Inflammatory Response – Changes in the Exudative Phase (Nursing)

00:01 So let's continue with this inflammatory response.

00:03 Now you end up with a leaky membrane.

00:05 When you have a leaky membrane, fluid starts shifting.

00:09 That's how we end up with an extra fluid in the alveoli.

00:13 Now, look what you've got down there, look proteases blink blink.

00:17 You've got some fibroblasts.

00:18 Yeah, that's not real good, those are kind of stiff, that interstitium, right? That's now getting widened and edematous.

00:26 That means we got fluid building up there.

00:28 It's going to make it hard probation to breathe because they're going to be able to get oxygen in.

00:36 They just can't get it into the blood supply.

00:39 So these leaky membranes and fluid shifting is really a big problem.

00:44 It's because of that damage to the endothelium, allows the cells in the fluids to leak into the interstitial space and that causes the pulmonary edema and then it continues to keep leaking into the alveoli.

00:58 That is a ton of information, so make sure you really have that solid.

01:02 Look at the picture, what do you have there? What are the names of those cells that are migrating into the alveoli? Yeah, PMNs.

01:10 We know they make a lot of havoc once they get in there.

01:14 What's happening to that interstitium? It's getting wider.

01:18 It's getting full of fluids, it's getting edematous and that's what we mean when we say pulmonary edema.

01:25 Okay, so that's how the aveoli ends up filled.

01:27 We know what pulmonary edema is and we see that interstitial getting wider.

01:31 We got the proteases has the fibroblasts.

01:34 There are a lot of changes happening on a cellular level.

01:38 Now one more thing I want to tell you about this phase.

01:42 Patients in this phase are at an increased risk for clotting.

01:46 Okay, so make sure you have that written in.

01:49 You can see that this is a really delicate system, things are getting out of control.

01:53 Now, if we add clots on top of that, it's really going to be problematic.

01:58 It depends on how big the clots are, where they're located.

02:03 But look down there, so you've got the platelets in there just to remind you.

02:07 If the patient is at an increased risk for clotting, we could end up with some very inconvenient clots.

02:14 You know pulmonary embolism can cause immediate deaf for a patient.

02:18 So a patient in ARDS in this phase does have an increased risk for clotting.

02:23 You're going to want to keep an eye on that and the patient's lab work.

02:28 Now damaged and dying pneumocytes mean poor oxygen-carbon dioxide exchange.

02:33 Okay just doesn't work.

02:35 So, why are these cells being damaged? Because of all this inflammation that's going on there and it's filled with all these substances and it's just not working the way it is intended to work.

02:45 So those cells that fragile one cell alveolar wall membrane is getting damaged and those cells are not just damaged but they're dying.

02:55 We talked about these pneumocytes, that's the type l and the type ll, without those being intact we know a long as not very compliant and it doesn't exchange O2 and CO2 very well.

03:08 Also, when these cells are damaged, we have less surfactant.

03:12 And what we do have is not very effective.

03:15 Great! That puts us at an increased risk the alveoli to collapse.

03:21 So, see how the inflammatory response is good until it is out of control.

03:26 This is a very clear example of when it is out of control, and it is overwhelmed, the body.

03:33 Now we have this alveolar collapse risk.

03:35 We know that it's increased and we know why.

03:37 Because those cells are not able to function and do their role.

03:41 We know that the type l and type ll are damaged and they're dying.

03:44 They have inadequate surfactant and things just aren't in the order they need to be in order to have compliant lungs and effective gas exchange.

03:54 Can you imagine trying to breathe through this? I mean, can you just stop for a minute, just a really cool picture.

04:01 We're talking about a lot of cellular stuff.

04:03 But stop and think about why this is so brutal for our patients.

04:08 See this is why we can't oxygenate them very well.

04:12 This is why their P/F ratio is so low in ARDS.

04:16 Because we're trying to get oxygen from here down through all this goop and it just doesn't work.

04:23 If you think this is bad, I've got more to tell you about.