Med Surg Exam 1 (Respiratory System) Flashcards
“Impaired Gas Exchange”
- correlated to what condition?
- assessment finding (lung sound)
- correlated ot ARDS
- fine crackles on auscultation (best heard on the back)
4 examples of impaired gas exchange diseases
- pneumonia
- atelectasis
- cystic fibrosis
- tuberculosis
“Ineffective Airway Clearance”
- interventions (3)
- contraindicated intervention
- interventions: (1) encourage fluids, (2) suction airway, (3) coughing
- do not increase oxygen delivery
“Inadequate Ventilation” or “Ineffective Breathing Pattern”
- correlated to what condition?
- indicated by what s/s (6)
- correlated to COPD (high respiratory acidosis)
- s/s: tripod position, pursed lip breathing, decreased RR, morning headache, tachycardia, muscle weakness
“Inadequate Perfusion”
- assessment s/s (6)
- perfusion complications due to mechanical ventilation?
- interventions (2)
- s/s: cool, clammy, diaphoretic skin, pale extremities, decreased LOC, prolonged capillary refill time
- decreased CO
- interventions: (1) monitor, (2) give drugs and IV fluids to maintain adequate CO
What disease process causes a patient to not adequately ventilate due to the physical inability to expand lungs?
COPD
What is an EARLY assessment finding of hypoxemia? Late assessment finding?
- Early: Agitation / change in LOC
- Late: Cyanosis
Prevention for “Impaired Gas Exchange” (4)
- deep breathing
- huff and staged coughing
- incentive spirometry
- early ambulation
What is the optimal max O2 administration for patient?
PaO2 greater than 60 mmHg and SaO2 90% or more at the lowest O2 concentration
Interventions for “Impaired Gas Exchange” (5)
- Patient positioning - PRONE position (requires an ICU intensivist, respiratory therapist, and 3-4 other nurses)
- Postural drainage
- Humidification
- Hydration
- Nutrition: maintain protein and calories, administer through TPN or G/J-tube
Interventions for “Inadequate Airway Clearance” (5)
- Encourage fluids
- Airway suctioning
- Patient repositioning: HOB at 30 degree angle
- Chest physiotherapy
- Humidification
When suctioning the airway, what should the nurse do? (2)
- Suction on the way UP the tube, do not suction on the way down
- Small amounts at a time around the mouth, through the nose (NG), throat, and top of lungs through trach)
Normal ABG levels: pH, paO2, PaCO2, HCO3, BE
pH: 7.35-7.45 paO2: 80-100 paCO2: 35-45 HCO3: 22-26 BE: -2 - +2
Base excess indications (BE)
> +2 means metabolic alkalosis
< -2 means metabolic acidosis
Normal range for mean arterial blood pressure? Formula for mean arterial blood pressure (MAP)?
Normal range: 70-100 mmHg
Formula = [systolic + 2{diastolic)] / 3
What is a physical assessment finding of respiratory acidosis?
Tachycardia
Which arterial blood gas value is necessary to identify if a condition is compensated or uncompensated?
Blood pH
A nurse is analyzing an ABG report of a client with COPD and respiratory acidosis. Which compensation mechanism is likely to occur?
The kidneys will retain bicarbonate
What are the three stages of ARDS?
- injury or exudative phase
- reparative or proliferative stage
- fibrotic or fibroproliferative phase
Define ARDS
sudden and progressive form of ARF in which an inflammatory response damages the alveoli-capillary membrane and becomes permeable to fluid
ARDS is a condition that develops because
alveolar capillary membrane permeability has changed, leading to fluid collecting in the alveoli sacs
Acute respiratory failure is not a _____, it is a ____.
ARF is not a condition, it is a diagnosis
Possible causes of ARDS? (9)
- pneumonia
- car accident/chest trauma
- COVID
- COPD
- infections
- spinal cord injury
- pulmonary embolism
- premature infants
- exhaustion
Examples of direct injuries that cause ARDS? (5)
- aspiration of gastric contents
- bacteria
- virus
- COVID
- COPD
Examples of indirect injuries that cause ARDS? (5)
- chest trauma
- pulmonary embolism
- O2 toxicity
- shock
- sepsis
Progression of ARDS to ARF is indicated by? (3)
- increased WOB
- respiratory distress
- use of accessory muscles
S/S of ARF (4, in order)
- tachypnea
- tachycardia
- diaphoresis
- cyanosis
ARDS goal?
PaO2 of 60 mmHg or less and SaO2 above 90%
If a patient’s paO2 levels are low (lower than 60) when oxygenated (ex: 100% rebreather mask), this indicates that the patient is?
Progressing to acute respiratory distress
2 types of acute respiratory failure?
- hypoxemia
2. hypercapnia
Hypoxemic RF is an _____ issue. Insufficient _____ (PaO2 less than?)
- oxygenation issue
- insufficient OXYGEN (PaO2 less than 60 mmHG)
s/s of hypoxemic RF? (4)
- change in LOC / restless (FIRST)
- dusky skin
- dysrhythmias / tachycardia
- tachypnea
4 pathophysiological reasons for hypoxemic RF?
- V/Q mismatch
- shunting
- alveolar hypotension
- diffusion limitation
Hypercapnic RF is a ______ issue. Inadequate ______.
- VENTILATORY issue
- inadequate CO2 REMOVAL
What are 4 general etiological factors for hypercapnic RF?
- CNS problems
- neuromuscular conditions
- abnormal chest movement
- conditions of the airway and alveoli
What is an EMERGENT INTERVENTION for the progression of acute hypoventilation to severe hypercapnic ARF?
Apply a bag-valve mask and assist with breathing
List the RESPIRATORY causes of hypoxemic RF (5)
- ARDS
- Hepatopulmonary syndrome (V/Q mismatch)
- Pulmonary embolism
- Pneumonia
- Toxic inhalation
- s/s of pulmonary embolism (2).
- Why would a pulmonary embolism lead to hypoxemic RF?
- What would be used to differentiate a pulmonary embolism from an acute coronary event?
- SOB, painful to breathe
- decreased perfusion of the lungs leaves little blood to pick up oxygen from the alveoli
- ECG
List the CARDIAC causes of hypoxemic RF (3).
- anatomic shunt (ventricular septal defect)
- CARDIOGENIC SHOCK
- high cardiac output (diffusion limitation)
- Describe the reason why a cardiogenic shock could lead to hypoxemic RF
- s/s of cardiogenic shock (4)
- decreased blood flow through the pulmonary vasculature –> decreased blood flow to lungs
- hypotension, cyanosis, clubbing of fingers, cool/clammy skin
RESPIRATORY causes of hypercapnic RF (3).
- asthma (narrowing airways; wheezing, high-pitched sounds)
- COPD
- CF
CNS causes of hypercapnic RF (4).
- brainstem injury or infarction
- sedative and opioid overdose
- spinal cord injury
- severe head injury
TRAUMA causes of hypercapnic RF (3)
- kyphoscoliosis
- pain from severe obesity
- thoracic trauma (flail chest)
NEUROMUSCULAR cause of hypercapnic RF
Guillain-Barre Syndrome
While caring for a patient admitted with a pulmonary embolism, the nurse notes a change in the patient’s SaO2 from 94% to 88%. What should the nurse do FIRST?
Increase the amount of oxygen delivered
What is the most common cause of a V/Q mismatch?
increased secretion in the airways (ex: COPD, pneumonia, asthma)
Interventions for V/Q mismatch (2)
- O2 therapy (reverse hypoxemia)
2. treat underlying cause
Describe the physiological mechanism of a shunt that will lead to RF.
blood exits the heart and misses gas exchange (d/t anatomical or intrapulmonary shunt) = alveoli will fill with fluid = impaired gas exchange
Describe adventitious lung sounds and possible reasons (3)
- fine crackles = pulmonary edema
- coarse crackles = fluid
- absent or diminished = atelectasis, pneumonia, hypoventilation
What is the main cause of death for patients on treatment for ARDS?
Multiple organ dysfunction syndrome accompanied by SEPSIS (vital organs are affected) = decompensated heart failure leads to diminished gas exchange
RESPIRATORY complications of ARDS treatment (7)
- O2 toxicity
- VAP
- Barotrauma
- Abnormal lung function
- Volutrauma
- Alveolar hypoventilation
- Alveolar hyperventilation
O2 toxicity leads to (3)
- decreased surfactant production
- fibrotic changes in the alveoli
- increased pulmonary capillary permeability
O2 toxicity prevention
Avoid ventilation at all times to decrease the possibility of dependency and weaning complications
What is barotrauma?
When the ALVEOLI ARE OVERDISTENDED and rupture with excess pressure due to high mechanical ventilation and high peak pressures (PEEP)
Intervention for barotrauma?
Decrease the tidal volume and PEEP to 5 cm H20 if mechanically ventilated
Define volutrauma.
Too much volume going into patient’s lungs during mechanical ventilation
GASTROINTESTINAL complication of ARDS treatment
STRESS ULCER (high risk related to diversion of blood from GI tract to respiratory system to meet O2 demand)