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Critical Care > Problems Involving Respiratory Function > Flashcards

Problems Involving Respiratory Function Flashcards

1
Q

Ventilation

A

Breathing in and out

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2
Q

Perfusion

A

Blood flow

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3
Q

Compliance

A

Ease with which the lungs expand

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4
Q

Resistance

A

Force that has to be overcome to move air in and out of lungs

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5
Q

Elastance

A

Tendency of lungs to recoil

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6
Q

Work of breathing

A

Amount of O2 it takes just to breathe

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7
Q

Tidal volume

A

Amount of air that moves in and out with normal respiration

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8
Q

Residual volume

A

Amount of air left in alveoli after a forced exhalation

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9
Q

Functional residual capacity

A

Air left in alveoli after a normal exhalation
(*Allows for continuous gas exchange)

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10
Q

Shunting

A

Blood flowing past a non-vented alveolus

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11
Q

Anatomical Dead space

A

Wasted air (keeps airway open)

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12
Q

Alveolar deadspace

A

Air in alveoli that doesn’t participate in O2 exchange because the alveoli do not have blood flow

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13
Q

What is physiological deadspace?

A

A combination of anatomical and alveolar deadspace

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14
Q

Factors that need to be in place for adequate respiration

A

Ventilation
Perfusion
Diffusion
Adequate O2 in air

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15
Q

Examples of disorders that could cause diffusion problems

A

Pulmonary edema
Chronic bronchitis (stiffens alveolar wall)
Pneumonia

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16
Q

Definition of respiratory failure

A

Inability of the respiratory system to maintain adequate ventilation and/or oxygenation of the tissues

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17
Q

Respiratory failure ABG levels:

A

PaO2 <60 mmHg
SaO2 < 90%
PaCO2 > 45 mmHG with acidemia

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18
Q

What are the two types of ARF?

A

Ventilation failure
Oxygenation failure

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19
Q

Characteristics of ventilation failure (vs. oxygenation failure)

A

Normal perfusion
*Inadequate ventilation
Shunting
Impaired gas exchange
Hypoxemia
*Hypercapnia

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20
Q

Nursing diagnoses due to oxygenation failure

A

*Inadequate oxygenation
Ventilation-perfusion abnormality
Diffusion abnormality
Impaired gas exchange
Hypoxemia

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21
Q

What causes Ventilation Failure ARF?

A

Mechanical abnormalities of the lungs or chest wall
CNS abnormalities
Dysfunctional respiratory muscles

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22
Q

Things that can cause Oxygenation Failure ARF?

A

Ventilation is normal; perfusion interrupted
Shunting
Diffusion abnormality
Anemia
Decreased cardiac output

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23
Q

What kills the patient no matter what type or cause of ARF?

A

Hypoxemia

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24
Q

Signs and symptoms of ARF

A

Restlessness
Dyspnea
Orthopnea (having to sit up to breathe)
Hyperventilation
Accessory muscles
Intercostal retractions
Tachycardia
Decreased breath sounds
Bradypnea
Decreased LOC (late indicator)

25
Q

How is ARF diagnosed?

A

Arterial blood gasses
Pulse oximeter

26
Q

Priority problems for acute respiratory failure

A

Decreased gas exchange
Dyspnea
Activity intolerance
Insufficient airway clearance
Anxiety
Fear of suffocation

27
Q

Interventions for ARF

A

*1st: ventilate &/or oxygenate!
*2nd: determine and treat the cause

28
Q

How is the use of low-flow vs. high-flow oxygenation systems determined?

A

Low-flow is for pts who are able to ventilate
High-flow delivers intended amt of O2 regardless of ability to ventilate

29
Q

Examples of low-flow oxygenation systems

A

Nasal cannula
Simple face mast
Partial rebreather
Non-rebreather

30
Q

Examples of high-flow oxygenation systems

A

Venti mast
Face tent
Trach collar
T-piece
HFNC

31
Q

Functions of the HFNC

A

Warms/humidifies air
Can deliver 60L/min
Up to 100% FiO2

32
Q

*Uses for HFNC

A

Hypoxemia respiratory failure
Copious secretions
Pneumonia
PE
COVID 19
If BiPAP is contraindicated

33
Q

How is a bag valve mask set up?

A

Must be attached to 15 L O2 and bag must be 2/3 full to start

34
Q

Two types of mechanical ventilators

A

NPPV (noninvasive) - uses CPAP mask

IPPV (invasive) - uses Endotrachial tube

35
Q

Circumstances IPPV is indicated

A

ONLY 2:
Apnea
Respiratory arrest

36
Q

NPPV indications

A

COPD
DNR/DNI
Pulmonary edema
Pneumonia
Malignancy

37
Q

Contraindications for NPPV

A

Hemodynamic instability
Inability to clear secretions
Risk of aspiration
Inability to remove mask if vomiting occurs
Uncooperative patient

(Must be alert, oriented, and cooperative)
Need to make sure they can tolerate for at least first 30 min

38
Q

*Nursing care for NPPV

A
  • Assess and prevent skin breakdown (barrier protection under mask)
  • Assess tolerance of mask
  • Monitor for vomiting
  • Aspiration precautions
  • Monitor for hypoxia (need to try something else if this happens)
39
Q

Examples of meds that pt may be on while on ventilator

A

Bronchodilators
Corticosteroids
Mucomyst ICS
Diuretics
Antibiotics

40
Q

Definition of VAP

A

Pneumonia that develops at the time of or within 48 hrs of intubation

41
Q

Have completely memorized:

VAP Bundle

A
  • HOB up at least 30-45 degrees
  • Sedation vacations/readiness to wean daily
  • Avoid intubation/reintubation
  • Minimize sedation (Avoid benzodiazepines)
  • Facilitate progressive mobility
  • Oral care with toothbrush
  • Early enteral nutrition
  • Change vent circuitry only when needed
42
Q

*Definition of ARDS (Acute respiratory distress syndrome)

A

Severe acute lung injury resulting in ARF manifested by:
- Refractory hypoxemia (so severe that it’s resistant to tx even with 100% O2)
- Non-cardiogenic pulmonary edema
- Atelectasis (wide spread alveolar collapse)
- Decreased compliance (stiff lungs) (difficult for to ventilate)

43
Q

Berlin Criteria for ARDS

A
  • Acute onset within one week of clinical insult
  • Bilateral pulmonary opacities not explained by other conditions
  • Altered PaO2/FiO2 ratio (refractory hypoxemia)
44
Q

4 most common causes of ARDS

A

*Sepsis = most common (indirect cause)
Aspiration (direct cause)
Pneumonia (direct)
Trauma (indirect)

45
Q

What is the severity of an acute lung injury determined by?

A

Degree of hypoxemia
Amount of PEEP required to be used

46
Q

What is the underlying cause of ARDS?

A

SIRS (Systemic Inflammatory Response Syndrome)
- Very heightened inflammatory response that damages lung tissue and cause small holes in capillaries supplying blood to the lungs. Allows fluid into the lungs and alveoli.
- results in pulmonary edema, which makes lungs wet, decreasing compliance, making ventilation difficult, dropping PO2

47
Q

Early assessment cues of ARDS

A

Tachypnea/Dyspnea/SOB
Hyperventilation (Resp alkalosis)
Refractory hypoxemia (can’t keep O2 sat up)
Fine crackles
Restlessness
Change in LOC
Fever/tachycardia (no improvement, keeps declining)

48
Q

Progressive assessment cues of ARDS

A
  • CXR showing alveolar infiltrates
  • Increasing respiratory distress with retractions, accessory muscle use, cyanosis
  • Decreased lung compliance (can measure if pt on ventilator)
  • Hypoventilation (bradypnea)
    • respiratory acidosis, metabolic acidosis
49
Q

*Treatment for decreased gas exchange from ARDS

A

*IMV - lung protective strategies (very gentle vent settings)
*PEEP (recruits alveoli and prevents atelectasis)
Suction only when absolutely necessary (often leads to O2 desaturation)

50
Q

Ventilator settings for ARDS to protect the lungs

A

Lowest FiO2 to maintain PaO2 >60 mmHg
Tidal Volume 4-8 mL/kg IBW (normal = 10-15mL/kg IBW)
Low end-inspiratory Peak Pressure (<30 cmH2O)
PP = pressure reached at end of inspiration cycle

51
Q

PEEP setting for treating ARDS

A

5-20cmH2O - higher levels in mod/severe diagnosis
(While other vent settings are lower)

52
Q

Complications of PEEP at higher levels for ARDS

A

Barotrauma & Pneumothorax
Decreased venous return causes decreased CO

53
Q

Medications used when pt has an alteration in comfort with ARDS

A

Analgesics - MSO4 (morphine), Fentanyl

Sedatives - Propofol

NeuroMuscular Blocking Agent (NMBA) - cisatracurium

54
Q

When should a NMBA be used for ARBS

A

To decrease work of breathing
To improve Ventilatory dyssynchrony
Only when essential for oxygenation

55
Q

Nursing considerations for giving a NMBA

A

*May increase HR & BP (pt may not be sedated enough if this happens)
- Causes respiratory depression
**Do not give without initial sedative!!
*Lubricate and tape eyes closed (pts that are sedated/paralyzed)

56
Q

*Adverse effects from prone positioning

A

Facial edema
*Accidental extubation
Assessment & suctioning more difficult
*Pressure ulcers
Corneal ulceration
Peripheral nerve damage
Aspiration

57
Q

*Nursing care for positioning a pt in prone position without a pronator bed

A
  • Maintain proper body alignment
  • Pillows/foam support to prevent overextension/flexion of spine & reduce weight bearing on bony prominences
  • Place pads at shoulders, iliac crest, knees for skin & peripheral nerve damage
  • Reposition arms often to prevent contractures
  • Reposition head what to decrease facial edema & ocular pressure
  • Moisture barrier to face to protect from secretions
  • Absorbent pads/emesis basin to capture secretions
  • Lubricate eyes & tape shut to prevent corneal dryness/abrasions
  • Hydrocolloid dressing to chest, pelvis, elbows, knees
  • Frequent oral care and suctioning
  • Patient/family education regarding use of prone
  • Assess frequently for tolerance
  • Continue tube feeding as tolerated (Post pyloric feeding encouraged)
58
Q

Goal of fluids/electrolytes for pts with ARDS

A

Maintain perfusion without overload

59
Q

Nutrition for pts with ARDS

A

Special guidelines required
Watch for feeding intolerance (residuals, prealbumin level = best measure)

Critical Care (35 decks)

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