Respiratory Management

Question 1

Ventilation impairment

Answer 1

anything that impairs breathing

muscle weakness, trauma, LOC, obstruction, restrictive pulmonary D/O

Question 2

Diffusion impairment

Answer 2

where breathing takes places

decreased surface area, pulmonary edema, pneumonia, ARDS
- in all these, there is something blocking the ability to breathe (fluid, air mucus)

Question 3

Perfusion impairment

Answer 3

decreased Hgb, decreased perfusion, pulmonary vasoconstriction (constriction caused decreased perfusion)

Question 4

acute respiratory failure (ARF)

Answer 4

pulmonary system fails to maintain adequate gas exchange

most common organ failure seen in the ICU; mortality 22-75%
mortality varies with the # of additional organ failures

Has 2 different types; cannot breathe normally and CO2 will be either normal or high

Question 5

Alveolar hypoventilation

Answer 5

cause of ARF

amount of O2 brought into alveoli do not meet the demands of the tissues

Question 6

Ventilation/perfusion mismatch

Answer 6

cause of ARF
ventilation and blood flow are mismatched
alveoli are under ventilated, they cannot adequately perform gas exchange
can breathe in but there is an area of the lung that will not have blood/gas exchange

Question 7

intrapulmonary shunting

Answer 7

cause of ARF
blood hits arterial system w/out any oxygenation
extreme form of ventilation/perfusion mismatch
unoxygenated blood is mixed throughout the body bc unoxygenated blood was picked up

Question 8

acute lung injury

Answer 8

pulmonary manifestation of MODS

noncardiac pulmonary edema (no heart damage)
disruption of the alveolar-capillary membrane (fluid leaks out)
injury to pulmonary vasculature or airways

all done at cellular level

Question 9

Exudative-acute phase of ALI

Answer 9

leakage of fluid due to increased pulmonary capillary permeability
interstitial/alveolar edema
intrapulmonary shunting and V/Q mismatching
decreased lung compliance secondary to atelectasis
pulmonary HTN

Question 10

S/S of exudative-acute phase of ALI

Answer 10

tachypnic/restless
resp. alkalosis
PaO2 normal
CXR normal
use of accessory muscles/lungs may be clear

Question 11

Fibroproliferative Phase of ALI

Answer 11

alveoli become enlarged/misshapen, scarring of pulmonary cap membrane
further decreased compliance “stiffening” of lungs
pulmonary HTN
further hypoxemia
refractory hypoxemia

Question 12

S/S of fibroproliferative phase of ALI

Answer 12

increased use of accessory muscles
crackles/rale
increased agitation
infiltrates on CXR
hyperventilation
decreased SVO2
lactic acidosis
increased HR, decreased BP
end organ dysfunction

Question 13

Resolution phase of ALI

Answer 13

recovery takes several weeks
alveolar cap membrane is re-established
- hyaline membranes are cleared
- intraalveolar fluid is transported out of the alevolus into the into the intersitium
- alveolar epithelial cells are restored

Question 14

Pneumonia

Answer 14

acute inflammation caused by infection

community-acquired pneumonia (CAP)
health care associated pneumonia (HCAP)
hospital associated pneumonia (HAP)
- ventilated-associated pneumonia (VAP)

Question 15

S/S pneumonia

Answer 15

dyspnea, fever, cough
course crackles
dullness to percussion

Question 16

S/S aspiration pneumonititis

Answer 16

presents w/ acute respiratory distress symptoms, SOB, wheezing, cyanosis, signs of hypoxemia, tachypnea, tachycardia, hypotension, fever (indicates infection), crackles, copious amounts of sputum, CXR

Question 17

pulmonary embolism

Answer 17

clot occludes area in pulmonary arterial bed and disrupts blood flow to an area of the lung

Question 18

thrombotic emboli

Answer 18

DVTs, right ventricle, upper extremities, and pelvic veins

Question 19

nonthrombotic emboli

Answer 19

fat tumors, amniotic fluid, air, foreign bodies

Question 20

S/S of PE

Answer 20

tachycardia, tachypnea, dyspnea/SOB/apprehension, fever, rales/crackles, pleuritic chest pain, cough, DVT, hemoptsys