Respiratory Flashcards
Risk factors for opioids
resp depression
hypotension
constipation
CNS depression
risk factors for ketamine/acetaminophen
increased risk for liver/kidney damage
What are the indications neuromuscular blockade?
Emergency intubation
Manage elevated ICP
improve tolerance of ventilation
How do we determine if neuromuscular blockade is enough?
Train-of-four
What is the care of immobile, paralyzed patient?
eye lubrication
DVT prophylaxis
oral care
urinary catheter
vital signs and assessments
Repositioning and ROM
ARF is defined as…?
inability of the resp system to provide oxygenation and/or remove CO2
Two ways ARF can be classified
oxygen failure resulting in hypoxemia but no rise in CO2
or
ventilation failure resulting in hypercapnia and hypoxemia
What is type 1 ARF?
oxygenation failure
PaO2 LOWER THAN 60 mm hg WITH NORMAL-DECREASED CO2
What is type 2 ARF?
ventilation failure (hypercapnic)
PaCO2 GREATER THAN 45 mm hg
what are the 4 mechanisms that reduce PaO2 causing oxygenation failure?
Hypoventilation
V/Q mismatch
intrapulmonary shunting
diffusion defects
What is ventilation?
amount of gas that enters the alveoli per minute
What factors can lead to hypoventilation?
drug overdose
neuro disorders
abd/thoracic surgery (pain)
what is intrapulmonary shunting?
blood passes thru lungs w/o picking up any oxygen
What can cause intrapulmonary shunting?
atelectasis
pneumonia
pulmonary edema
What is V/Q mismatch?
ventilation and perfusion mismatch
the rate of ventilation does not match rate of perfusion
What is normal ventilation?
4 L/min
What is normal perfusion?
5 L/min or 0.8 ratio
What are some causes of V/Q mismatch?
pneumonia
PE
pulmonary edema
What are diffusion defects?
oxygen has a difficult time moving across membrane
what can cause diffusion defects?
fluid in alveoli
pulmonary fibrosis
Oxygenation effects 3 things?
Cardiac output
hemoglobin
tissues
what is a normal cardiac output?
600-1000 mL
What 2 things cause failure of ventilation?
V/Q mismatch
hypoventilation
What do you assess for ARF?
manifestations of hypoxia and hypercapnia
vital signs
breath sounds
neuro function
What are EXPECTED findings for ARF?
dyspnea
vital sign abnormalities
cough
chest pain
alteration in cognition
what are UNEXPECTED findings for ARF?
resp rate above 30
O2 sat less than 90 and doesn’t respond to oxygen therapy
signs of shock
abnormal ABGs
resp arrest
Interventions for treating ARF
maintain patent airway
optimize oxygen delivery
minimize oxygen demand
treat underlying cause
signs of respiratory muscle fatigue
diaphoresis
nasal flaring
tachycardia
retractions
What is Acute Respiratory Distress Syndrome and what is the criteria?
severe form of ARF
1.) acute onset within 1 week
2.) bilateral pulmonary opacities not explained by other conditions
3.) altered PaO2/FiO2 ratio
What are some common causes of ARDS?
sepsis
pneumonia
aspiration
What are the risk factors for ARDS?
alcohol use disorder
female
older than 60
Explain acute stage of ARDS
uncontrolled inflammation
damage to the alveolar epithelium, becomes more permeable and fluid leaks
Explain proliferative phase of ARDS
lungs try to heal itself but causes scarring
making lungs stiffer further worsening hypoxemia
Explain fibrotic stage of ARDS
lungs become stiff and fibrotic
decreased residual capacity
Rt > Lt shunting
Expected assessment findings for ARDS
Agitation
restlessness
dyspnea
increased RR and WOB
increased HR decreased Cardiac output
What tests would you look at for ARDS?
chest XR
pulmonary function tests
BNP and coags
ABGs
What are unexpected findings of ARDS?
labs indicating organ failure
delirium
ET-tube mispositioning
What is prone positioning?
placing patients on their stomach to help them breathe better
Benefits of prone positioning
less lung compression
improve heart function
better drainage of secretions
Management of ARDS
Low tidal volume ventilation to minimize trauma
PEEP to keep alveoli open
Prone positioning
ECMO
VAP Bundle
HOB 30-35
Oral care q 2 hours
Ulcer prophylaxis
DVT prophylaxis
Spontaneous awaking trials
CLABSI bundle
Hand hygiene
CHG
Barrier precautions
Catheter Care maintenance
