Respiratory Failure

Question 1

Acute resp. failure (ARF)

Answer 1

-caused by failure to adequately ventilate and/or oxygenate

Question 2

Ventilator Failure

Answer 2

due to a mechanical abnormality of the lungs or chest wall, impaired muscle function (the diaphragm), or a malfunction in the respiratory control center of the brain.

Question 3

Oxygenation failure

Answer 3

can result from a lack of perfusion to the pulmonary capillary bed (PE), or a condition that alters the gas exchange medium ( PE, pneumonia)

Question 4

Criteria for ARF

Answer 4

• PaO2 less than 60
• SaO2 less than 90%
• PaCO2 greater than 50 in conjunction with a pH less than 7.30

Question 5

Acute respiratory distress syndrom (ARDS)

Answer 5

a state of acute resp failure with a mortality rate of 25%-40%

Question 6

Indicators present with ARDS

Answer 6

• dyspnea
• bilateral noncardiogenic pulmonary edema
• reduced lung compliance
• diffuse patchy bilateral pulmonary infiltrates
• severe hypoxemia despite administration of 100% O2

Question 7

Severe acute resp. syndrome (SARS)

Answer 7

result of a VIRAL INFECTION from a mutated strain of coronaviruses, group of viruses that also cause the common cold

-AIRBORNE

Question 8

Objective data

Answer 8

-rapid, shallow breathing
-cyanotic, mottles, dusky skin
-tachycardia
-hypotension
-substernal, suprasternal retractions
-decreased saO2 (less than 90)
adventitious breath sounds ( wheezing, rales)
-cardiac arrhythmias
-confusion
-lethargy

Question 9

Hemodynamic monitoring

Answer 9

pilmoary capillary wedge pressure with ARDS is usally low or within the expected reference range 4-12 mm Hg

Question 10

Medications

Answer 10

• Benzodiazepines
• General anesthesia
• Corticosteroids
• opiod analgesics
• Neuromusculor blocking agents

Question 11

General anesthesia

Answer 11

Propofol (diprivan)

Question 12

Propofol

Answer 12

(diprivan)
-Contraindicated for clients with HYPERLIPIDEMIA and EGG ALLERGIES

• administer to clients who are intubated and ventilates
• monitor for hypotension
• titrate to desired sedation

Question 13

Corticosteroids

Answer 13

• Methylprednisone sodium succinate (Solu-medrol)

- Dexamethasone sodium phosphate

Question 14

Methylprednisone sodium succinate & Dexamethason sodium phosphate

Answer 14

Action: reduces WBC migration, decreases inflamation, and helps stabilize the alveolar-capillary membrane during ARDS

• D/C gradually
• adminsiter with an ANTIULCER MED (pepcid) to prevent peptic ulcer formation
• monitor weight and BP
• monitor glucose and electrolytes
• advise pt. to take oral with food

Question 15

Opiod Analgesics

Answer 15

Morphine Sulfate
Fentanyl citrate (Sublimaze)

Question 16

Morphine Sulfate & Fentanyl Citrate (sublimaze)

Answer 16

Action: provides pain management

• monitor Resp.
• monitor BP, HR, SaO2
• Monitor ABGs (hypercapnia can result from depressed respirations)
• use cautiosly with hypnotic sedatives
• HAVE NALOXONE HYDROCHLORIDE and RESUSCITATION EQUIPMENT FOR SEVERE RESP. DEPRESSION IN CLIENTS WHO ARE NOT RECEIVING VENTILATION

Question 17

Neuromuscular blocking agents

Answer 17

Vecuronium

Question 18

Vecuronium

Answer 18

actions: facilitates ventilation and decreases oxygen consumption. often used with painful ventilatory modes (IVR & PEEP)

• only for those intubated and ventilated
• monitor ECG, BP, and muscle strength
• Give with pain meds and sedatives
• HAVE NEOSTIGMINE METHYLSULFATE and ATROPINE SULFATE (ATROPAIR) AVAILABLE TO REVERSE THE EFFECTS OF THE NEUROMUSCUlAR BLOCKING AGENT
• have resuscitation equipment available
• paralysis is medication induced

Question 19

Antibiotics

Answer 19

Vancomycin (vancocin)

Question 20

Vancomysic

Answer 20

(vancocin)

• treats identified organisms
• give IV doses slowly
• do not give with other meds
• monitor coagulopathy and renal function
• take with food and finish the prescribed dose