue or lobe

• in hospital—isolation with negative air pressure room, keep doors & windows closed respirator mask,
• all times—rest, prevent transmission (isolation, mask, room),  diet High in PRO, CHO, vitamins (esp B6) and frequent small meals & nutritious snacks
• teach pt & family about transmission, need for testing, long term drug therapy

life threatening condition characterized by rapid shift of fluid from plasma into pulmonary interstitial tissue and alveoli

• most common cause is cardiac disease
• inhalation of noxious gases, rapid administration of IV fluids, opiate & barbiturate overdoses

• usually occur at noc after pt has been laying down due to increased return of venous blood to heart
• sudden onset of breathlessness & sense of suffocation,
• increase in BP, resps, pulse, 
• dyspnea, orthopnea, crackles become coarse, louder & more diffuse
• wheezes are present with significant obstruction of airways by fluid,
• cough producing copious amts of frothy blood tinged sputum, pt drowning in own fluid
• anxiety ranging from restlessness to panic occur

• immediate trmt to reduce total volume of circulating fluid & improve respiratory exchange
• Lasix IV, digitalis to increase cardiac output & decrease systolic
• O2, ABG’s, pulse ox to determine oxygenation, bronchodilators
• morphine to decrease anxiety & promote vasodilation