Respiratory Failure part 2

Question 1

is a syndrome of inadequate gas exchange due to dysfunction of one or more essential components of the respiratory system.

Answer 1

Respiratory Failure

Question 2

Respiratory system

Answer 2

Chest wall (including pleura and diaphragm)
Airways
Alveolar – capillary unit Pulmonary circulation
Nerves
CNS or Brain Stem

Question 3

Classification

Answer 3

Acute
Chronic
Acute on chronic

Question 4

Causes

Answer 4

Type I
Type II
Type III

Question 5

Type I respiratory failure

Answer 5

Pneumonia
Cardiogenic pulmonary edema
Non-cardigenic pulmonary edema
Pulmonary embolism
Atelectasis
Pulmonary fibrosis

Question 6

Type II respiratory failure

Answer 6

Central hypoventilation
Asthma
COPD
Neuromasculr chest wall disorders
Myopathies
Neuropathies
Kyphoscoliosis
Myasthenia gravis
Obesity hypoventilation syndrome

Question 7

Type III respiratory failure

Answer 7

Inadequate post - operative analgesia, upper abdominal incisio
Obesity, ascites
Excessive airway secretions
tobacco smoking

Question 8

Type IV respiratory failure

Answer 8

Cardiogenic shock
Septic shock
Hypovolemic shock

Question 9

Diagnosis: History

Answer 9

Sepsis
Pneumonia
Pulmonary embolus
COPD exacerbation
Cardiogenic pulmonary edema

Question 10

suggested by sudden onset of shortness of breath or chest pain

Answer 10

Pulmonary embolus

Question 11

suggested by history of heavy smoking, cough, sputum production

Answer 11

COPD exacerbation

Question 12

suggested by chest pain, paroxysmal nocturnal dyspnea, and orthopnea.

Answer 12

Cardiogenic pulmonary edema

Question 13

Diagnosis: Physical Findings

Answer 13

Hypotension
Hypertension
Wheezing
Stridor
Elevated jugular venous pressure
Tachycardia and arrhythmias

Question 14

usually with signs of poor perfusion suggests severe sepsis or massive pulmonary embolus.

Answer 14

Hypotension

Question 15

usually with signs of poor perfusion suggests cardiogenic pulmonary edema.

Answer 15

Hypertension

Question 16

Wheezing suggests airway obstruction:

Answer 16

Bronchospasm
Secretions
Pulmonary edema

Question 17

suggests upper airway obstruction

Answer 17

Stridor

Question 18

suggests right ventricular dysfunction due to accompanying pulmonary hypertension

Answer 18

Elevated jugular venous pressure

Question 19

may be the cause of cardiogenic pulmonary edema

Answer 19

Tachycardia and arrhythmias

Question 20

Diagnosis: Laboratory Workup

Answer 20

ABG
Complete blood count
Cardiac serologic markers
Microbiology

Question 21

Diagnostic Investigations

Answer 21

Pulmonary function tests/bedside spirometry
Bronchoscopy
Chest radiography
Electrocardiogram
Echocardiography

Question 22

Respiratory Failure: Management

Answer 22

ABC’s
Ensure airway is adequate
Ensure adequate supplemental oxygen and assisted ventilation, if indicated
Support circulation as needed

Question 23

Infection tx

Answer 23

Antimicrobials, source control .

Question 24

Airway obstruction

Answer 24

Bronchodilators, glucocorticoids

Question 25

Improve cardiac function

Answer 25

Positive airway pressure, diuretics, vasodilators, morphine, inotropes .

Question 26

Management

Answer 26

Mechanical ventilation

Question 27

Non - invasive

Answer 27

Mask: usually orofacial to start

Question 28

Invasive

Answer 28

Endotracheal tube (ETT)
Tracheostomy – if upper airway is obstructed

Question 29

Indications for Mechanical Ventilation

Answer 29

Cardiac or respiratory arrest. Tachypnea or bradypnea with respiratory fatigue. Acute respiratory acidosis. Inability to protect the airway associated with depressed level of consciousness of consciousness Shock associated with excessive respiratory work Inability to clear secretions with impaired gas exchange Short term adjunct in management of acutely increased intracranial pressure (ICP)

Question 30

Non Invasive Ventilation

Answer 30

COPD exacerbation
Cardiogenic pulmonary edema
Obesity hypoventilation syndrome

Question 31

Nursing Management.

Answer 31

Assess the patient’s tissue oxygenation status regularly. Evaluate ABG results To enhance V/Q matching, turn the patient on a regular and timely basis to rotate and maximize lung zones. Regular, effective use of incentive spirometry Regular patient turning and repositioning enhances diffusion by promoting a healthy, wellperfused alveolar surface. These actions, as well as suctioning, help mobilize sputum or secretions.