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Respiratory Failure Flashcards

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1
Q

What is the function of the respiratory system?

A

To facilitate gas exchange (oxygen and carbon dioxide)

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2
Q

What happens without adequate gas exchange?

A

Metabolic needs of the body are not met and tissue/organ failure will occurr

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3
Q

What does management of patients with acute respiratory illnesses focus on?

A
  • improving oxygenation and ventilation
  • treating the underlying cause
  • reducing anxiety
  • preventing complications
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4
Q

What is respiratory failure?

A

The state in which one or both gas exchanging functions are inadequate (insufficient amount of oxygen for transfer to the cells or insufficient removal of carbon dioxide)

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5
Q

Is respiratory failure a condition or a disease?

A

A condition

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6
Q

What are some disease processes associated with respiratory failure?

A
  • pneumonia

- COPD

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7
Q

What is respiratory failure classified as?

A
  • hypoxemia

- hypercapnic

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8
Q

What is hypoxemia?

A
  • low levels of oxygen within the blood
  • pulse oximetry < 90%
  • PaO2 < 60mmHg
  • oxygen failure (inadequate oxygen transfer between alveoli and capillary bed)
  • ex: pneumonia, pulmonary emboli, toxic inhalation (smoke), poor cardiac output (heart failure)
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9
Q

What is hypercapnia?

A
  • excessive amounts of CO2 in the blood (cant ventilate properly)
  • measured using pulse oximetry and arterial blood gases
  • PaCO2 > 45 mmHg
  • ventilatory failure (CO2 retention)
  • ex: trauma, neuromuscular disease, sedation (CNS), COPD
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10
Q

What is ventilation - perfusion mismatch a cause of?

A

Hypoxemia

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11
Q

What is ventilation - perfusion mismatch?

A
  • not enough air entering the lungs (poor ventilation)
  • insufficient blood supply, cannot carry enough oxygen to the cells (poor perfusion)
  • ex: pulmonary embolus, asthma, COPD
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12
Q

What is shunting a cause of?

A

Hypoxemia

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13
Q

What is shunting?

A
  • blood exists in the heart but has not been involved in gas exchange
  • blood did not go to the lungs and less/low oxygenated blood is transferred into the vascular system
  • can be due to structural heart abnormalities ( atrial septal defect, ventricular septal defect)
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14
Q

What is diffusion limitation a cause of?

A

Hypoxemia

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15
Q

What is diffusion limitation?

A
  • decrease in gas exchange across the alveolar - capillary membrane due to process that thicken or destroy the membrane
  • results in poor gas exchange; occurs more often during exercise than rest
  • ex; emphysema, pulmonary fibrosis
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16
Q

What is alveolar hypoventilation a cause of?

A

Hypoxemia

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17
Q

What is alveolar hypoventilation?

A
  • a decrease in ventilation that results in an increase in carbon dioxide levels and a subsequent decrease in oxygenation levels
  • causes: chest wall dysfunction, restrictive lung disease, neuro-muscular disease (Guillain-Barre syndrome, Myasthenia Gravid)
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18
Q

What does hypercapnia lead to?

A

Acid-base imbalance

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19
Q

What are some causes of hypercapnia?

A
  • trauma; rib fractures
  • medications that depress CNS (depressants, anaesthetics)
  • neuro-muscular disease; cystic fibrosis, Myasthenia gravis
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20
Q

What happens when respiratory failure occurs in the airways and alveoli?

A
  • fluid enters the lungs and interferes with gas exchange
  • bronchospasm reduces airflow
  • alveoli destroyed by infection or enzyme imbalance
  • secretions that are extremely viscous obstructing gas exchange
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21
Q

What happens when the respiratory failure occurs in the central nervous system?

A
  • respirations are decreased by opioids or CNS depressants

- brainstem injury (ANS)

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22
Q

What happens when respiratory failure occurs in the chest wall?

A
  • soft tissue injury (ribs)
  • kyphoscoliosis
  • morbid obesity
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23
Q

What happens when respiratory failure occurs due to neuromuscular conditions?

A
  • spinal cord injury (cervical)
  • phrenic nerve injury (impairs diaphragm)
  • muscle weakness or paralysis
  • muscular dystrophy, myasthenia gravis
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24
Q

What is tissue oxygen delivery determined by?

A

The amount of oxygen carried by hemoglobin

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25
Q

Respiratory failure can increase problems for patients with ____?

A
  • anemia

- cardiac problems

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26
Q

What needs to be assessed for tissue oxygen delivery?

A
  • cardiac status (heart rate and rhythm)
  • blood counts (RBS’s, Hgb, and Hct)
  • peripheral extremities (pallor, coolness, and cyanosis)
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27
Q

What is an example of acute or rapid onset or respiratory failure?

A
  • patient with asthma experiences an exacerbation

- bronchospasm and a marked decrease in airflow

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28
Q

What is an example of gradual onset respiratory failure?

A
  • patient with COPD who develops a respiratory infection

- worsening their condition

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29
Q

What is an early sign in respiratory failure?

A
  • change in patients mental status
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30
Q

What are some late signs of respiratory failure?

A
  • decreased LOC (lethargy)
  • acidosis
  • hypotension
  • bradycardia and weak pulses
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31
Q

What is dyspnea?

A
  • difficulty breathing
  • some other things occur with it as well such as change in mental status, restlessness, confusion, agitation, tachycardia, mild hypertension, cool, pale, and clammy skin
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32
Q

What is tachypnea?

A
  • rapid and or shallow breaths

- pulse oximetry (SpO2) <90%

33
Q

What is hypoxia?

A
  • the condition in which the partial pressure oxygen (PaO2) has fallen sufficiently to cause signs and symptoms of inadequate oxygenation
34
Q

What can severe hypoxia lead to?

A

Anaerobic metabolism

35
Q

What is the waste product of anaerobic metabolism?

A

Lactic acid

36
Q

What does lactic acid need to be buffered with?

A
  • bicarbonate
37
Q

What causes acidosis?

A
  • a build up of carbon dioxide and an increase in lactic acid production while using up bicarbonate stores
38
Q

What does an acidotic blood pH significantly affect?

A
  • heart rhythm

- renal and brain function

39
Q

What are some diagnostic studies for respiratory failure?

A
  • history and physical assessment
  • chest x-ray
  • arterial blood gas (ABG) analysis (PaO2 < 80mmHg and or CO2 > 45 mmHg, assess serum pH level)
  • labs (CBC - RBC, H & H, sputum and or blood cultures, electrolytes)
  • advanced diagnostic testing (V/Q lung scan, CT scan, ECG monitoring)
40
Q

What health information should be obtained when assessing for respiratory failure?

A
  • past medical history (lung disease, exposure to toxins, recent travel)
  • medications (use of oxygen, bronchodilators, immune suppressants, corticosteroids)
  • surgery (thoracic or abdominal)
  • previous intubations
41
Q

What information should be gathered in an objective assessment when assessing for respiratory failure?

A
  • acute respiratory failure (exacerbation of current issue (COPD, pneumonia))
  • tachypnea and or dyspnea
  • shallow breathing
  • does patient remain in an upright position (tripod position)
  • difficulty speaking, only a few words between breaths
  • late signs like retraction and cyanosis
  • neurological (confusion, restlessness, agitation)
  • cardiovascular (tachycardia, hypertension, mild edema)
  • integumentary (pale, cool, and clammy skin, peripheral cyanosis)
42
Q

What is a retraction?

A

The inward movement of intercostal muscles

43
Q

What is cyanosis?

A

The blueing of the lips or fingertips

44
Q

What are some nursing diagnoses for respiratory failure?

A
  • impaired gas exchange
  • ineffective airway clearance
  • ineffective breathing pattern
45
Q

What are some ways to prevent respiratory distress?

A
  • deep breathing and coughing
  • use of incentive spirometer
  • ambulation as soon as possible
  • head of bed elevated
  • optimizing hydration and nutrition
46
Q

Respiratory problems require ____ interventions?

A

Respiratory interventions

47
Q

What is the number one thing to assess in terms of respiratory distress?

A

ABS’s

  • airway
  • breathing
  • circulation
48
Q

What are some oxygen respiratory therapies for respiratory failure?

A
  • oxygen therapy to correct hypoxemia
  • nasal cannula
  • masks (simple, venturi, rebreather, and non-rebreather)
  • BIPAP or CPAP machines
  • intubation
49
Q

What are the flow rates for each oxygen device?

A
  • nasal cannula (2-4L/min)
  • simple face mask (6-12L/min (35-50%))
  • venturi mask (24-50% (more precise))
  • partial rebreather mask (6-10L/min (40-60%))
  • non-rebreather mask (60-90% (high flow))
  • high flow cannula (up to 60L/mon (21-100%)
50
Q

Do people with COPD need high or low flow oxygen?

A

Low

51
Q

What can extended use of high flow oxygen cause?

A

Injury to the lungs

  • toxic free radicals are metabolite of oxygen
  • damage enzymes - surfactant
  • increased microvascular permeability
52
Q

What can retained secretions lead to?

A
  • narrowing airways

- limiting of gas exchange

53
Q

What is augmented coughing?

A

Nurse assisted to help force air out of the lungs

54
Q

What is huff coughing?

A

A series of coughs saying the word huff which moves secretions upwards?

55
Q

What are some respiratory techniques for mobilizing secretions?

A
  • positioning
  • elevating the head of the bed at least 45 degrees
  • chest physiotherapy
  • airway suctioning (yonkers - oral secretions, nasal tracheal suctioning)
56
Q

When someone with lung secretions is lying down, which lung should be facing down?

A

The good lung should be facing down (allows secretions to drain out of good lung)

57
Q

What is positive pressure ventilation?

A
  • if the patient cant improve their ventilation or respiratory status
  • non-invasive positive pressure treatments may be implemented (CPAP and BIPAP)
58
Q

What is CPAP and what does is stand for?

A

Continuous positive airway pressure

  • a constant level of pressure above atmospheric pressure is continuously applied to the upper airway
  • the positive pressure is intended to prevent upper airway collapse or to reduce the work of breathing in conditions such as acute respiratory distress
  • highly effective in managing obstructive sleep apnea
59
Q

What is BIPAP and what does it stand for?

A

Bilevel positive airway pressure

  • delivers higher pressure on inspiration and maintenance lower pressure on expiration
  • keeps alveoli inflated, promoting gas exchange and increased exhalation of CO2
  • nurses are required to assess respiratory status, monitor o2 sat, assess skin for breakdown under mask, ensure adequate nutrition and hydration, interventions to manage patients anxiety
60
Q

What are some goals of medication therapy?

A
  • relief of bronchospasms
  • reduction of airway inflammation
  • reduction of pulmonary congestion
  • treatment of infection
  • reduction of anxiety and restlessness
61
Q

What medication should be used for relief of bronchospasms?

A
  • bronchodilators
  • binds to beta adrenergic receptors
  • fenoterol hydrobromide, salbutamol, albuterol
62
Q

What medication should be used for reduction in airway inflammation?

A
  • corticosteroids
  • supress inflammatory response
  • methylprednisolone
63
Q

What medication should be used for reduction in pulmonary secretions?

A
  • diuretics

- reduces fluid volume in the vascular system

64
Q

What medication should be used for pulmonary infections?

A
  • start with a broad spectrum antibiotic
  • culture the phlegm (target specific pathogen)
  • excessive mucous - treatment with expectorant (gaifenesin)
65
Q

What medication should be used for anxiety/restlessness?

A
  • anxiety and agitation increase oxygen consumption (increased metabolic rate)
  • sedatives, opioids, or muscle relaxants may be needed
  • benzodiazepines (lorazepam), opioids (morphine)
  • nurses are required to monitor for sedation (impact on oxygenation) and encourage the use of non-pharmacological interventions
66
Q

What’s important to treat in respiratory failure?

A

The underlying cause

  • VQ mismatch - PE - anticoagulants to prevent clot enlargement
  • pneumothorax - chest tube to re-inflate the lung field
  • shunting - surgery to repair heart defects
67
Q

What does maintaining cardiac output involve?

A
  • increased work of breathing can increase intrathoracic pressure
  • monitor heart rate, blood pressure, and peripheral perfusion (poor perfusion can be related to hypovolemia and high heart rates can increase cardiac output)
  • treat with fluids or medications
68
Q

What does monitoring hemoglobin involve?

A
  • hemoglobin carries oxygen molecules to the cells
  • low hemoglobin = poor oxygenation
  • monitor for signs of poor oxygenation
  • monitor hemoglobin and hematocrit levels
  • monitor red blood cell count
  • assess ability to perform ADL’s
69
Q

What does nutritional therapy involve?

A
  • increased respiratory efforts = increased metabolic rate
  • ensure patients are receiving enough nutrients
  • take into consideration previous medical conditions
  • monitor weight, input and output, and bowel pattern
  • monitor for aspiration
  • provide high value nutrients and fluids
70
Q

What is acute respiratory distress syndrome?

A
  • sudden and progressive form of acute respiratory failure
  • often triggered by an inflammatory response
  • alveolar-capillary membrane becomes damaged which leads to increased permeability
  • alveoli become filled with fluid which impairs gas exchange
71
Q

What is the most common cause of acute respiratory distress syndrome?

A

Sepsis (gram negative bacteria)

- can also occur due to trauma for gastric aspiration, inhalation of corrosive materials, DKA and pancreatitis

72
Q

What is the first stage of ARDS?

A

Injury/Exudative phase

  • occurs 1-7 days after initial direct injury to the lungs
  • neutrophils adhere to pulmonary circulation, damaging pulmonary vascular lining which increases capillary permeability
  • fluid invades the interstitial space and slowly enters the alveolar space
  • surfactant is damaged - impairing lung compliance
  • hyaline membranes begin to line alveoli which leads to the development o atelectasis and fibrosis
73
Q

What is the second stage of ARDS?

A

Reparative or proliferative phase

  • begins 1-2 weeks post injury - inflammatory response
  • influx of neutrophils, monocytes, and lymphocytes with fibroblast proliferation = dense fibrous tissue
  • increased pulmonary vasculature resistance - pulmonary hypertension
  • hypoxemia worsens due to thickened alveolar membrane and widespread fibrosis
74
Q

What is the third stage of ARDS?

A

Fibrotic (chronic or late stage)

  • occurs 2-3 weeks post lung injury
  • the lungs are remodelled by collagenous and fibrous tissues
  • diffuse scarring impact lung compliance
  • outcomes for patients in this stage are poor
75
Q

What are some defining features of ARDS?

A
  • hypoxemia that persists even when 100% oxygen is given
  • decreased pulmonary compliance
  • dyspnea, changes in respiratory pattern, work of breathing
  • abnormal lung sounds, not heard initially (injury is occurring in interstitial spaces, not airways)
76
Q

What are the signs and symptoms of ARDS?

A
  • increased work of breathing
  • hyperpnea, noisy respirations
  • cyanosis
  • retractions - intercostally (between ribs) or substernally (below ribs)
77
Q

What is involved in a diagnosis assessment for ARDS?

A
  • blood gases - PaO2 < 60mmHg
  • despite oxygen therapy - intubation and mechanical ventilation
  • sputum culture - bronchoscopy
  • chest x-ray - white out appearance
78
Q

What are some interventions for ARDS?

A
  • intubation and mechanical ventilation with positive end expiratory pressure (PEEP)
  • frequent respiratory assessment (q1hr)
  • antibiotics and IV access - monitor fluid status
  • nutritional therapy - enteral nutrition (tube feeding)
  • turning q2hr
  • oral care and skin care
79
Q

What is SARS and what does it stand for?

A

Severe acute respiratory distress syndrome

  • serious acute respiratory infection cause by coronavirus
  • treatment is the same as respiratory failure
  • if it worsens, use ARDS treatment plan
  • outbreak in 2012

Nursing Theory (6 decks)

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