Module 9: Care of a Patient with Acute Respiratory Disorders

Question 1

What is Sleep Apnea?

Answer 1

• most common sleep disordered breathing condition
• characterized by periodic pauses in breathing during sleep
• types:
  
  • Obstructive (OSA) - particle or complete collapse of the pharyngeal airway
  • Central - CNS disorder in which the brainstem fails to signal respiratory muscles to inhale
  • Complex - combination of both

Question 2

What are the risk factors for sleep apnea

Answer 2

• obesity
  
  • large neck
  • small airways
  • male
  • elderly
  • smokers
  • use alcohol or sedatives
  • family history
  • hypertension

Question 3

S&S for Sleep apnea

Answer 3

• loud snoring
  
  • excessive daytime sleepiness
  • waking up abruptly with shortness of breath
  • dry mouth and throat upon waking
  • morning headache
  • insomnia and frequent arousal from sleep
  • observed pauses in breathing while sleeping

Question 4

Consequences of Sleep Apnea

Answer 4

• increase risk of complications following major surgery/general anesthetic
  
  • depression
  • psychosocial difficulties - relationship problems, poor academic or work performance
  • brain damage
  • hypertension -due to drops in 02 during sleep
  • sudden cardiac event or death - due to lack of 0

Question 5

Diagnosis and treatment of sleep apnea

Answer 5

• patient history - quality of sleep, excessive daytime sleepiness
  
  • laboratory tests - CBC, thyroid function,
    > ABG’s
  • sleep studies:
    
    • heart monitor
    • O2 saturation
    • body movements
      > Treatment
• • depends on the type of sleep apnea
    
    • options include:
    • weight loss
    • continuous positive airway pressure (CPAP)
    • dental/oral appliances
    • surgery

Question 6

non-invasive ventilation

Answer 6

• provides ventilator support through a patients upper airway using an mask or similar device
• patient must be able to maintain a patent airway
• patient must be able to remove mask
• patient must be complaint
• patient must be spontaneously breathing
• should not be used for patient requiring frequent suctioning

Question 7

Continuous Postive Airway Pressure (CPAP)

Answer 7

• continuous positive airway pressure
• tight-fitting mask attached to machine
• titrated to deliver the minimal level of CPAP to reverse OSA
• continuous steady pressured flow of air keeps the airway open

Question 8

Bi level Positive Airway Pressure

Answer 8

• bi-level positive airway pressure
• positive inspiratory and expiratory pressure
• used for acute and chronic respiratory failure
• used as a last alternative before intubation

Question 9

hyperventilation

Answer 9

ventilation in excess of the required to eliminate the normal venous carbon dioxide

Question 10

hypoventilation

Answer 10

ventilation if inadequate to meet the body’s oxygen demand or to eliminate sufficient carbon dioxide

Question 11

hypoxia

Answer 11

inadequate tissue oxygenation at the cellular level

Question 12

S&S of Respiratory Distress

Answer 12

• diminished or absent breath sounds
• adventitious breath sounds
  - wheezes
  - cackles
• changes in mental status, confusion, somnolence
• cyanosis of the oral mucosa, lips, and nails beds
• increased respiratory rate
• pursed lip breathing
• nasal flaring

Question 13

Acute Respiratory Failure (ARF)

Answer 13

• inadequate ventilation resulting from inability of the lungs to adequately maintain arterial oxygenation of eliminate carbon dioxide
• lungs cannot adequately remove carbon dioxide from the blood or when oxygen is not released into the blood effectively

Question 14

Discuss why patients may require an endotracheal tube

Answer 14

• involves the placement of a semi-rigid endotracheal tube through the mouth or nose and into the trachea
• performed during emergency situations or as part of a planned procedure
• rapid sequence intubation -a fast acting sedative and neuromuscular blocking agent cause immediate unconsciousness and paralysis
• indications:
  
  • establish or maintain airway potency
  • allow for deliver of anesthetics
  • facilitate mechanical ventilation
• assisting with endotracheal intubation
  
  • gather equipment and know how to use it

Question 15

Complications of Mechanical Ventilation

Answer 15

1. Artificial airway
   
   • infection
   • necrosis
2. Oxygen Toxicity
   
   • nitrogen washout, crushing atelectasis
   • oxygen free radicals cause lung injury
3. High airway Pressures
   
   • pneumothorax (treatment is chest tube)

Question 16

Care for a Ventilated Patient

Answer 16

• ventilated patient requires continuous cardiac monitoring and 1:1 nursing care
• NG or OG tube
• frequent mouth care
• repositioning q2h; HOB at > 30 degrees
• alternate means of communication
• restraints if necessary
• sedation/paralytics if necessary

Question 17

Demonstrate how to manually ventilate a patient with an ambu-bag

Answer 17

• making sure to have adequate seal around the mouth
• delivering breathings every 6-8 seconds
• generally in hospital entail oxygen into our ambulation-bag

Question 18

Discuss why patients would require mechanical ventilation

Answer 18

• indications for mechanical ventilation
  
  • apnea
  • acute respiratory failure
  • acute hypoxemic respiratory failure
  • inability to protect own airway
  • impending respiratory failure
  • GS less than 8 intubate

Question 19

Outline the role of the practical nurse in caring for the patient on mechanical ventilation

Answer 19

• promotes gas exchange in the lungs by producing positive intrathoracic and positive away pressure
• settings and modes are based on individual patient requirements
• breathing tube and ventilation very uncomfortable for the patient
• patients are usually sedated, unless in weaning modes
• suction is required was cannot cough up own secretions