Acute Respiratory Failure Notes

Question 1

Acute Respiratory Failure (ARF) Definition

Answer 1

Inadequate oxygenation and ventilation

Question 2

Hypoxemic Respiratory Failure

Answer 2

PaO2 < 60 mm Hg when receiving inspired O2 concentration of 60% of more,
Main problem: inadequate exchange of O2.

Question 3

Hypercapnic Respiratory Failure

Answer 3

PaCO2 > 50mm Hg with acidemia

Main problem: insufficient CO2 removal

Question 4

When do you need urgent intervention

Answer 4

hemodynamic instability
increased respiratory effort
Decreased LOC.

Question 5

Early s&s of ARF

Answer 5

Change in mental status: restlessness, agitation, confusion (inadequate o2), morning headache and slow RR (inadequate CO2 removal). 
Tachycardia
Tachypnea
Slight diaphoresis
Mild HTN

Question 6

S&s of ARF

Answer 6

WOB: lying down, sitting upright, or tripod position.
Decreased ability to speak due to dyspnea
Pursed-lip breathing
Retraction of intercostal space or supraclavicular area
Use of accessory muscles
Paradoxical breathing
Auscultate breath sounds for abnormalities.

Question 7

Most common diagnostic studies

Answer 7

Chest X-ray - identify possible causes

ABGs - evaluate oxygenation and ventilation status and acid-base balance.

Question 8

ARF management

Answer 8

O2 therapy
Mobilize secretions
Positive pressure ventilation (PPV)
Drug therapy 
Supportive Therapy

Question 9

O2 therapy:

Answer 9

Administer O2 at lowest possible FIO2
Use appropriate O2 delivery device (maintain PaO2 at 60 mmHg or higher, and SaO2 at 90% higher).
O2 toxicity and absorption atelectasis can occur with high FIO2 and long exposure.

Question 10

How to mobilize secretions

Answer 10

Proper positioning
Effective cough
Chest physiotherapy
Suctioning
Humidification 
Hydration
Early ambulation

Question 11

Proper positioning

Answer 11

Position pt. upright with HOB at least 30 degrees

Risk for aspiration or one-sided lung disorders, use side-lying position or good lung down.

Question 12

Effective coughs

Answer 12

Augmented cough (quad cough)
Huff cough
Staged cough

Question 13

Augmented cough (quad cough)

Answer 13

Place hands in anterolateral base of pt.’s lungs and move hand upwards during deep breathing.

Question 14

Huff cough

Answer 14

Pt takes a deep breath, hold breath for 2-3 sec, exhales.

Coughs while saying huff

Question 15

Stage cough

Answer 15

sitting position, breathes in and out 3-4 times through mouth, cough when bending fwd, and press pillow against diaphragm.

Question 16

Positive pressure ventilation and 2 forms

Answer 16

Most useful in pts with neuromuscular problems.

CPAP and BiPAP

Question 17

Difference btwn CPAP and BIPAP

Answer 17

CPAP delivers 1 level of pressure
BiPAP delivers 2 levels of pressure, must be awake, alert, stable v/s, and support spontaneous ventilation. BiPAP is most often used because it opens collapse airways and decrease shunts.

Question 18

Drug therapy:

Answer 18

Corticosteroids - reduce inflammation
Bronchodilators (albuterol) - reduce bronchospasm, short acting can be given in 15-30 min intervals.
Lasix, morphine & nitroglycerin - reduce pulmonary congestion
Anti-bx- tx infection, do cultures before administering
Benzodiazepine (lorazepam) fentanyl and morphine - reduce anxiety, pain and restlessness

Question 19

What do you need to monitor for IV corticosteroids?

Answer 19

Potassium levels and adrenal insufficiency

Question 20

What do you need to monitor for drug tx of anxiety, pain and restlessness?

Answer 20

Monitor pain, hypoxemia, electrolyte imbalance, TBI, & drug reactions
Monitor pts for CNS, cardiac and respiratory depression, esp. non-intubated pts.