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capstone > Acute Respiratory Failure > Flashcards

Acute Respiratory Failure Flashcards

1
Q

What percentage of the air is o2?

A

21%

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2
Q

Explain the anatomy of the lungs

A 
Trachea
Right lung
- upper 
- middle
- lower
Left lung
- upper
- lower
bronchi 
alveoli
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3
Q

What is the primary function of the respiratory system

A

exchange of respiratory gases, oxygen and carbon dioxide between the circulatory blood and the lungs by diffusion across the alveolar – capillary membrane

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4
Q

What is Perfusion?

A

the mechanism the body uses to exchange gases between the atmosphere and the blood

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5
Q

What is ventilation?

A

the movement of gases into and out of the lungs by inspiration and expiration

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6
Q

What is the difference between perfusion and ventilation?

A

Ventilation - the mechanics

perfusion - the exchange

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7
Q

What kinds of ventilation (mechanical) problems can happen?

A 
OUTSIDE
• Neuro patients
• Myastenias gravis (decompression of spinal cord)
• Guillain-Barré syndrome (auto immune)
• Muscular problem
• Diaphragm
• Muscles around rib cage
INSIDE
• PE
• Pulmonary oedema
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8
Q

What kinds of exchange issues can occur?

A 
Decrease level of oxygen due to atmosphere changes
Low blood volume
Blockage preventing the exchange
• PE
• Pulmonary oedema
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9
Q

What does respiratory failure result in?

A

insufficient oxygen is transferred to the blood resulting in hypoxaemia (decrease in PaO2) or inadequate carbon dioxide is removed, resulting in hypercapnia (increased PaCO2

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10
Q

What are the clinical manifestations of respiratory failure?

A

CNS alteration in mental state - restlessness, agitation, anxiousess
Respiratory - increased rate less depth
CVS - Higher HR
Skin - cool clammy
Neuro muscular - may feel weak, tremor, seizure

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11
Q

How is diagnosis made for acute respiratory failure?

A

Clinical Observation/assessment
Chest X-Ray
ABG Analysis

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12
Q

Explain acute respiratory distress syndrome (ARDS)

A

ARDS refers to a form of non cardiogenic pulmonary oedema resulting in hypoxaemic
respiratory failure

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13
Q

How quickly can ARDS develop?

A

24-48 hours

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14
Q

give 5 examples of aetiologies which can lead to the development of ARDS

A 
¡ - Sepsis (most common)
¡ - Pneumonia
¡ - Aspiration and other chemical pneumonitis
¡ - Trauma (second most common); lung contusion, penetrating lung injury 
¡ - Pancreatitis
¡ - Multiple blood transfusions
¡ - Smoke or toxic gas inhalation
¡ - Drugs
¡ - Burns
¡ - Near drownings
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15
Q

What are the stages of ARDS?

A
  1. Injury stage
  2. Reparative or proliferative stage
  3. Fibrotic stage
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16
Q

Explain the injury stage?

A
  • 1–7 days after direct lung injury or host insult
  • Inflammatory response – presence of oedema
  • Fluid interstitial (surrounding)
  • ↑ Work of breathing (WOB)
  • ↑ Respiratory rate
  • ↓ Tidal volume
  • Interstitial and alveolar edema (noncardiogenic pulmonary edema)
  • Shunting of pulmonary capillary blood O2
17
Q

Explain the Reparative or Proliferative stage

A
  • 1–2 weeks after initial lung injury
  • Alveolar sac are filled with fluid containing neutrophils and erythrocytes
  • Lung becomes dense
  • Lung compliance continues to ↓
  • If reparative phase persists, widespread fibrosis results
18
Q

Explain the Fibrotic stage

A 
• 2–3 weeks after initial lung injury
• Lung is completely remodeled by sparsely collagenous and fibrous
tissues
• ↓ Lung compliance
• ↓ Area for gas exchange
19
Q

What are the early signs of ARDS?

A

Dyspnoea, tachypnoea, cough and restlessness Chest auscultation may reveal scattered crackles ABG - mild hypoxia with respiratory alkalosis
Chest x-ray may be normal or may show minimal scattered interstitial infiltrates

20
Q

What are the late signs of ARDS?

A
  • ↑ work of breathing
  • Pulmonary function ↓
  • compliance and ↓ lung volumes (notably↓ Functional Residual Capacity (FRC)
  • Mental state changes (as hypoxia worsens)
  • CXR - diffuse and bilateral interstitial and alveolar infiltrates progressing on to a white out picture
  • As the condition degenerates, hypoxaemia, hypercapnia and metabolic acidosis ensue
21
Q

Why does renal failure occur in ARDS?

A
  • Occurs from decreased renal tissue oxygenation from hypotension, hypoxemia, or hypercapnia
  • May also be caused by nephrotoxic drugs used for infection associated with ARDS
22
Q

What nursing assessments can be done to detect ARDS?

A
  • History of lung disease
  • Exposures to lung toxins
  • Tobacco use
  • Related hospitalisations
  • Extreme obesity
  • Use of O2, inhalers, nebulisers,
  • Previous intubation
  • Thoracic or abdominal surgery
  • Exercise
23
Q

What sudden changes should you look for upon nursing assessment?

Name 8

A
  • Diaphoresis
  • Dizziness
  • Dyspnea, wheezing, cough, sputum, palpitations, swollen feet
  • Changes in sleep pattern
  • Fatigue
  • Headache
  • Chest pain
  • Anxiety
  • Restlessness
  • Agitation
  • Pale, cool, clammy or warm, flushed skin
  • Use of accessory muscles
  • Shallow breathing with increased respiratory rate
  • Tachycardia progressing to bradycardia
  • Extra heart sounds
  • Abnormal breath sounds
  • Hypertension progressing to hypotension
  • Abdominal distention, ascites
  • Confusion, delirium
  • Changes in ABGs
  • Decreased tidal volume
  • Abnormal x-ray
24
Q

Following recovery what should you expect of the airway and ABG results?

A
  • Pao2 within normal limits or at baseline
  • Sao2 >90% ( dependant on patients presentation)
  • Patent airway
  • Clear lungs on auscultation
25
Q

What O2 therapy should be used?

A
  • High-flow systems used to maximize O2 delivery
  • Spo2 continuously monitored
  • Give lowest concentration that results in Pao2 60 mm Hg or greater
  • Patients will commonly need intubation with mechanical ventilation because Pao2 cannot be maintained at acceptable levels
26
Q

What happens in mechanical ventilation?

A

• PEEP at 5 cm H2O (depends on person)
▪ Opens collapsed alveoli
• Higher levels of PEEP are often needed to maintain Pao2 at 60 mm
Hg or greater
• High levels of PEEP can compromise venous return
▪ ↓ Preload, CO, and BP

27
Q

What is PEEP?

A

P - positive
E - End
E - Expiratory
P - Pressure

by using peep it keeps the alveoli open
patient then has a higher chance of a better exchange

28
Q

What are the risks of PEEP?

A

If the person has pneumonia the lungs cannot fill adequately and the air flow with transfer to other lung which can make the lung pop

29
Q

How do we evaluate recovery?

A
  • No abnormal breath sounds
  • Effective cough
  • Normal respiratory rate, rhythm, and depth
  • Appropriate use of accessory muscles

capstone (19 decks)

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