Acute Respiratory Failure Flashcards
acute resp failure
A condition in which the resp system fails in one or both of its major functions: gas exchange and ventilation
PCO2 <45, pH <7.35, PaO2 <60
how is ARF diagnosed?
ABGs, CXR, C&S (sputum/blood) and supported by physical assessment.
- clinical presentation
- history
- CBC
- CT scan (CNS causes, chest trauma)
- V/Q scan (PE)
T or F: ARF is the most common type of organ failure seen in critical care units with ~56% of patients in CC experiencing it.
True
____ of patients with ARF need mech vent and die in hospital from it
1/3
types of resp failure
type 1, type 2, mixed
type 1 resp failure
acute hypoxemic respiratory failure: the primary problem is a defect in gas exchange
type 2 resp failure
acute hypercapnic respiratory failure: the primary problem is inadequate ventilation
mixed resp failure
difficult to locate the primary source of the
respiratory failure…giving rise to patient
responses related to both impaired gas exchange and ventilation
management of ARF is broken down into 2 main categories which are ______
treatment of primary cause
supportive medical management
treatment examples
pneumonia - give abx
PE - give thrombolytics
anesthesia - provide reversal agent or let wear off
supportive management
- multipronged approach
- promoting adequate gas exchange (supplemental O2, PPV)
- correcting acidosis
- pharmacological intervention (bronchodilators, steroids, sedation, analgesia, paralytics)
- initiating nutritional support
- preventing further complications
non-invasive vs invasive ventilation
- non invasive = CPAP (oxygenation), BiPAP (ventilation and oxygenation)
- invasive ventilation = ETT, trach
bronchodilators
- beta agonists (salbutamol, ipratropium)
- goal is to decrease airway resistance and dilate airways
steroids
- oral (prednisone), inhalation (fluticasone), IV (hydrocortisone)
- dose and delivery are all dependent on pt condition and history
- used to reduce airway inflammation
sedation
- depends on pt situation
- used to assist with and maintain adequate ventilation, comfort patient, decrease WOB
how much sedation would you give if a pt is on non-invasive ventilation?
sedation up to the point of decreasing anxiety RASS of 0 or -1 is: ativan or small doses of midazolam
how much sedation would you give if a pt is on invasive ventilation?
- sedation to ensure that the individual is able to tolerate the breathing tube and mechanical ventilation. pt-dependent so may range from RASS of 0 to -5
- can be accomplished with benzodiazepines (midazolam infusion or bolus), alpha 2 agonist (precedex) or general anesthetic (propofol)
- always set pt specific goals
paralytics
- used rarely and only in specific situations
- if unable to ventilate patient
- intubation
- IF using paralytics ensure that the patient is adequately sedated prior to administration!!
correct acidosis: what does hypoxemia cause? impaired ventilation leads to ____? what should we correct?
- hypoxemia causes impaired tissue perfusion, production of lactic acid and development of metabolic acidosis
- impaired ventilation lead to CO2 accumulation and respiratory acidosis
- correct oxygenation and ventilation and acidosis should correct
should we use sodium bicarb in correcting acidosis?
NO - minimal benefit, can make worse; shifts the oxy-hemoglobin dissociation curve to left and can worsen tissue hypoxia
nutritional support
- essential part of healing
- ensure pt is receiving adequate calories in relation to metabolic demands
- commonly overlooked
- don’t overfeed - can increase CO2
- don’t underfeed - decreases ventilation drive and muscle strength
potential complications
- ischemic-anoxic brain injuries
- cardiac dysrhythmias
- venous thromboembolism
- stress ulcers
- GI bleed
- barotrauma, infection, injury from vent
- infection, injury, dislodgement from artificial airways, nutrition, arterial and venous cannulation sites
nursing management
- positioning (HOB elevated, good lung down, frequent repositioning)
- prevent desat (hyperoxygenate prior to suction, spacing out activities/care, ensure equip secure, administer pain/sedation PRN, control fever to control demand)
- promote secretion clearance (hydration, suction)
- pt and family teaching
pneumonia: what is it? who is most at risk?
- acute inflammation of the lung parenchyma caused by an infectious agent that can lead to alveolar consolidation
- most at risk are elderly, cardiorespiratory disease and/or immunosuppression
- symptoms can vary from mild to severe
- 8th leading cause of death overall
