Respiratory

Question 1

Hypoxemic Respiratory Failure Causes

Answer 1

• Ventilation/Perfusion (Q) mismatch:
  
  • ↓ Ventilation
  • ↓ Perfusion
• Shunt:
  
  • Anatomic
  • Intrapulmonary
• Diffusion limitation

Question 2

V/Q stands for

Answer 2

Ventilation/Perfusion

Question 3

Hypercapnic Respiratory Failure Causes

Answer 3

• 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

Question 4

Acute Respiratory Failure Clinical Manifestations - Hypercapnic Failure?

Answer 4

• Neuro changes
• Dyspnea and HA
• ↑ ↓ RR
• ↑ HR
• ↑BP

Question 5

Acute Respiratory Failure Clinical Manifestations - Hypoxemic Failure?

Answer 5

• Neuro changes
• Dyspnea
• ↑ RR
• ↑ HR
• ↑BP

Question 6

How what diffentiates hypoxemic failure from hypercapnic failure?

Answer 6

retention of CO2 in hypercapnic failure causes a HEADACHE

Question 7

What diagnostic tests are run in a pt in Acute Respiratory Failure?

Answer 7

• 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)

Question 8

What is the difference between BiPAP and CPAP?

Answer 8

• BiPAP: different pressure for inspiration and experation

- CPAP: constant pressure for both

Question 9

Acute Respiratory Failure Nursing/Collaborative Management

Answer 9

• Prevention-early recognition

- Respiratory therapy

Question 10

Types of respiratory therapy for patient with acute respiratory failure?

Answer 10

• Oxygen therapy
• Mobilization of secretions (pat back with cupped hands)
• Positive pressure ventilation (PPV)
  
  • Mask (BiPAP, CPAP)
  • Intubation

Question 11

Drug Therapy for acute respiratory failure?

Answer 11

• Bronchodilators (albuterol)
• Corticosteroids (methylprednisolone)
• Diuretics
• Nitrates
• IV antibiotics (vancomycin/ceftriazone)
• Sedatives, Benzodiazepines, Narcotics (ativan/versed)

Question 12

Physiologic aging results in what respiratory changes?

Answer 12

• ↓ Ventilatory capacity
• Alveolar dilation
• Larger air spaces
• Loss of surface area
• Diminished elastic recoil
• Decreased respiratory muscle strength
• ↓ Chest wall compliance

Question 13

Acute Respiratory Failure Gerontologic Considerations

Answer 13

• Physiologic aging
• Lifelong smoking
• Poor nutritional status
• Less available physiologic reserve

Question 14

Sudden progressive form of acute respiratory failure?

Answer 14

Acute Respiratory Distress Syndrome (ARDS)

Question 15

Acute Respiratory Distress Syndrome (ARDS)

Answer 15

• Sudden progressive form of acute respiratory failure
• Alveolar capillary membrane damaged -↑ permeability to intravascular fluid
• 50% mortality rate

Question 16

Acute Respiratory Distress Syndrome (ARDS) starts with?

Answer 16

Alveolar capillary membrane damaged, which ↑ permeability to intravascular fluid

Question 17

Direct causes of ARDS?

Answer 17

aspiration, pneumonia, inhalation

Question 18

Indirect causes of ARDS?

Answer 18

secondary result of a massive systemic insult

Question 19

Pathophysiology of ARDS?

Answer 19

thought to be due to stimulation of the inflammatory and immune systems

Question 20

ARDS causes?

Answer 20

• Severe dyspnea
• Hypoxia
• Decreased lung compliance
• Diffuse pulmonary infiltrates (white out lung)

Question 21

3 phases of ARDS?

Answer 21

1) Injury or Exudative
2) Reparative or Proliferative
3) Fibrotic

Question 22

Injury or Exudative phase of ARDS occurs?

Answer 22

1 - 7 days after initial injury

Question 23

Summary of processes of the Injury or Exudative phase of ARDS?

Answer 23

• Pulmonary edema and atelectasis
• V/Q mismatch-severe
• Shunting of pulmonary capillary blood
• Refractory hypoxemia

Question 24

Occurs when oxygenation continues to decrease regardless of the amount of O2 given?

Answer 24

refractory hypoxemia

Question 25

Reparative or Proliferative phase of ARDS occurs?

Answer 25

1 to 2 weeks after initial injury

Question 26

Summary of processes of the Reparative or Proliferative phase of ARDS?

Answer 26

- Influx or neutrophils, monocytes, and lymphocytes - Lung becomes dense and fibrous – ↓ compliance - ↑ Pulmonary vascular resistance, pulmonary HTN

Question 27

Fibrotic or chronic/late phase of ARDS occurs?

Answer 27

2 to 3 weeks after initial injury

Question 28

Summary of processes of the Fibrotic or chronic/late phase of ARDS?

Answer 28

- Lung completely remodeled - ↓ Lung compliance - ↓ surface area for gas exchange - Pulmonary hypertension

Question 29

Early symptoms of ARDS?

Answer 29

- May not exhibit respiratory symptoms or - Dyspnea, tachypnea, cough, restlessness - Normal or scattered crackles

Question 30

Interpretation of Arterial Blood Gas results/values of pt in the early stage of ARDS will show?

Answer 30

Mild hypoxemia and respiratory alkalosis

Question 31

Early chest xrays of ARDS patient?

Answer 31

May be normal or have minimal scattered interstitial infiltrates

Question 32

ARDS clinical manifestations: Progressive

Answer 32

- Symptoms worsen - evident discomfort, ↑ WOB - ↑ fluid accumulation, - ↓ lung compliance - Pulmonary Function Tests (PFTs) show ↓ compliance and lung volume

Question 33

ARDS clinical manifestations: Late

Answer 33

- Suprasternal retractions - Tachycardia, diaphoresis - ↓ mentation - Cyanosis, pallor - Hypoxemia despite ↑ FIO2 - Hypercapnia causing muscle fatigue, hypoventilation

Question 34

ARDS Complications

Answer 34

- MO Dysfunction - Sepsis - Ventilator - Ventilator Associated - Pneumonia (VAP) - Ventilator complications - Stress ulcers - Renal failure

Question 35

Major causes of death in ARDS patient?

Answer 35

- MODS | - Sepsis