Acute Respiratory Failure Flashcards by Kyleigh Overbey

What are the levels of PaO2, PaCO2, Ph in ARF?

less than 60 mm hg(80-100 mm hg normal), greater than 50 mm hg(35-45 mm hg norm.), less than or equal to 7.30(7.35-7.45 norm.)

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Examples of failure of oxygenation by hypoventilation, ventilation/perfusion mismatch, diffusion defects?

sedation, pain, ab/chest surgery, neuro pts; pulm. Embolism; increase intrastial fluid

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Examples of failure of oxygenation by low Co, low hemoglobin, tissue hypoxia?

MI, HF, a fib, shock, sepsis; anemia; left sided shift of oxyhemoglobin dissociation curve.

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What shows the earliest signs of hypercapnia and hypoxia?

change in neuro status

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What are some signs of hypoxia? Hypercapnia?

confusion, restless, anxious; sleep, lethargic, coma

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In unilateral lung disease how do you position pt?

Good lung down when laying on side

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What nursing intervention helps maximize airway clearance?

reposition every 2 hours

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ARDS ends in?

Respiratory failure

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Why do you apply PEEP?

to keep airways open

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What is ARDS?

Noncardiogenic pulmonary edema

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What are the diagnostic criteria for ARDS?

acute onset within one week on injury, PaO2/FiO2 ratio less than 200, bilateral infiltrates

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ARDS PEEP requirements?

greater than 5 cm H2O

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Possible direct causes for ARDS?

aspiration, diffuse pneumonia, fat embolism, near drowning, neurogenic pulmonary edema, oxygen toxicity, pulm. Contusion, trauma

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Possible indirect causes for ARDS?

sepsis, cardiopulmonary bypass, anaphylaxis, DIC, drug OD, fractures, transfusion related lung injury (traly), eclampsia.

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What is some patho behind ARDS?

insult: systemic inflammatory response syndrome, damage alveolar cap. Membrane, increased cap. Permeability, pulm. Edema, atelectasis, decreased lung compliance, impaired gas exchange, V/Q mismatch

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What should we be concerned about with ARDS?

renal failure and MODS

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Which patients have a high risk for ARDS?

Pneumonia, Aspiration, Trauma, Sepsis, COPD

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In ARDS you will see hypercapnia, why?

trying to compensate for respiratory alkalosis

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T/F in ARDs we should check Na, may have hypernatremia.

FALSE : hypercalcemia

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What are some symptoms of ARDS?

dyspnea, tachypnea, hyperventilation w. normal BS (early), increase temp and pulse, increased PIP on ventilation, white out chest xray, hypoxemia, crackles

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Tx for ARDS?

higher PEEP, lung preventative strategies, vent: high freq (because prone to resp. acidosis), pressure control, and inverse-ratio

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How much should tidal vol. of ARDS patient be?

6 ml/kg

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T/F it is important to manage sedation and pain relief in ARDS pts.

TRUE

What positon is good for ARDS patients why?

relieve pressure off of lungs, increase perfusion, promotes expelling secretions.

What are concerns with prone position?

aspiration, keep airway, skin breakdown, padding bony prominences.

Too much PEEP can cause?

Increased ITP could lead to pneumothorax, decreased CO and venous return, Increased ICP

T/F Adequate nutrition and fluid and electrolyte balance are important in ARDS patients?

TRUE

What are some Physiological changes in COPD?

mucous hypersecretion, ciliary dysfunction, chronic airway inflammation, airway remodeling, thickening of pulmonary vessels (decreases gas exchange ability)

T/F in COPD pts are prone to left side HF

FALSE: right

What are some clinical manifestations of COPD?

wheezes, barrel chest, anxious, chronic cough, crackles, clubbing, hypercapnia.

What is important for tx of stable COPD?

broncho dilator, flu shot, quit smoking.

What are some causes of ARF in COPD?

acute exacerbations, CHF/pulm. Edema, dysrhythmias, pneumonia, dehydration, electrolyte imbalances

Progress RF in COPD leads to decreased O2 and increased CO2 causing?

uncompensated respiratory acidosis.

What are some signs of uncompensated respiratory acidosis?

increase WOB, increase in abnormal BS, tachycardia, decreased CO, ABG worsen, PaO2 less than 60

What should we be cautious with in COPD patient?

over oxygenating them

What are some effects of exacerbation of Asthma?

hyperventilation with air trapping results in respiratory acidosis, severe hypoxemia

What is an alternative medication management of asthma?

heliox: helium and O2, NPPV

How do we know asthma patients airway is improving?

less or more wheezing depending on pt, can speak more, blood gases better

Who are at increased risk for pneumonia?

elderly, smoker, alcoholic, chronic diseases, head injury, immunosuppression

what are the core measures for pneumonia?

oral care, 1st dose antibiotics within 6-8 hrs of admit, 1st 24 hours blood cultures, talk about flu and pneumonia vaccine, smoking cessation.

What are some s/s of pneumonia?

fever, cough, purulent sputum, hemoptysis(blood in sputum), dyspnea/tachypnea, chest pain, adventitious BS

What are some alterations in blood gases in pneumonia?

hypoxemia, respiratory alkalosis.

Why is it easier for patients on a ventilator to get pneumonia?

When you are ventilated epiglottis moves out of the way and can’t defend against aspiration of bacteria; cuff of ventilator doesn’t work as well to prevent aspiration.

What is the VAP bundle (what you should do for patient)?

elevate HOB 30-45 degrees, awake daily and assess readiness to wean, stress ulcer disease prophylaxis, venous thromboembolism (VTE) prophylaxis, oral care

Why do we avoid normal saline during suctioning?

because wash bacteria in lower airways.

In VAP what are ways to prevent infection and aspiration?

avoid re-intubation, oral intubation, ETT with continuous aspiration of subglottic secretions, sedation and weaning protocols, aseptic suctioning of ET tube.

In pulmonary embolism what is the virchows triad?

venous stasis, altered coagulability, damage to vessel walls

PE patients are prone to?

pulm. Htn and right ventricular failure.

What are some s/s of PE?

symptoms of DVT, acute dyspnea, great sense of doom, tachycardia, cough, hemoptysis, crackles, wheezes, hypoxemia

What are some ways to diagnosis PE?

CT angiography(noninvasive), Pulm. angiogram, MRI,

What kind of heparin do you give PE patients?

molecular-weight heparin

What are some prevention measures of PE?

compression devices, position changes, tx dysrhythmias, prophylactic anticoag. therapy, avoid pillows under knees.

What are some complications of PE?

HF, obstructive shock, Death

What are some nursing implications for PE?

monitor coag levels, switch to oral anticoag, assess for signs of pulm. htn which may lead to RVF, JVP, peripheral edema, assess CO.

Normal PTT? INR?

21-35 sec, less than 2.

What is PTT therapeutic range? INR?

46-80 sec; 2-3; increase both causes slower clotting.

What is antidote for Heparin? Coumadin?

Protamine Sulfate; Vit. K