Chapter 65 & 67 - Respiratory Failure

Question 1

What significant problem occurs in the ICU that contributes to delirium and affects recovery?

Answer 1

Sleep Deprivation

Question 2

When measuring for left ventricular end diastolic pressure under normal conditions, what measurement do you use?

Answer 2

Pulmonary artery wedge pressure (PAWP)

Question 3

When measuring for right ventricular PRELOAD or right ventricular end diastolic pressure under normal conditions, what measurement do you use?

Answer 3

Central Venous Pressure (CVP)

Question 4

What is continuous arterial pressure monitoring used for?

Answer 4

To obtain systolic, diastolic, and mean BP

Question 5

How do we assess the patient’s ability to respond to fluids by increasing SV or preload responsiveness?

Answer 5

Use Arterial pressure-based cardiac output (APCO)

Question 6

What does APCO measure?

Answer 6

CCO and CCI

Question 7

How do we choose to manage patients with complicated cardiac, pulmonary, and intravascular volume problems in the acute phase?

Answer 7

Pulmonary Artery pressure monitoring (PA)

Question 8

What kind of hemodynamic information does PA give?

Answer 8

SV
Fluid volume
PA diastolic
PAWP
CVP
Core temperature
Oxygen Saturation

Question 9

What do ScvO2 and SvO2 measure and reflect?

Answer 9

Oxygenation of arterial blood
Tissue perfusion
Tissue O2 consumption

Question 10

What is happening if there is a sustained decrease in the ScvO2 and SvO2?

Answer 10

There is a decrease in arterial oxygenation, low cardiac output, low level of hemoglobin, or and increase in O2 consumption and extraction.

Question 11

Difficulty in obtaining a noninvasive SpO2 involves?

Answer 11

Patients who are Hypothermic, receiving IV vasopressin therapy, have hypoperfusion Ior vasoconstriction.

Question 12

What are the major indications for ICG?

Answer 12

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

Question 13

Your cardiac patient is no longer responding to conventional drug therapy adequately, what is the next step in care?

Answer 13

The patient will be placed on CADs to help decrease cardiac work and increase/improve organ perfusion

Question 14

What are the three reasons CADs would be used in the interim for support?

Answer 14

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

Question 15

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?

Answer 15

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.

Question 16

IABP is also referred to as what?

Answer 16

Counterpulsation

because the timing of balloon inflation is opposite to ventricular contraction.

Question 17

What setting do you place your patient on for the IABP during the acute phase?

Answer 17

1 cycle of inflation and deflation for every heartbeat (1:1)

Question 18

What complications can result from IABP?

Answer 18

Dislodging of plaque, aortic dissection, thrombus or embolus formation, compromised distal circulation

Question 19

VADs provide patients with what kind of support?

Answer 19

Left, right or biventricular support for failing hearts while allowing more mobility

Question 20

As the nurse caring for a patient with a VAD, what are some observations you are looking for?

Answer 20

Observe for bleeding, cardiac tamponade, ventricular failure, infection, dysrhythmias, renal failure, hemolysis, and thromboembolism

Question 21

Is death for those on CADs imminent?

Answer 21

Some patient will recover but many die and need psychological support.

Question 22

What is CPAP and what does it do?

Answer 22

Continuous positive airway pressure provides pressure to the lungs continuously preventing airway pressure from falling to 0

Question 23

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?

Answer 23

CPAP

Question 24

What is BiPAP and what does it do?

Answer 24

Bilevel positive airway pressure provides 2 levels of positive pressure support.

Question 25

During patient teaching of their new BiPAP, how do you explain how this system works?

Answer 25

The BiPAP delivers a higher inspiratory positive airway pressure and a lower expiratory positive airway pressure along with oxygen

Question 26

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?

Answer 26

BiPAP

Question 27

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?

Answer 27

Endotracheal Intubation

Question 28

What is Endotracheal Intubation (ET)?

Answer 28

The placement of a tube into the trachea via the mouth or nose past the larynx

Question 29

What situations call for ET?

Answer 29

Upper airway obstruction
Apnea
High risk of aspiration
Ineffective clearance of secretions
Respiratory distress or failure

Question 30

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?

Answer 30

The nose will be used to intubate this patient

Question 31

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?

Answer 31

Tracheotomy

Question 32

PAWP =

Answer 32

left ventricular fuction

Question 33

Cardioversion

Answer 33

used for tachycardia

Question 34

Pacemaker

Answer 34

Slow rates

Question 35

Increased CVP

Answer 35

Fluid overload

Question 36

Decreased CVP

Answer 36

Dehydration

Question 37

Hypodermic Respiratory Failure

Answer 37

Oxygenation Failure