ARF/ ARDS

Question 1

hypoxia vs hypoxemia

Answer 1

hypoxemia = low O2 in blood (PaO2<80 mm Hg, <60 if chronic lung disease)
hypoxia= low O2 in tissues

Question 2

ventilation vs perfusion

Answer 2

• Ventilation (V) AIR MOVEMENT
• Perfusion (Q) BLOOD FLOW

Question 3

what happens when ventilation and perfusion are mismatched?

Answer 3

When they do not match in the lung (or an area of the lung
)–> Respiratory failure

Question 4

is a PE a perfusion or ventilation issue?

Answer 4

perfusion

Question 5

is pneumothorax a perfusion or a ventilation issue?

Answer 5

ventilation

Question 6

what causes respiratory failure- ventilation, oxygenation, both?

Answer 6

–Ventilation or
–Oxygenation or
–Both

Question 7

what happens in ventilation failure? is the perfusion normal or abnormal?

Answer 7

The problem is with Air Movement
–Inadequate air movement in alveoli
• Perfusion is normal
• Air cannot move in and out of the lungs enough
• Oxygen cannot get to the alveoli
• CO2 is stuck in the alveoli

• Blood is flowing by to pick up oxygen but it is a wasted trip…There isn’t enough O2 in the alveoli to pick up (only CO2)

Question 8

causes of ventilation failure?

Answer 8

• Physical Problems with chest and lungs
• Injury or failure of the respiratory control center
• Inability to control function of respiratory muscles

Question 9

causes of ventilation failure

Answer 9

• Drug overdose
• Rib Fractures
• Pneumothorax
• Airway obstruction
• Paralysis
• Brain injury
• Spinal Cord injury

• Physical Problems with chest and lungs
• Injury or failure of the respiratory control center
• Inability to control function of respiratory muscles

Question 10

causes of perfusion failure

Answer 10

• Pulmonary emboli
• Pneumonia
• Pulmonary edema

Question 11

causes of combined oxygen and perfusion failure?

Answer 11

• Leads to worse respiratory failure/ hypoxemia than ventilation or perfusion failure alone
• Abnormal lungs seen with
–Chronic bronchitis
–Asthma
–Cystic fibrosis
–Emphysema
–ARDS

Question 12

assessment findings for acute resp. failure?

Heart rate? pulses? breathing style? bp? mental status?

Answer 12

• Dyspnea
• Orthopnea
• Respiratory Pattern
• Lung Sounds
• Pulse Oximetry
• ETCO2 (end tidal co2 monitoring- Co2 breathing out at end of breath, 35-45)
• ABG’s
• Restlessness, agitation, irritability
• Confusion
• Change in LOC
• Hypotension
• Bradycardia
• Weak pulses

Question 13

interventions for acute resp. failure?

Answer 13

Oxygen, Oxygen, Oxygen
• Treat underlying cause
• Positioning
• Assist with anxiety
• Energy conserving measures

Question 14

ARDS causes (3 main categories)

Answer 14

(ARF, systemic inflammation, lung injury)

• Acute Respiratory Failure with
–Reduced Compliance (lungs are getting stiff/rigid- can lead to fibrosis)
–Dyspnea
–Pulmonary edema
–Diffuse pulmonary infiltrates
–Severe Hypoxemia

• Often associated with another disease process that may cause acute lung injury (ALI) from systemic inflammatory response
–Sepsis
–Pancreatitis
–Trauma
–Transfusions

• Also caused by direct injury to lungs
–Aspiration
–Pneumonia

Question 15

pathophysiology of ARDS

Answer 15

With ARDS, the alveolar-capillary membrane become more permeable
• This allows fluid, waste and protein mediators into alveoli
• Reduced production of surfactant (reduced compliance)
• ALVEOLAR ARE UNABLE TO EXCHANGE GAS

Question 16

ARDS assessment findings

Answer 16

• Increased work of breathing
• Loud breathing- adventitious breathing sounds
• Cyanosis
• Use of accessory muscles for breathing
• Confusion

Question 17

ards diagnostics (4)

Answer 17

• ABG
• Chest X-ray
• Sputum culture – bacterial component for underlying thing we could treat like pneumonia
• PF ratio (PaO2, FiO2 ration) <300 = indicative ARDS

Question 18

why do a sputum culture with ards?

Answer 18

test for bacterial component for underlying thing we could treat like pneumonia

Question 19

PF Ratio < _____ = indicative of ARDS

Answer 19

<300

Question 20

Why do we give ARDS patients PEEP?

Answer 20

◦ alveoli collapsed at end of respiration in ARDS, give a little bit of positive pressure prevents collapse of alveoli
◦ a normal person does not have collapsed alveoli at end of breath becuase we have the surfactant we need to keep them open

Question 21

ARDS intervention

Answer 21

Peep
mechanical ventilation
sedation
paralytics
analgesics
proning
mobility
ecmo
iv fluid- maybe
enteral nutrition

Question 22

why put ARDS patients in prone position?

Answer 22

◦ more alveoli in posterior portion of lungs, proning allows for their expansion