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Complex DMR > Acute resp failure > Flashcards

Acute resp failure Flashcards

1
Q

Parameters for Hypoxemia

A

PAO2<60 on 60% O2

focuses on Oxygenation

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2
Q

Parameters for hypercapnia

A

PaCO2 >45
pH<7.35
Focuses on ventilation

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3
Q

What can cause hypoxemia/oxygenation failure

A

Pneumonia, Pulmonary embolism, pulmonary edema, ARDS

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4
Q

What can cause hypercapnic/ventilatory failure

A 
Asthma
• COPD
• Pain
• Drug overdose
• Neurological disorders
– MG
– GB
– MS
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5
Q

Failure of Oxygenation

Hypoxemic Failure Physiological changes

A

-Low CO
-Low HGB
-Ventilation-perfusion mismatch (V/Q
mismatch)
– Intrapulmonary shunting
– Increased dead space ventilation
• Diffusion defects

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6
Q

High V/Q & ex

A

Deadspace

alveoli ventilated but not perfused, can occur with PE

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7
Q

Low V/Q & ex

A

Shunt, alveoli perfused but not ventilated

Fluid in alveoli (pneumonia)

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8
Q

Anatomic shunt

A

blood passes throughout an anatomic channel in the heart bypassing the lungs– ventricular septal defect

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9
Q

Physiologic shunt

A

Blood flows through the pulmonary capillaries without participating in gas exchange Low VQ
Pneumonia/ards

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10
Q

Diffusion limitations

A

thickened alveolar capillary membrane impairs gas exchange

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11
Q

What can cause failure of ventilation/hypercapnic failure

A 
Alveolar hypoventilation
• Respiratory muscle fatigue
• CNS depressants
• Head injury
• Chest wall abnormalities
• Neuromuscular conditions
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12
Q

Signs of hypoxemia

A 
Tachycardia/Tachypneia
Inc BP
Restlessness 
Confusion 
Anxiety
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13
Q

Signs of hypercapnia

A 
Tachycardiac/tachypneia
Headache
Dec LOC
Inc Somnolence
Dizzy (maybe pink)
Flushed
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14
Q

Why do patients go into tripod position

A

Increases AP diameter &decreases work of breathing

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15
Q

General Resp failure

Physical symptoms

A 
Pursed-lip breathing
• Retractions
• Orthopnea
• Tripod position – increases AP
diameter – decreases work of
breathing
• Inability to speak in full sentences (severe asthma &amp; other resp failure)
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16
Q

Diagnostic Blood work for resp failure

A

Blood work
– Arterial blood gases (severe distress only due to invasive nature)
– SvO2 (severe distress only due to invasive nature)
– Hbg & Hct
– Sputum cultures (infection)
Pulse ox

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17
Q

Diagnostic imaging for resp failure

A

CXR

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18
Q

Medical management of Respiratory distress & why

A

• Oxygen/Respiratory Management

  • Bronchodilators (ease and help movement of air in and out)
  • Corticosteroids (Dec inflammatory process)
  • Diuretics (excess volume)
  • Hydration (prevent secretions from getting dry, dry secretions are hard to cough up)
  • Nutrition
  • Treatment of underlying cause
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19
Q

Respiratory management of Acute resp failure (oxygen delivery devices)

A

Nasal cannula (2-4L)
Face mask (25-40% O2) if nasal cannula isnt doing the job
Venturi mask
Nonrebreather

Noninvasive PPV
BiPAP
CPAP

PPV

20
Q

Non rebreather

A

Pt with SOB, sats low
Provide 100% to patient
Turn O2 up high so that it fills up with O2.

When pt breathes they inhale O2 and prevents CO2 from being rebreathed

21
Q

Venturi

A

Color coded for FIO2

22
Q

Bipap/CPAP

A

Positive pressure ventilation in non invasive way, tightly fit.
CPAP: Helps keep lungs/alveoli inflated.Continuous pressure at all time.

Bipap: more pressure on inhalation to inflate alveoli less pressure on exhalation to help exhale

23
Q

What assesments would you do as the nurse to for acute respiratory failure

A 
Vitals (SPO2)
ABGS/Svo2
Neurological assessment (hypercapnic/O2 failure LOC)
Breath sounds
Cardiac monitoring
24
Q

Secretion managment

A

Chest physical therapy
Airway suctioning/effective coughing
Positioning: HOB, OOB,
good lung down (optimize ventilation perfusion ratio)

25
Q

How to Hydration and humification

A

Adequate fluid intake
IV hydration
Humidification devices

26
Q

What is Pneumothorax/Hemothorax

A

collection of air/blood in the pleural space
reduction in the negative thoracic pressure and poor lung expansion
Reduction of gas exchange at the alveolar level resulting in hypoxemia

27
Q

Manifestations of hemo/pneumo thorax

A 
Dec O2
Tachypnea= Resp alkalosis
Later=Resp acidosi
Pain (CXR &amp; ECG r.o MI)
SOB
Agitation, anxiety
Later - Dec LOC
28
Q

How do you treat hemo/pneumo thorax

A

Chest tube

Dry (water seal chamber, traps air)

29
Q

What should you monitor as the nurse for a hemo/pneumo thorax (Chest tube considerations

A

Monitor vital signs/spo2 pain SOB, secure connections (chest tube & container & chest & any connections),
(bubbling on expiration is good, and still air in pleural space that is being emptied) Continuous bubbling is a leak!

tidaling in the water seal chamber (air move up and down in inspiration/exp no more bubbling but still disruption).

Disruption healed, no movement.

Monitor drainage to report if excessive

If there is a break, place distal end, place in water to maintain sterile water seal

30
Q

Positioning of a hemo/pneumo thorax drain

A

Hemo: low to drop by gravity
Pneumo: up high bc air rises

31
Q

What should you monitor as the nurse for a hemo/pneumo thorax (vitals)

A

Monitor vital signs/spo2 pain SOB,

32
Q

What happens if there is a break in the chest tube system

A

If there is a break, place distal end, place in water to maintain sterile water seal, immediately hook the system back up, DONT CLAMP!!!! Can cause pressure on the heart (tension pneumothorax)

33
Q

Risk factors DVT (PE)

A

Virchow’s triad
• Venous stasis/prolonged immobility**
• Vessel wall damage
• Hypercoagulability

34
Q

General PE risk factors

A 
-DVT
– Virchow’s triad
• Venous stasis/prolonged immobility
• Vessel wall damage
• Hypercoagulability
• Obesity
• Smoking
• Fracture (hip/leg)
• Major surgery/trauma
• Malignancy
35
Q

Types of PE

A 
-Blood clot
• Fat embolus
• Air embolus
• Amniotic fluid
• Tumor particles
36
Q

PE Patho

A 
Obstruction in
Pulmonary Artery->Ventilation‐
Perfusion Mismatch
(high V/Q/dead
space ventilation)->Hypoxemia
Local
Vasoconstriction
37
Q

Classification of PE

A

Massive
submassive
low risk

38
Q

Massive PE

A

– Profound hypotension
– R & L ventricular dysfunction
– Shock/cardiac arrest

39
Q

Submassive PE

A

–Normotensive
– R ventricular dysfunction
– Elevated cardiac markers

40
Q

Low Risk

A

Normotensive/No ventricular dysfunction or elevation in cardiac
markers

41
Q

Initial PE Symptoms

A

-Dyspnea
• Chest pain**
• Tachypnea
• Tachycardia

42
Q

Submassive/Massive

PE symptoms

A 
• R heart failure with JVD
• Hypotension
• Anxious/restless/confused
• Hypoxia
• Poor peripheral perfusion
• Hemoptysis with pulmonary
infarction
43
Q

Diagnosis of PE

A 
Imaging 
CXR r/o other causes 
CT Scan 
Lab Testing
D-Dimer: Fibrin degredation?
ABG 
Cardiac markers
44
Q

Treatment/medical management of PE

A

Anticoagulation (factor X, hep, warfarin)
• IVC filters - prevent recurrence
• Cautious fluid management (careful of R heart failure)
• Hemodynamically compromised (break down clot)
– Thrombolytics
– Embolectomy
– Vasoactive/inotropic support

45
Q

Tests that nurse should monitor PE

A 
Oxyfenation
Chest pain
VS
Labs: ABGs Lactate Coag studies, cardiac markers
UO: marker for CO
46
Q

Nursing actions for PE

A 
Provide O2
• Elevate HOB
• Medication Management
• Fluid management
• Bleeding precautions

Complex DMR (12 decks)

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