Respiratory Failure/ARDS – 20

Question 1

ARDS – PaO2/FIO2 ratio

Answer 1

</= 200

Question 2

Sudden, progressive ARF in which Alveolar cap. membrane damaged –>more permeable to intravascular fluid–>Alveoli fill with fluid

Answer 2

ARDS

Question 3

Injury or exudative phase

Time Period

Answer 3

1-7 days after insult

Question 4

Reparative or proliferative phase

Time Period

Answer 4

1-2 wks after initial lung injury

Question 5

Fibrotic or chronic/late phase

Time Period

Answer 5

2-3 wks after initial lung injury

Question 6

Neutrophils adhere to plum microcirculation–> damage to vascular endothelium & increased cap perm–>Engorgement of peribronchial & perivascular interstitial space–>Intrapulm. shunt develops –>alveoli fill w/ fluid & bld passing through cannot be oxygenated; Alveolar cells (I & II) damaged–>Surfactant dysfunx & atelectasis–>Hyaline membranes line alveoli. Severe V/Q mismatch & shunting of pulmonary cap blood–>hypoxemia
(Unresponsive to increasing O2 concentrations)–>Lungs become less compliant

Answer 6

1-7 days after insult

Injury or exudative phase

Question 7

Influx of neutrophils, monocytes, and lymphocytes–>Fibroblast proliferation. Lung becomes dense and fibrous, compliance continues to decrease. Hypoxemia worsens.

Answer 7

reparative phase persists

1-2 wks after initial lung injury

Question 8

If reparative phase persists

Answer 8

widespread fibrosis results

If phase is arrested, lesions resolve

Question 9

Lung completely remodeled (sparsely collagenous & fibrous tissues); Requires long-term mechanical ventilation; Survival chances poor

Answer 9

2-3 wks after initial lung injury
Fibrotic or chronic/late phase
Survival chances poor

Question 10

dyspnea
tachypnea
cough
restlessness
Auscultation normal-fine, scattered crackles

Answer 10

ARDS- Initial presentation

Question 11

Chest Xray ARDS

Answer 11

normal or scattered interstitial infiltrates initially

Question 12

Evident discomfort
↑WOB
Intercostal & suprasternal retractions
Pulmonary funX tests –> decreased compliance & lung vol.

Answer 12

ARDS-increased fluid accumulation and decreased compliance

Question 13

Chest x-ray–>whiteout/ white lung

Answer 13

d/t consolidation and coalescing infiltrates widespread throughout lungs

Question 14

Rupture of overdistended alveoli during mechanical ventilation

Answer 14

Barotrauma

Question 15

smaller tidal volumes results in

Answer 15

higher PaCO2
Permissive hypercapnia
Keep pH >/= 7.2
Decreased risk of Baro & Volutrauma

Question 16

Occurs when large tidal volumes used to ventilate noncompliant lungs–>Alveolar fx/tears and mvmnt of fluids & proteins into alveolar spaces

Answer 16

Volutrauma

Question 17

NDx ARDs

Answer 17

Ineffective airway clearance
Ineffective breathing pattern
Risk for imbalanced fluid volume
Anxiety
Impaired gas exchange
Imbalanced nutrition: less than body requirements

Question 18

Overall goals for patient with ARDS

Answer 18

PaO2 >/= 60 mmHg

Adequate lung ventilation to maintain normal pH

Question 19

Goals for patient recovering from ARDS

Answer 19

PaO2 normal for age/baseline with FIO2 21%
SaO2 >/= 90%
Patent airway/ Clear lungs

Question 20

Oxygen administration

Answer 20

Give lowest concentration that –> PaO2 60 mmHg+
ScvO2 = 60% to 80%
SpO2 continuously monitored > 90%

Question 21

When FIO2 exceeds 60% for more than 48 hours–>

Answer 21

Risk for 02 tox

Question 22

Additional pressures from PEEP can

Answer 22

compromise venous return to R side of the heart–>Decreased preload, CO, and BP

Question 23

PEEP @ 5cm H20 compensates for

Answer 23

loss of glottic function

Question 24

Prior to initiation of Vibratory pack for chest PT

Answer 24

Obtain baseline assessment

Question 25

Anxiety Goal ARDs

Answer 25

Decreased anxiety ( <+2 )

Question 26

2 Classifications of ARF

Answer 26

Hypoxemic respiratory failure

Hypercapnic respiratory failure

Question 27

Hypoxemic respiratory failure d/t

Answer 27

Insufficient O2 transferred to the blood

Question 28

Hypercapnic respiratory failure d/t

Answer 28

Inadequate CO2 removal

Question 29

ARF
PaO2 of 60 mm Hg or less
Inspired [O2] of 60%+

Answer 29

Hypoxemic Respiratory Failure

Question 30

ARF
PaCO2 above norm (>45 mm Hg)
(pH <7.35)

Answer 30

Hypercapnic Respiratory Failure