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Sophomore 2 Test 4 > ABGs, ARDS, and Mechanical Vent > Flashcards

ABGs, ARDS, and Mechanical Vent Flashcards

1
Q

General Causes of Respiratory Failure

A
  1. Ventilatory Failure/Hypercapnia

2. Oxygenation Failure/Hypoxemic

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2
Q

Disorders Leading to Ventilatory Failure

A
  1. Impaired function of the CNS
  2. Neuromuscular dysfunction
  3. Musculoskeletal dysfunction
  4. Pulmonary dysfunction
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3
Q

What kind of CNS dysfunction can lead to ventilatory failure?

A
  1. Drug OD
  2. Head trauma
  3. Infection
  4. Sleep apnea
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4
Q

What kind of neuromuscular dysfunction can lead to ventilatory failure?

A
  1. Myasthenia gravis
  2. Gillian-Barre
  3. ALS
  4. Spinal cord trauma
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5
Q

What kind of musculoskeletal dysfunction can lead to ventilatory failure?

A
  1. Chest trauma
  2. Kyphoscoliosis
  3. Malnutrition
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6
Q

What kind of pulmonary dysfunction can lead to ventilatory failure?

A
  1. COPD
  2. Asthma
  3. Cystic fibrosis
  4. ARDS
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7
Q

What kind of disorders can lead to oxygenation failure?

A
  1. Pneumonia
  2. ARDS
  3. Pulmonary edema
  4. Hypoventilation
  5. Hypovolemic shock
  6. COPD
  7. Pulmonary embolism
  8. Restrictive lung diseases
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8
Q

Why can inadequate ventilation and respiratory failure occur postoperatively?

A
  1. Effects of anesthesia
  2. Pain medications
  3. Hurts to breathe
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9
Q

What is chronic respiratory failure?

A

Deterioration in the gas exchange function of the lung that has developed insidiously or has persisted for a long period after an episode of acute respiratory failure

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10
Q

Two causes of chronic respiratory failure

A
  1. COPD

2. Neuromuscular disease

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11
Q

Clinical Manifestations of Acute Respiratory Failure

A
  1. Restlessness
  2. Fatigue
  3. HA
  4. Dyspnea
  5. Air hunger
  6. Tachycardia
  7. Increased BP
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12
Q

Clinical Manifestations of Acute Respiratory Failure as it Progresses

A
  1. Confusion
  2. Lethargy
  3. Tachycardia
  4. Central cyanosis
  5. Use of accessory muscles
  6. Diaphoresis
  7. Respiratory arrest
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13
Q

Acute Respiratory Failure

A

Sudden and life-threatening deterioration of the gas exchange function of the lung. Failure of the lungs to provide adequate oxygenation or ventilation for the blood

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14
Q

Acute Respiratory Failure ABGs

A
  • Decrease in PaO2 < 50 mm Hg (hypoxemia)
  • Increase in PaCO2 > 50 mm Hg (hypercapnia)
  • pH < 7.35; but always hypoxemic
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15
Q

Acute Respiratory Distress Syndrome (ARDS)

A

Occurs as a result of acute alveolar damage, inflammatory triggers release mediators, causing injury to alveolar and capillary membrane, as well as other structural damage to the lungs, severe ventilation-perfusion mismatch occurs, alveoli collapse, small airways are narrowed, resulting in severe hypoxemia. Blood is interfaced with nonfunctioning alveoli and gas exchange is markedly impaired (shunting)

  • Typically develops over 4-48 hours
  • Initially closely resembling severe hemodynamic pulmonary edema
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16
Q

Causes of ARDS

A
  1. Direct injury to the lungs (smoke inhalation, near drowning)
  2. Indirect injury to the lungs (shock, sepsis, pneumonia, overdose)
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17
Q

Clinical Manifestations of ARDS

A
  1. Rapid onset of severe dyspnea (12 to 48 hours after initiating event)
  2. Arterial hypoxemia (unresponsive to 100% O2)
  3. Sudden and progressive pulmonary edema (non-cardiac)
  4. Increasing bilateral dense infiltrates on chest x-ray (“ground glass”)
  5. Reduced lung compliance (stiff lungs)
  6. Intercoastal retrations
  7. Crackles
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18
Q

Diagnostics for ARDS

A
  1. BNP
  2. ECHO
  3. Pulmonary artery catheterization (Swan-Ganz) ** definitive method
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19
Q

ARDS Medical Management

A
  1. ID and treat underlying cause
  2. Intubation and mechanical ventilation (settings determined by status)(CMV or A/C w/PEEP)
  3. PEEP critical (improves oxygenation but not natural history of syndrome)
  4. Goal is PaO2 > 60 mm Hg or O2 sat > 90% at lowest possible FiO2
  5. Circulatory support, adequate fluid volume, nutritional support
  6. Inotropics or vasopressors
  7. PA line/Swan-Ganz/BNP/ECHO
  8. Nutritional therapy vital (enteral first consideration)
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20
Q

Pharmacologic Agents for ARDS

A
  1. Surfactant replacement
  2. Pulmonary antihypertensive agents
  3. Antisepsis agents
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21
Q

ARDS Nursing Management

A
  1. Suction PRN
  2. Positioning (prone)
  3. Turn frequently
  4. Reduce anxiety because it increases O2 demands
  5. Promote rest
  6. Assess nutritional status
  7. Document ventilator settings
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22
Q

What should be done if PEEP cannot be maintained?

A

Lots of sedation and possibly paralytics

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23
Q

Mechanical Ventilation

A

Provides warm body temperature 100% humidified O2 at levels 21-100%

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24
Q

Indications for Mechanical Ventilation

A
  1. PaO2 < 50 mm Hg with FiO2 > 0.60
  2. PaCO2 > 50 mm Hg with pH < 7.25
  3. RR > 35/min
  4. Peri-operatively
  5. Treatment of severe head injury
  6. Oxygenate when ventilation is inadequate
  7. To rest the respiratory muscles
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25
Q

Types of Mechanical Ventilation

A
  1. Negative pressure ventilators

2. Positive pressure ventilators

26
Q

Negative Pressure Ventilators

A
  • Exerts negative pressure on the external chest (iron lung, body wrap)
  • Do not require intubation
  • Requires a proper fit
  • Contraindicated in unstable or complex patients
  • Mainly used in chronic respiratory failure associated with neuromuscular conditions
27
Q

Positive Pressure Ventilators

A

Exerts positive pressure forcing alveoli to expand during inspiration, expiration occurs passively (ET tube or tracheostomy)

28
Q

Types of Positive Pressure Ventilators

A
  1. Pressure cycled vents
  2. Time cycled vents
  3. Volume cycled vents
  4. Noninvasive positive-pressure vents (NIPPV)
29
Q

Pressure Cycled Vents

A

Delivers flow of air until it reaches a preset pressure, cycles off, passive expiration.
- Intermittent Positive Pressure Breathing (IPPB) also used to administer aerosolized meds

30
Q

Time Cycles Vents

A

Used with newborns and infants, terminate or control inspiration after a preset time

31
Q

Volume Cycled Vents

A

Most commonly used positive pressure ventilators, volume of air preset, vent cycles off, exhalation passive

32
Q

Noninvasive Positive Pressure Vents (NIPPV)

A

Wears a mask

  • CPAP
  • Bi-PAP
33
Q

Ventilator Modes

A
  1. Assist Control
  2. Intermittent Mandatory Ventilation (IMV)
  3. Synchronized Intermittent Mandatory Ventilation (SIMV)
  4. Pressure Support Ventilation (PSV)
  5. Positive End of Expiratory Pressure (PEEP)
  6. Continuous Positive Airway Pressure (CPAP)
34
Q

Assist Control

A
  • A/C or CMV
  • Provides full support, tidal volume (VT), respiratory rate, FiO2
  • Every breath gets full support, even if patient initiates a breath over set respiratory rate
  • Used when they are 1st intubated or coming back from surgery
  • Does everything for the patient
35
Q

Intermittent Mandatory Ventilation (IMV)

A

Combination of mechanically assisted breaths (preset intervals) and spontaneous breaths (patient’s own tidal volume)
- Not used often

36
Q

Synchronized Intermittent Mandatory Ventilation (SIMV)

A

Combination of mechanically assisted breaths (breaths per minute) and spontaneous breaths (patient’s own tidal volume)

  • Regular and weaning modes
  • Allows patient to breathe on their own a little
37
Q

Pressure Support Ventilation

A

Applies pressure to the airway throughout the patient-triggered inspiration to decrease resistance within the tracheal tube and ventilator tubing

38
Q

Positive End Expiratory Pressure (PEEP)

A
  • Involves the maintenance of positive pressure at the end of expiration
  • Holds the alveoli open, thus increasing gas exchange across the alveolar-capillary membrane
  • Improves PO2 with lower concentrations of oxygen
  • PEEP pressures range from 2.5-10 cm H2O
  • PEEP increases intrathoracic pressure and cause hypotension and shock
  • Not used alone, used with other ventilator modes
39
Q

Types of Ventilator Alarms

A
  1. Volume
  2. Pressure
  3. Apnea alarm
40
Q

Volume Alarms

A

Low Pressure Alarms

- Indicate low exhaled volume die to disconnection, cuff leak, and tube displacement

41
Q

Pressure Alarms

A

High Pressure Alarms

- Indicate excess secretions, biting tube, kinks in tubing, coughing, pulmonary edema, bronchospasm, and pneumothorax

42
Q

Apnea Alarms

A

Ventilator does not detect spontaneous respiration in a preset time period

43
Q

Nursing Assessment for the Ventilator Patient

A
  1. All body systems and an in-depth respiratory assessment
  2. Any spontaneous effort
  3. Any evidence of hypoxia
  4. Adventitious breath sounds
  5. Evaluation of settings and functioning of ventilator
  6. Neurological status and effectiveness of coping
  7. Assess GI status and nutritional status
  8. I/O
  9. HOB 30-45 degrees
  10. Reposition ET tube Q24h
  11. Provide alternate method of communication
44
Q

Potential Complications and Nursing Implications of Ventilator Patients

A
  1. Fluid retention
  2. Oxygen toxicity
  3. Hemodynamic compromise
  4. Risk for aspiration
  5. GI ulceration (stress ulcers)
  6. Ventilator acquired pneumonia (VAP)
  7. Barotrauma
45
Q

Maintaining a Patent Airway with a Ventilator Patient

A
  1. Assess position and integrity of tube
  2. Document tube placement in cm at the teeth or lips
  3. Use two staff members for repositioning and re-securing tube
  4. Apply soft wrist restraints per hospital policy
  5. Use caution when moving client
  6. Suction oral and tracheal secretions
  7. Support ventilator tubing to prevent mucosal erosion and displacement
  8. Assess respiratory status every 1-2 hours
  9. Monitor and document ventilator settings hourly
  10. Suction and reposition client to promote mobility of secretions
46
Q

Medications for Ventilator Patients

A
  1. Analgesics
  2. Sedatives
  3. Neuromuscular Blocking Agents
  4. Ulcer-Preventing Agents
  5. Antibiotics
  6. Corticosteroids
47
Q

Analgesics Used for Ventilator Patients

A
  1. Morphine

2. Hydromorphone

48
Q

Sedatives used for Ventilator Patients

A
  1. Lorazepam
  2. Midazolam
  3. Propofol
49
Q

Neuromuscular Blocking Agent used for Ventilator Patients

A

Vecuronium bromide - give with pain meds and sedation

50
Q

Ulcer Preventing Agents used for Ventilator Patients

A
  1. Pantoprazole

2. Famotidine

51
Q

Signs of Weaning Intolerance

A
  1. RR > 30 or < 8
  2. BP or HR changes > 20% of baseline
  3. SaO2 < 90%
  4. Dysrhythmias, elevated ST segment
  5. Significant decrease in tidal volume
  6. Labored respirations, increased use of accessory muscles, diaphoresis
  7. Restlessness, anxiety, decreased LOC
52
Q

Procedure for Extubation

A
  1. Explain
  2. Suction
  3. Deflate cuff
  4. Cough
  5. AFM observe for stridor, distress
53
Q

Weaning

A
  1. Adequate psychological preparation
  2. A/C to SIMV to CPAP to T-piece
    * May take hours, days, or weeks
    * Temporarily withdraw sedation
54
Q

Normal pH

A

7.35 - 7.45

55
Q

Normal CO2

A

35 - 45

56
Q

Normal HCO3

A

22 - 26

57
Q

Causes of Metabolic Acidosis

A
  1. DM
  2. Shock
  3. Renal failure
58
Q

Causes of Metabolic Alkalosis

A
  1. Volume depletion
  2. Vomiting
  3. NG output
  4. Diuretics
59
Q

Causes of Respiratory Acidosis

A
  1. Pneumonia
  2. COPD
  3. Anesthesia
  4. Narcotics
60
Q

Causes of Respiratory Alkalosis

A

Hyperventilation

Sophomore 2 Test 4 (5 decks)

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