Respiratory Flashcards
Hypoxemic Respiratory Failure Causes
- Ventilation/Perfusion (Q) mismatch:
- ↓ Ventilation
- ↓ Perfusion
- Shunt:
- Anatomic
- Intrapulmonary
- Diffusion limitation
V/Q stands for
Ventilation/Perfusion
Hypercapnic Respiratory Failure Causes
- Airways and alveoli
- Central nervous system (decreased drive to breath: OD/stroke)
- Chest wall (decreased chest wall expansion: flail chest)
- Neuromuscular conditions that cause muscle weakness, impairing resp muscle use
Acute Respiratory Failure Clinical Manifestations - Hypercapnic Failure?
- Neuro changes
- Dyspnea and HA
- ↑ ↓ RR
- ↑ HR
- ↑BP
Acute Respiratory Failure Clinical Manifestations - Hypoxemic Failure?
- Neuro changes
- Dyspnea
- ↑ RR
- ↑ HR
- ↑BP
How what diffentiates hypoxemic failure from hypercapnic failure?
retention of CO2 in hypercapnic failure causes a HEADACHE
What diagnostic tests are run in a pt in Acute Respiratory Failure?
- Arterial Blood Gas (ABG) analysis
- Chest x-ray (CXR)
- CBC,
- Complete Metabolic Panel (e-lytes)
- Urinalysis
- Sputum/blood cultures (infection)
- V/Q lung scan/CT chest (PE)
What is the difference between BiPAP and CPAP?
- BiPAP: different pressure for inspiration and experation
- CPAP: constant pressure for both
Acute Respiratory Failure Nursing/Collaborative Management
- Prevention-early recognition
- Respiratory therapy
Types of respiratory therapy for patient with acute respiratory failure?
- Oxygen therapy
- Mobilization of secretions (pat back with cupped hands)
- Positive pressure ventilation (PPV)
- Mask (BiPAP, CPAP)
- Intubation
Drug Therapy for acute respiratory failure?
- Bronchodilators (albuterol)
- Corticosteroids (methylprednisolone)
- Diuretics
- Nitrates
- IV antibiotics (vancomycin/ceftriazone)
- Sedatives, Benzodiazepines, Narcotics (ativan/versed)
Physiologic aging results in what respiratory changes?
- ↓ Ventilatory capacity
- Alveolar dilation
- Larger air spaces
- Loss of surface area
- Diminished elastic recoil
- Decreased respiratory muscle strength
- ↓ Chest wall compliance
Acute Respiratory Failure Gerontologic Considerations
- Physiologic aging
- Lifelong smoking
- Poor nutritional status
- Less available physiologic reserve
Sudden progressive form of acute respiratory failure?
Acute Respiratory Distress Syndrome (ARDS)
Acute Respiratory Distress Syndrome (ARDS)
- Sudden progressive form of acute respiratory failure
- Alveolar capillary membrane damaged -↑ permeability to intravascular fluid
- 50% mortality rate
Acute Respiratory Distress Syndrome (ARDS) starts with?
Alveolar capillary membrane damaged, which ↑ permeability to intravascular fluid
Direct causes of ARDS?
aspiration, pneumonia, inhalation
Indirect causes of ARDS?
secondary result of a massive systemic insult
Pathophysiology of ARDS?
thought to be due to stimulation of the inflammatory and immune systems
ARDS causes?
- Severe dyspnea
- Hypoxia
- Decreased lung compliance
- Diffuse pulmonary infiltrates (white out lung)
3 phases of ARDS?
1) Injury or Exudative
2) Reparative or Proliferative
3) Fibrotic
Injury or Exudative phase of ARDS occurs?
1 - 7 days after initial injury
Summary of processes of the Injury or Exudative phase of ARDS?
- Pulmonary edema and atelectasis
- V/Q mismatch-severe
- Shunting of pulmonary capillary blood
- Refractory hypoxemia
Occurs when oxygenation continues to decrease regardless of the amount of O2 given?
refractory hypoxemia
Reparative or Proliferative phase of ARDS occurs?
1 to 2 weeks after initial injury
Summary of processes of the Reparative or Proliferative phase of ARDS?
- Influx or neutrophils, monocytes, and lymphocytes
- Lung becomes dense and fibrous – ↓ compliance
- ↑ Pulmonary vascular resistance, pulmonary HTN
Fibrotic or chronic/late phase of ARDS occurs?
2 to 3 weeks after initial injury
Summary of processes of the Fibrotic or chronic/late phase of ARDS?
- Lung completely remodeled
- ↓ Lung compliance
- ↓ surface area for gas exchange
- Pulmonary hypertension
Early symptoms of ARDS?
- May not exhibit respiratory symptoms
or - Dyspnea, tachypnea, cough, restlessness
- Normal or scattered crackles
Interpretation of Arterial Blood Gas results/values of pt in the early stage of ARDS will show?
Mild hypoxemia and respiratory alkalosis
Early chest xrays of ARDS patient?
May be normal or have minimal scattered interstitial infiltrates
ARDS clinical manifestations: Progressive
- Symptoms worsen
- evident discomfort, ↑ WOB
- ↑ fluid accumulation,
- ↓ lung compliance
- Pulmonary Function Tests (PFTs) show ↓ compliance and lung volume
ARDS clinical manifestations: Late
- Suprasternal retractions
- Tachycardia, diaphoresis
- ↓ mentation
- Cyanosis, pallor
- Hypoxemia despite ↑ FIO2
- Hypercapnia causing muscle fatigue, hypoventilation
ARDS Complications
- MO Dysfunction
- Sepsis
- Ventilator
- Ventilator Associated
- Pneumonia (VAP)
- Ventilator complications
- Stress ulcers
- Renal failure
Major causes of death in ARDS patient?
- MODS
- Sepsis
