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240 > ARDS + respiratory > Flashcards

ARDS + respiratory Flashcards

1
Q

bronchial circulation

A

does not participate in gas exchange
left bronchiole circulation is rooted from aorta
right sided bronchioles are supplied by arteries (intercostal, subclavian, mammary)
veins empty into vena cava

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2
Q

ventilation

A

mechanical act of moving air into and out of respiratory tree
involves musculoskeletal and nervous sustems

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3
Q

respiration

A

process of transporting O2 and CO2 across alveolar capillary membranes by diffusion across concentration gradient

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4
Q

physiology of ventilation

A

diaphragm contracts and flattens
increases volume of thoracic cavity
creates a relative negative intrapulmonary pressure

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5
Q

compliance

A

ability of lungs and thorax to stretch and expand given a change in pressure
decreased in pulmonary fibrosis
increased in emphysema and COPD

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6
Q

age related changes

A

decreased cough/laryngeal reflexes
decrease in alveoli, respiratory muscle strength
increased VQ mismatches, AP diameter, residual volume

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7
Q

autonomic respiration

A

controlled by brainstem

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8
Q

voluntary ventilatory effort

A

controlled by cerebral cortex

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9
Q

central chemoreceptors

A

detect level of H ion in blood

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10
Q

peripheral chemoreceptors

A

sensitive to oxygen, CO2, and H levels

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11
Q

dead space units

A

ventilation exceeds perfusion

pulmonary embolism or pulmonary infarct

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12
Q

shunt unit

A

perfusion exceeds ventilation

pneumonia or atelectasis

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13
Q

silent unit

A

ventilation and perfusion are impaired

severe ARDS or pneumothorax

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14
Q

oxyhemoglobin dissociation curve

A

97% of O2 is bound to Hgb (SaO2)

3% dissolved in serum (PaO2)

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15
Q

shift right

A

fever
acidosis
rise in CO2 (hypercapnia)
rise in 2, 3 diphosphoglycerate

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16
Q

shift left

A

hypothermia
rise in pH (alkalosis)
low CO2

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17
Q

PaO2

A

80-100 mm Hg

reflects the partial pressure of O2 in arterial blood

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18
Q

SaO2

A

93-100%

represents saturation of Hgb with O2

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19
Q

type 1 respiratory failure

A

hypoxemic failure

stems from a disruption of O2 transport from alveolus to arterial flow

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20
Q

type 2 respiratory failure

A

hypoxemic hypercapnic failure
originates in musculoskeletal or anatomical lung dysfunction/suppression
high concentration of CO2 in alveolus = hypercapnia
inability to replace CO2 with O2 = hypoxemia

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21
Q

type 1 respiratory failure nursing dx

A

impaired gas exchange

r/t: alterations in alveolar capillary membrane, excessive secretions, VQ mismatch

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22
Q

type 1 respiratory failure interventions

A

provide supplemental O2
positioning
maintain airway patency
treat underlying causes of ACM alterations, VQ mismatches

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23
Q

type 2 respiratory failure nursing dx

A

ineffective breathing pattern

r/t: alveolar hypoventilation, musculoskeletal dysfunction, neurological trauma

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24
Q

type 2 respiratory failure interventions

A

provide mechanical ventilation as needed
treat causes of alveolar hypoventilation
optimize musculoskeletal dysfunctions
optimize neurological defects

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25
Q

s/s of hypoxia

A 
tachypnea, dyspnea
tachycardia, dysrhythmias
HTN
confusion, restlessness
lethargy
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26
Q

low flow O2 therapy

A 
nasal cannula (up to 6 LPM)
simple mask (8-12 LPM)
nonrebreather mask (prevent room air from being inhaled)
Venturi mask (adjustable dial with desired FiO2 and LPM flow)
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27
Q

high flow O2 therapy

A

delivers O2 at higher rate than pt’s inspiratory flow rate
may have some positive pressure effect
wide nasal cannula, nasal pillow, face mask

28
Q

mechanical ventilation

A

NIV or invasive

29
Q

mechanical ventilation desired outcomes

A 
relief of sx of respiratory distress
rest fatigued muscles of respiration
improved oxygenation, ventilation
pH balance
stabilization of chest wall
provision of sedation/anesthesia
30
Q

noninvasive ventilation (NIV) indications

A

COPD exacerbation
obesity hypoventilation syndrome
cardiogenic pulmonary edema
lung contusions

31
Q

noninvasive ventilation contraindications

A

apnea

recent airway or GI surgery

32
Q

noninvasive ventilation

A

supports ventilation without insertion of artificial airway
ventilation through upper airway using an interface with a tight seal
most common: CPAP, BIPAP

33
Q

CPAP

A

continuous positive airway pressure
allows more lung units to be available for gas exchange
helps open alveoli and prevent atelectasis during expiration
increases partial pressure of O2 in the alveoli

34
Q

BiPAP

A

bilevel posiive airway pressure
allows clinician to set higher inspiratory pressure and lower expiratory pressure
reduces work of breathing

35
Q

noninvasive ventilation concerns

A

skin protection
anxiolytics
tissue ischemia 2/2 tight fit of mask

36
Q

invasive mechanical ventilation

A

provided by positive pressure ventilator

positive pressure is applied at patient’s airway by means of naso/endotracheal tube or tracheostomy

37
Q

endotracheal intubation

A

larygnoscope
stethoscope to auscultate for placement
suction with orotracheal device
bag valve mask

38
Q

nursing actions during endotracheal intubation

A

alert physician to decreases in SaO2 below 90%
auscultate for correct tube placement
note marking on tube at lip
monitor for patient to wake because of choking sensation

39
Q

tracheostomy indications

A

pts requiring long term mechanical ventilation (?21 days)

pts with airway obstruction

40
Q

tracheostomy

A

incision in the neck at cricothyroid membrane to access trachea and create a stoma to insert tube

41
Q

tracheostomy complications

A 
bleeding
infection
ulceration
dysphonia
tube obstruction
fistula
42
Q

controlled mandatory ventilation

A

tidal volume delivered at a set rate independent of patient effort

43
Q

assist-control ventilation (AC)

A

patient regains some control of rate of breathing

44
Q

synchronized intermittent mandatory ventilation (SIMV)

A

patient receives a minimum number of breaths with set Vt

may take additional breaths as determined by the pt

45
Q

CPAP ventilator setting

A

used frequently as pts become ready for extubation

often used in conjunction with pressure support ventilation to offer bilevel vent pressures

46
Q

pressure control ventilation

A

less frequently used

provides a set pressure instead of tidal volume during respiratory cycle

47
Q

apnea alarm

low minute volume alarm

A

check if pt is connected to ventilator
ensure pt is not overly sedated
pt may require higher level of ventilatory support

48
Q

high pressure alarm

A

ensure tubing is not kinked or compressed
assess need for suctioning
assess for ventilator dyssynchrony
report alarm to responsible clinician

49
Q

high minute volume alarm

A

assess for anxiety
assess for s/s hypoxia (tachycardia, HTN, restlessness, cyanosis)
pt may require higher level of vent support or sedation

50
Q

endotracheal suction

A

every 2-4 hours

facilitates airway patency

51
Q

ventilators and restraints

A

restraints prevent accidental extubation

52
Q

ventilators and nutrition

A

early enteral nutrition reduces risk of nutritional deficiencies
routine GI assessment
aspiration risk

53
Q

weaning protocols

A 
is pt:
hemodynamically stable?
SaO2 > 92% ?
able to follow simple commands?
FiO2/ABGs
54
Q

acute respiratory distress syndrome (ARDS)

A

inflammatory disorder that damages the alveolar capillary membrane and interferes with gas exchange
2/2 sepsis usually

55
Q

ARDS criteria

A
  1. acute onset hypoxemia
  2. diffuse b/l opacities on chest radiography that cannot be explained by HF or nodules
  3. moderate to severe impairment of oxygenation
56
Q

exudative phase of ARDS patho

A

capillary membranes leak and protein rich fluid fills alveoli
type 1 alveolar cells destroyed
hyaline membranes are formed

57
Q

exudative phase of ARDS assessment

A

chest x-ray may be normal or show dependent infiltrates
tachypnea, dyspnea
change in LOC
lung sounds may be clear

58
Q

fibroproliferative phase of ARDS patho

A 
type II alveolar cells are damaged
surfactant production declines
peak inspiratory pressure increases
compliance declines
V/P mismatch
59
Q

fibroproliferative phase of ARDS assessment

A 
chest x ray shoes diffuse b/l infiltrates and elevated diaphragm
refractory hypoxemia with hypercarbia
crackles on auscultation
right HF develops
agitation
60
Q

recovery/fibrotic phase of ARDS patho

A

development of fibrotic tissue in the ACM resulting in alveolar disfigurement
decreased compliance
pulmonary HTN
dead space ventilation increased

61
Q

recovery/fibrotic phase of ARDS assessment

A 
leukocytosis, fever
worsening infiltrates on CXR
decreased tissue perfusion
tachycardia + hypotension
lactic acidosis
end-organ dysfunction
62
Q

early s/s of ARDS

A 
dyspnea, tachypnea
cyanosis
abnormal breath sounds
change in LOC
confusion
retrosternal discomfort
fever
63
Q

vent management of ARDS

A 
tidal volume 4-8mL/kg
plateau pressure <30 cm H2O
FiO2 > 60%
judicious use of PEEP
permissive hypercapnia
maintain SaO2 88-95%
64
Q

extracorporeal life support (ECMO) indications

A

ARDS with:
severe hypoxemia
uncompensated hypercapnia, pH <7.15
end expiratory plateau pressures >35-45 cm H2O who fail prone positioning trial

65
Q

ARDS medications

A 
neuromuscular blocking agents
statins
corticosteroids
vasodilators
surfactant
beta agonists
66
Q

contraindications for prone positioning

A

spinal injuries
elevated ICP
abdominal compartment syndrome
hemodynamic instability

240 (7 decks)

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