Chapter 65 & 67 - Respiratory Failure Flashcards
What significant problem occurs in the ICU that contributes to delirium and affects recovery?
Sleep Deprivation
When measuring for left ventricular end diastolic pressure under normal conditions, what measurement do you use?
Pulmonary artery wedge pressure (PAWP)
When measuring for right ventricular PRELOAD or right ventricular end diastolic pressure under normal conditions, what measurement do you use?
Central Venous Pressure (CVP)
What is continuous arterial pressure monitoring used for?
To obtain systolic, diastolic, and mean BP
How do we assess the patient’s ability to respond to fluids by increasing SV or preload responsiveness?
Use Arterial pressure-based cardiac output (APCO)
What does APCO measure?
CCO and CCI
How do we choose to manage patients with complicated cardiac, pulmonary, and intravascular volume problems in the acute phase?
Pulmonary Artery pressure monitoring (PA)
What kind of hemodynamic information does PA give?
SV Fluid volume PA diastolic PAWP CVP Core temperature Oxygen Saturation
What do ScvO2 and SvO2 measure and reflect?
Oxygenation of arterial blood
Tissue perfusion
Tissue O2 consumption
What is happening if there is a sustained decrease in the ScvO2 and SvO2?
There is a decrease in arterial oxygenation, low cardiac output, low level of hemoglobin, or and increase in O2 consumption and extraction.
Difficulty in obtaining a noninvasive SpO2 involves?
Patients who are Hypothermic, receiving IV vasopressin therapy, have hypoperfusion Ior vasoconstriction.
What are the major indications for ICG?
Early signs and symptoms of pulmonary or cardiac dysfunction
Determining cardiac or pulmonary cause of SOB
Evaluating the cause and management of hypotension
Monitoring after removing a PA catheter or justifying PA catheter insertion
Evaluating drug therapy
Diagnosing rejection after heart transplant
Your cardiac patient is no longer responding to conventional drug therapy adequately, what is the next step in care?
The patient will be placed on CADs to help decrease cardiac work and increase/improve organ perfusion
What are the three reasons CADs would be used in the interim for support?
The left, right, or both ventricles require support while recovering from an acute injury
The heart requires surgical repair but the patient must be stabilized
The heart has failed and the patient is awaiting a heart transplant
The patient you are seeing has a sustained increased afterload, an increased systolic pressure, decreased coronary blood flow and decreased perfusion to their vital organs. What is the patient a candidate for?
Intraaortic Balloon Pump
because it works by temporarily reducing afterload, systolic pressure, and augmenting aortic diastolic pressure, which results in improved coronary blood flow and perfusion to vital organs.
IABP is also referred to as what?
Counterpulsation
because the timing of balloon inflation is opposite to ventricular contraction.
What setting do you place your patient on for the IABP during the acute phase?
1 cycle of inflation and deflation for every heartbeat (1:1)
What complications can result from IABP?
Dislodging of plaque, aortic dissection, thrombus or embolus formation, compromised distal circulation
VADs provide patients with what kind of support?
Left, right or biventricular support for failing hearts while allowing more mobility
As the nurse caring for a patient with a VAD, what are some observations you are looking for?
Observe for bleeding, cardiac tamponade, ventricular failure, infection, dysrhythmias, renal failure, hemolysis, and thromboembolism
Is death for those on CADs imminent?
Some patient will recover but many die and need psychological support.
What is CPAP and what does it do?
Continuous positive airway pressure provides pressure to the lungs continuously preventing airway pressure from falling to 0
A patient comes to the ER complaining of being unable to breathe while sleeping throughout the night. The doctor diagnoses the patient with obstructive sleep apnea. What intervention will the doctor prescribe for this patient?
CPAP
What is BiPAP and what does it do?
Bilevel positive airway pressure provides 2 levels of positive pressure support.
During patient teaching of their new BiPAP, how do you explain how this system works?
The BiPAP delivers a higher inspiratory positive airway pressure and a lower expiratory positive airway pressure along with oxygen
Your new patient just arrived to the floor and was diagnosed with heart failure due to COPD, what will that patient be prescribed to help with their respiratory exacerbation?
BiPAP
A patient admitted to the ER with pneumonia due to covid has an SpO2 of 70% on 2L of oxygen, they are in respiratory distress, what will the immediate situation call for?
Endotracheal Intubation
What is Endotracheal Intubation (ET)?
The placement of a tube into the trachea via the mouth or nose past the larynx
What situations call for ET?
Upper airway obstruction Apnea High risk of aspiration Ineffective clearance of secretions Respiratory distress or failure
Your patient just came into the ER with fractures to his upper vertebral column due to a MVA, he is in respiratory failure with an SpO2 of 40%, what measure will be taken to ET him?
The nose will be used to intubate this patient
ET is no longer an option for your ICU patient that needs a long term airway. What form of airway will this patient be a candidate for?
Tracheotomy
PAWP =
left ventricular fuction
Cardioversion
used for tachycardia
Pacemaker
Slow rates
Increased CVP
Fluid overload
Decreased CVP
Dehydration
Hypodermic Respiratory Failure
Oxygenation Failure
