Respiratory failure (ARF) Flashcards
Acute respiratory failure is not a disease but a what ?
Symptom
Why is acute respiratory failure a symptom?
because respiratory failure reflects insufficient lung function, usually being caused by an underlying condition
As mentioned previously acute respiratory failure is usually a result from an underlying condition, remembers its a symptom, not a disease, can you give examples to what others systems can cause respiratory failure ?
cardiac system
Centeral nervous system
how does respiratory failure occur ?
when oxygenation, ventilation or both are inadequate
What is the term called when you do not have enough oxygen in the blood ?
Hypoxemia
What is the term called when you have too much carbon dioxide in the blood called ?
hypercapnia
what are the 2 ways you can get respiratory failure?
either from the lack of oxygen
or
from having too much carbon dioxide
can patients have both types of respiratory failure at the same time ?
yes
how does acute respiratory failure present itself in a patient?
usually tachycardia, low blood pressure, increase respiratory rate and confusion may occur
how does chronic respiratory failure present itself in a patient?
develops slowly over days and weeks, generally starts off stable changes into changes that are no longer compensatory for the patient
its very common sense to know that when a patient is having a hard time breathing because hypoxemic respiratory failures is the depletion of air, but do you think hypercapnic respiratory failure does the same for the patient?
no, its not from the lack of air, its from the lack of explection of air
what are the 4 ways that hypoxemic respiratory failure occurs ?
V/Q mismatch
Shunt
Diffusion Impairment
Alevolar hypoventilation
what is v/q mismatch for hypoxemic respiratory failure, explain to me what this is ?
v/q mismatch is when ventilation ( airflow ) or perfusion ( blood flow ) in the lungs is impaired,
meaning its preventing the lungs from optimally delivering oxygen to the blood
what are some causes of v/q mismatch ?
lung disease
- COPD, asthma, atelectasis
Pain
- increased stress causes metabolic rate, meaning it increases the need of o2
atelectasis
pulmonary embolism
what is the first treatment for v/q mismatch, or in general when a patient is experiencing hypoxemic respiratory failure?
sit them up, provide 02 and treat the underlying cause
what are some common diagnostic methods we can use on a patient to see hypoxemic respiratory failure?
ABGs
pulse ox
LOC assessment
respiratory assessment
what is a shunt in the terms of hypoxemic respiratory failure ?
blood leaves the heart without gas exchange - extreme v/q mismatch
in other terms, blood will leave the heart however it will not receive fresh oxygen and not get rid of the carbon when trying to make that exchange
what’s the difference between shunt and a v/q mismatch?
v/q mismatch is the imbalance between ventilation and blood flow
shunt is from the result of reduced ventilation relate to blood Flow, leading to decreases oxygenation
what are 3 main causes of shunting in hypoxemic respiratory failure?
anatomic shunt ( heart )
- ventricular septal defect
intrapulmonary/capillary shunt
- blood flows through pulmonary capillaries without exchanging gases
- pneumonia for example
mechanical ventilation with high levels of oxygen
what is diffusion impairment of hypoxemic respiratory failure?
gas exchange across alveolar - capillary membrane is compromised by scarring of alveoli due to fibrosis or fluid in alveoli
gas exchange is happening so like oxygen and carbon dioxide are being able to change, however due to scarring in the alveoli, its preventing that, so think of like if scars were there, this wouldn’t be happening
what is a classical sign of diffusion impairment ?
you are breathing fine when resting, but then the second you do any movement or exercise, hypoxemic
patho behind this is because when you move, cardiac output causes blood to flow faster to the heart and there is no time to diffusion
what is alveolar hypoventilation in hypoxemic respiratory failure?
its a decreased ventilation learning to increase CO2 in the body
- mainly its associated with hypercapnic respiratory failure but since there is no air being pumped through, thats why its hypoxemic
what are some main causes of hypoxemic alveolar hypoventalation?
CNS conditions
chest wall dysfunction
acute asthma
resitrictive lung disease
what is the patho/ consequence of hypoxemia ?
when you dont have oxygen in your body, you become hypoxic ( not enough oxygen in your tissue ) learning to anaerobic metabolism
this releases lactic acid then causing your body to go into metabolic acidosis from how intense it is -> then cellular death
can your oxygen levels be normal when you are hypercapnic ?
if yes why ?
if no why?
yes, because oxygen is being in your body and releasing, however its due to the fact that you have so much carbon in your body that you go into respiratory failure
hypercapnic respiratory failure is considered a ____ failure and why ?
ventilatory failure
because you literally can’t vent out the carbon in you
what are the 2 methods that hypercapnic respiratory failure occurs?
either in an increase of co2 production, that your body kinda creates
or
decrease in alveolar ventilation which allows for distribution of carbon to stay in the body for longer than needed
what are the 4 causes of hypercpanic respiratory failure?
CNS problems
neuromuscular conditions
chest wall abnormalities
conditions affected the airways and or alveoli
can hypercapnic respiratory failure happen when you have normal lungs ??
can hypoxemic respiratory failure happen when you have normal lungs ?
yes
no
how does CNS problems cause / affect hypercpanic respiratory failure?
can you provide examples and explain this ?
suppress the drive to breathe
think of opioids, biggest thing to remember is the fact that it causes respiratory depression, the brain won’t even recognize the increase of co2 cause you’re not breathing it out
how does neuromuscular problems cause/ effect hypercapnic respiratory failure ?
can you provide an example of this ?
respiratory muscles can either be weak or paralysis causing difficultly exhaling CO2
GBS
peripheral nerve damage
how does chest wall abnormalities affect hypercapnic respiratory failure ?
can provide examples of this?
it prevents normal movement of chest wall and or diagram and limit the lung expansion
severe obesity
flail chest
how does airway and alveoli issues affect hyerpanic respiratory failure, there are 2 ways it does this ?
can you also provide at least one example of this ?
increased work of breathing due to obstruction from increased airway resistance
air trapping leads to respiratory muscle fatigue and ventilatory failure
cystic fibrosis
COPD
asthma
which do you think the body can tolerate more, having no oxygen or having too much carbon ?
having too much carbon
because if you have no oxygen, you’re a goner
how can respiratory failure be different from one another, think of the fact of severity reasons ? (3)
either from the amount of little or too much carbon/oxygen in the body
speed of change, acute vs chronic
the ability to compensate, maybe easier for younger people than older
what is the first sign of hypoxemic ARF ?
changes in mental status - agitation, restlessness, confusion
what is the first sign of hypercapnic arf?
morning headache ( somnolence )
decreased RR
decreased LOC
sleepy, tired, confused
what are some early signs of ARF, this applies to either hypoxemic or hypercapnic ?
tachycardia
tachypnea
pallor
mild increased work of breathing
what is a late sign of hypoxemia ?
cyanosis
what are some main things to look out for symptoms wise with patients going into hypoxemia respiratory failure?
accessory muscles
nasaling flairng
spo2 less than 80%
paradoxical chest movement ( late )
cyanosis ( late )
what are some specific signs of hypercapnia symptoms wise ?
tripod position
pursed-lip-breathing
shallow respirations
what is the main priority we need to do when a patient is not being able to breathe ?
test questions
what if you walk into the patients room and you see them struggling to breathe, what are you going to do ?
sit them up and provide oxygen
some basic questions
what are some assessment are we going to do with a patient with ARF?
position
work of breathing
ability to speak
respiratory rates
ausculate breathe sounds
accessory muscles
what are some diagnostic studies for arf?
chest x-ray
ABG
ct scan
what are some factors we want to consider when taking care of patients who are experiencing arf?
age
severity of onset
underlying conditions
most likely causes
what do we want to encourage patients to be doing when having arf?
cough
deep breathing
incentive spirometry
what do we want to prevent with patients who are having arf?
atelectasis
pneumonia
what are the 5 interventions of arf?
MP!!! For ARF
oxygen
mobilization of secretions
positive pressure ventilation
medication
nutritions
what’s the goal of oxygen with arf?
maintain adequate o2 and correct acid-base
notes
start with the lowest possible amount of oxygen
keep it at 90% pulse ox
watch out for complications of oxygen toxicity and any anxiety
why is oxygen dangerous with arf?
because too much oxygen can cause alveoli to collapse causing fluid to leak out causing pulmonary edema and other complications
why do we need to be careful with patients who are having oxygen and have COPD?
because they already live at a low level of oxygen, giving them too much cuts their drive to breathe
how can we help mobilize secretions ?
proper position - sitting up
effecting coughing - quad cough
suctioning should be the last thing
hydration
ambulation
what are the 2 forms of positive pressure ventilation ?
CPAP
BIPAP
what type of medications will be using on arf patients ?
short acting bronchodilator
corticosteroids
diuretics
morphine
nitroglycerine
opioids
benzo
why is nutrition a big thing in arf ?
because you burn a lot of calories trying to breathe
notes
gerontologic considerations
- at increased risk for arf
- decreased ventilatory capacity
larger air spaces
loss of surface area for gas exchange
decreased lung compliance
poor nutritional status
