Respiratory 2 Flashcards
Acute Respiratory Failure
Not a disease but a symptom
Hypoxemia occurs due to inadequate O2 transfer
Hypercapnia occurs due to insufficient CO2 removal
Hypoxemic Failure
a) What is it?
b) causes?
c) patho
a) Oxygen failure
PaO2 <60 with FiO2 60%
b) ARDS
Pneumonia
Massive PE
Toxic inhalation
Cardiac anatomic shunt
Shock
c) Alveolar hypoventilation
Shunt
Mismatch VQ
Hypercapnic Failure
a) what is it?
b) causes?
a) Ventilation failure
PaCO2>45 with pH< 7.35
↑CO2 production
Decrease alveolar ventilation
b) Asthma, COPD, CF
CNS-opioid overdose, head injury
Chest trauma, kyphoscoliosis, pain, obese
MS, ALS, GB
Clinical Manifestations
Restlessness
Confusion
(think O2 is not going to brain that well)
Tachypnea,Prolonged expiration, retraction
dysrhythmias, HTN, tachycardia
inability to talk in complete sentences(true SOB)
Diagnostic Studies
ABG, SpO2
ECG
Hemodynamic monitoring, SvO2
P/F ratio (PaO2 ÷ FiO2-oxygen content when inhales)
norml = > 400; acute lung injury/ARDS < 300
bad or good?
a) PaO2= 101
FiO2= 21%
b) PaO2= 85
FiO2= 40%
a) good
b) bad
Collab Care
O2 therapy (PaO2 ≥ 60, SaO2 ≥ 90)
Positioning HOB ≥ 45 º(30-45º)
Monitor trends/ABGs
incentive spirometry
How to use incentive spirometry
Sit straight up
Before you use the spirometer, breathe out normally
Place the mouthpiece in your mouth. Make sure your lips are closed tightly
Breathe in slowly and as deeply as you can
Hold your breath for 3–5 seconds,
Remove the mouthpiece from your mouth and breathe out normally.
Rest for a few seconds, then repeat the steps 10 or more times.
Do this every 1–2 hours when you are awake.
After each set of 10 deep breaths
Optimize Oxygen Delivery
how?
blood administration
fluid administration,
PEEP(pressure applied by the ventilator at the end of each breath)
Decrease Oxygen Demand
how?
rest periods
quiet/restful environment
treat fever
treat pain
Nutritional support
What is ARDS?
NO Evidence of Heart Failure
Sudden progressive
Characterized by:
Acute onset
Decreased compliance, “stiff/small lungs”
ARDS Criteria
Mild ARDS ?
Moderate ARDS?
Severe ARDS?
Acute onset (within one week of insult)
Bilateral infiltrates (CXR)
Refractory hypoxemia
P/F ratio <300 mm HG
P/F ratio < 200 mmHg
P/F ratio ≤ 100 mmHg
Causes
Direct lung injury
Indirect lung injury (sepsis most common cause)
Systemic inflammatory response syndrome (SIRS)
Multiple organ dysfunction syndrome (MODS)
Emerging causes
e-cigarettes and vaping
Drug-induced- chemotherapeutics and immunotherapies
Viral Pneumonia- H1N1influena, COVID
Clinical Presentation
Tachypnea, restlessness
Excessive accessory muscle use, crackles
Non-cardiogenic pulmonary edema
Crackles
Refractory hypoxemia
PaO2 < 60 mmHg on FiO2 > 50%
Increase FiO2 which does not increase PaO2
a) PaO2?
b) FiO2?
c) If FiO2 inc PaO2?
a) partial pressure of oxygen in the arterial blood
b) an estimation of the oxygen content a person inhales
c) should increase
refractory hypoxemia with inc FiO2 but not inc PaO2
nursing care
intubation
Sedation
Confirm placement(lung sound)
Tube patency
Oral Care(bacteria needs comeout)
Monitor for Ventilator-associated Pneumonia (VAP)
Exam
a) Assist Control Ventilation (AC)
b) Synchronized Intermittent Mandatory Ventilation (SIMV)
a) Pt cannot do anything
Machine all do for pt
Watch for alkalosis if inc RR
b)The machine is helping but the pt also breathing themselves
Weaning mode
Collaborative Management
a) PaO2 goal?
b) PEEP benefits?
c) PEEP risk?
a) greater than 60
b) may improve V/Q mismatch allowing FiO2 to be decreased
Recruit more alveoli for ventilation
c) Compromise venous return
Compress pulmonary capillary bed
Higher levels of PEEP
Can hyperinflate alveoli
Can result in barotrauma or volutrauma
a) The P/F ratio is 73, what are nursing priorities at this time?
b) What would you expect as changes in orders from the physician?
a) Increase Oxygenation to tissues
b) Ventilator changes
Increase PEEP
Increase O2
Mode change
How to evaluate effectiveness?
PaO2 and PaCO2 within normal ranges
Effective cough and expectoration
Normal respiratory rate, rhythm, and depth
Decreased or absent peripheral edema
Decreased anxiety
Verbalization of positive attitude toward outcome
