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Critical care Chapter 15 > Acute Respiratory Failure > Flashcards

Acute Respiratory Failure Flashcards

1
Q

Failure of Oxygenation occurs when the PaO2 cannot be adequately maintained, what are some causes?

A 
Hypoventilation
Intrapulmonary shunting
Ventilation-perfusion mismatch
Diffusion defects
Low cardiac output
Low hemoglobin level
Tissue hypoxia
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2
Q

Acute Respiratory Failure (ARF)

A 
Failure 
 Oxygenation 
 Ventilation 
 Both of the above  
Altered gas exchange (room air) 
 PaO2 < 60 mm Hg 
 PaCO2 > 50 mm Hg 
 pH ≤ 7.30
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3
Q

Hypoventilation

A

Drug overdose
Neurological disorders
Abdominal or thoracic surgery

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4
Q

Intrapulmonary Shunting

A

Blood shunted from right to left side of heart without oxygenation
 Qs/Qt disturbance

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5
Q

Causes of Intrapulmonary Shunting

A

 Causes: atrial or ventricular septal defect, atelectasis, pneumonia, pulmonary edema
 Why does administration of higher levels of oxygen nothelp in shunt disorders

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6
Q

Diffusion Defects

A

Diffusion of O2 and CO2 does not occur
 Fluid in alveoli
 Pulmonary fibrosis

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7
Q

Low Cardiac Output

A

Cardiac output must be adequate to maintain tissue perfusion
 Normal delivery is 600 to 1000 mL/min of oxygen

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8
Q

Low Hemoglobin

A

Hemoglobin necessary to transport oxygen

 95% of oxygen is bound to hemoglobin

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9
Q

Tissue Hypoxia

A

Some conditions prevent tissues from using oxygen despite availability  Cyanide poisoning  Tissue hypoxia results in anaerobic metabolism and lactic acidosis

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10
Q

The nurse suspects respiratory failure secondary to hypoventilation in a patient with:

A

A. Anxiety
B. Neuromuscular disease
C. Pulmonary embolism
D. Volume A/C ventilation at rate of 20 breaths/min

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11
Q

ideal blood PH

A

7.365

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12
Q

Kidneys produce

A

Bocarb

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13
Q

Medical Management

A 
Oxygen 
Bronchodilators 
Corticosteroids 
Sedation
Transfusions 
Therapeutic paralysis 
Nutritional support
 Hemodynamic monitoring
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14
Q

Acute Respiratory Distress Syndrome (ARDS)

A 
Noncardiogenic pulmonary edema
 Diagnostic criteria 
 PaO2/FiO2 ratio of less than 200 
 Bilateral infiltrates 
 Pulmonary capillary wedge pressure < 18 mm Hg  Acute lung injury scoring
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15
Q

If the PaO2 is 60 mm Hg and the FiO2 is 0.6, the PaO2/FiO2 ratio is:

A

A.100
B. 1000
C. 360
D. 3600

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16
Q

Symptoms of ARDS

A

 Dyspnea and tachypnea
 Hyperventilation with normal breath sounds
 Respiratory alkalosis
 Increased temperature and pulse
 Worsening chest x-rays that progress to “white out”
 Increased PIP on ventilation
 Eventual severe hypoxemia

17
Q

Treatment of ARDS

A

 Treat the cause
 Oxygenation and ventilation
 Positive end-expiratory pressure (PEEP)
 Possible nontraditional modes of ventilation: high-frequency, pressure-control, and inverse-ratio

18
Q

Treatment of ARDS (CONT)

A 
 Comfort 
 Sedation 
 Pain relief 
 Neuromuscular blockade 
 Decrease O2 consumption 
 Positioning 
 Prone positioning 
 Continuous lateral rotation therapy
19
Q

Treatment of ARDS

A

 Fluid and electrolyte balance
 Adequate nutrition
 Pharmacologic intervention
 Psychosocial support

20
Q

complications of ARDS

A

 Multiple organ dysfunction syndrome
 Renal failure
 Disseminated intravascular coagulation
 Long-term pulmonary effects associated with high oxygen and other therapies

21
Q

ARF in Chronic Obstructive Pulmonary Disease (COPD)

A

 Worsening V/Q mismatch (e.g., secretions and bronchoconstriction can lead to ARF)
 Causes: acute exacerbations, CHF/ pulmonary edema, dysrhythmias, pneumonia, dehydration, and electrolyte imbalances

22
Q

Assessment

A 
Dyspnea 
Chronic cough 
Sputum production 
Postbronchodilator spirometry limitations 
Pulmonary function studies 
Chest wall changes (barrel chest) 
Accessory muscles used for breathing 
Clubbing of the fingers 
Wheezing and crackles 
ABG (hypoxemia and hypercapnia
23
Q

Medical Management of ARF in COPD

A

 Correct hypoxemia
 Cautious administration of O2 (dont give too much)
 Noninvasive positive-pressure ventilation
 Ventilatory assistance

24
Q

ARF in COPD Medications

A 
 Medications 
 Beta2 agonists (bronchodilators) 
 Corticosteroids 
 Antibiotics (depends on cause) 
 Cautious administration of sedatives
25
Q

Ventilatory Assistance

A

 NPPV
 Intubation
 End-of-life issues
 Advance directives

26
Q

ARF in Asthma

A 
 Wheezing 
 Dyspnea 
 Chest tightness 
 Use of accessory muscles 
 Nonproductive cough 
 Hyperventilation initially 
 Peak expiratory flow reading is less than 50% of normal values
27
Q

Exacerbation of Asthma (Cont.)

A 
 Causes 
 Bronchodilators no longer working 
 Noncompliance with medications  
Effects 
 Hyperventilation with air trapping results in respiratory acidosis 
 Severe hypoxemia
28
Q

Medical Management

A

 Oxygen; ventilation in severe cases
 IV corticosteroids
 Inhaled bronchodilators; rapid-acting beta2-agonists  Teaching
Copyright © 2017 Elsevier Inc. All rights reserved. 60

29
Q

Pneumonia

A 
 Types 
Community-acquired 
Health care–acquired  
Hospital-acquired  
Ventilator-associated 
Increased risk: elderly, alcoholic, smokers, chronic diseases, head injury, immunosuppression
30
Q

Prevention of Pneumonia

A

 Influenza vaccine
 All persons over 6 months
 People at high risk for complications of influenza
 People in contact with those at high risk
 Health care providers
 At age 65, pneumococcal vaccination to prevent Streptococcus or pneumococcus
 Conjugate dose
 Polysaccharide dose

31
Q

Presentation of Pneumonia

A 
 Fever 
 Cough 
 Purulent sputum 
 Hemoptysis 
 Dyspnea/tachypnea 
 Chest pain (pleuritic) 
 Adventitious breath sounds
32
Q

VentilatorAssociated Pneumonia (VAP)

A

 Aspiration of bacteria from oropharynx or gastrointestinal tract
 Many potential causes
 Controversies about best way to diagnose—no “gold standard

33
Q

VAP Bundle

A

 Elevate head of bed 30 to 45 degrees
 Awaken daily and assess readiness to wean and extubate
 Stress ulcer disease prophylaxis
 Venous thromboembolism (VTE) prophylaxis
 Oral care

34
Q

Prevention of VAP

A 
 Hand washing and standard precautions 
 Surveillance 
 Ventilator bundle 
 Prevent transmission  Sterile water in circuit 
 Drain condensate AWAY from patient 
 Avoid normal saline during suctioning
35
Q

Treatment of VAP

A

Bacteria-specific antibiotic therapy

Critical care Chapter 15 (1 decks)

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