Acute Respiratory Failure Flashcards
Failure of Oxygenation occurs when the PaO2 cannot be adequately maintained, what are some causes?
Hypoventilation Intrapulmonary shunting Ventilation-perfusion mismatch Diffusion defects Low cardiac output Low hemoglobin level Tissue hypoxia
Acute Respiratory Failure (ARF)
Failure Oxygenation Ventilation Both of the above Altered gas exchange (room air) PaO2 < 60 mm Hg PaCO2 > 50 mm Hg pH ≤ 7.30
Hypoventilation
Drug overdose
Neurological disorders
Abdominal or thoracic surgery
Intrapulmonary Shunting
Blood shunted from right to left side of heart without oxygenation
Qs/Qt disturbance
Causes of Intrapulmonary Shunting
Causes: atrial or ventricular septal defect, atelectasis, pneumonia, pulmonary edema
Why does administration of higher levels of oxygen nothelp in shunt disorders
Diffusion Defects
Diffusion of O2 and CO2 does not occur
Fluid in alveoli
Pulmonary fibrosis
Low Cardiac Output
Cardiac output must be adequate to maintain tissue perfusion
Normal delivery is 600 to 1000 mL/min of oxygen
Low Hemoglobin
Hemoglobin necessary to transport oxygen
95% of oxygen is bound to hemoglobin
Tissue Hypoxia
Some conditions prevent tissues from using oxygen despite availability Cyanide poisoning Tissue hypoxia results in anaerobic metabolism and lactic acidosis
The nurse suspects respiratory failure secondary to hypoventilation in a patient with:
A. Anxiety
B. Neuromuscular disease
C. Pulmonary embolism
D. Volume A/C ventilation at rate of 20 breaths/min
ideal blood PH
7.365
Kidneys produce
Bocarb
Medical Management
Oxygen Bronchodilators Corticosteroids Sedation Transfusions Therapeutic paralysis Nutritional support Hemodynamic monitoring
Acute Respiratory Distress Syndrome (ARDS)
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
If the PaO2 is 60 mm Hg and the FiO2 is 0.6, the PaO2/FiO2 ratio is:
A.100
B. 1000
C. 360
D. 3600
Symptoms of ARDS
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
Treatment of ARDS
Treat the cause
Oxygenation and ventilation
Positive end-expiratory pressure (PEEP)
Possible nontraditional modes of ventilation: high-frequency, pressure-control, and inverse-ratio
Treatment of ARDS (CONT)
Comfort Sedation Pain relief Neuromuscular blockade Decrease O2 consumption Positioning Prone positioning Continuous lateral rotation therapy
Treatment of ARDS
Fluid and electrolyte balance
Adequate nutrition
Pharmacologic intervention
Psychosocial support
complications of ARDS
Multiple organ dysfunction syndrome
Renal failure
Disseminated intravascular coagulation
Long-term pulmonary effects associated with high oxygen and other therapies
ARF in Chronic Obstructive Pulmonary Disease (COPD)
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
Assessment
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
Medical Management of ARF in COPD
Correct hypoxemia
Cautious administration of O2 (dont give too much)
Noninvasive positive-pressure ventilation
Ventilatory assistance
ARF in COPD Medications
Medications Beta2 agonists (bronchodilators) Corticosteroids Antibiotics (depends on cause) Cautious administration of sedatives
Ventilatory Assistance
NPPV
Intubation
End-of-life issues
Advance directives
ARF in Asthma
Wheezing Dyspnea Chest tightness Use of accessory muscles Nonproductive cough Hyperventilation initially Peak expiratory flow reading is less than 50% of normal values
Exacerbation of Asthma (Cont.)
Causes Bronchodilators no longer working Noncompliance with medications Effects Hyperventilation with air trapping results in respiratory acidosis Severe hypoxemia
Medical Management
Oxygen; ventilation in severe cases
IV corticosteroids
Inhaled bronchodilators; rapid-acting beta2-agonists Teaching
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Pneumonia
Types Community-acquired Health care–acquired Hospital-acquired Ventilator-associated Increased risk: elderly, alcoholic, smokers, chronic diseases, head injury, immunosuppression
Prevention of Pneumonia
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
Presentation of Pneumonia
Fever Cough Purulent sputum Hemoptysis Dyspnea/tachypnea Chest pain (pleuritic) Adventitious breath sounds
VentilatorAssociated Pneumonia (VAP)
Aspiration of bacteria from oropharynx or gastrointestinal tract
Many potential causes
Controversies about best way to diagnose—no “gold standard
VAP Bundle
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
Prevention of VAP
Hand washing and standard precautions Surveillance Ventilator bundle Prevent transmission Sterile water in circuit Drain condensate AWAY from patient Avoid normal saline during suctioning
Treatment of VAP
Bacteria-specific antibiotic therapy
