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NSG 430 - Critical Care > T3: Respiratory Failure & ARDs > Flashcards

T3: Respiratory Failure & ARDs Flashcards

1
Q

Causes of ARDS

A

sepsis (infection), pneumonia, status asthmaticus

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2
Q

what is one of the first things people present with in respiratory failure

A

altered level of consciousness

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3
Q

hypoxemia

A

insufficient oxygen transferred to the blood

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4
Q

how is hypoxemia reflected in ABGs

A

Decreased PaO2 and SaO2

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5
Q

hypercapnia

A

inadequate CO2 removal

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6
Q

how is hypercapnia reflected in ABGs

A

Increased PaCO2

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7
Q

PaO2 level in hypoxemic patient

A

<60mmHg

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8
Q

PaCO2 level in hypercapnic patient

A

> 50mmHg

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9
Q

most common physiologic mechanisms of hypoxemic respiratory failure

A

-v/q mismatch
-shunting
-diffusion limitation
-alveolar hypoventilation

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10
Q

V/Q mismatch

A

An imbalance in the amount of oxygen received in the alveoli and the amount of blood flowing through the alveolar capillaries

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11
Q

shunting

A

through heart bypassing lungs OR through lungs without gas exchange

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12
Q

diffusion limitation

A

Gas exchange across alveolar-capillary membrane is compromised, exchange of CO2 and O2 cannot occur because of the thickened alveolar-capillary membrane

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13
Q

increased lactic acid. from hypoxemia can cause

A

metabolic acidosis

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14
Q

respiratory manifestations of hypoxemia

A

-dyspnea, tachypnea, prolonged expiration
-nasal flaring
-intercostal muscle retraction
-use of accessory muscles
-decreased SpO2 (less than 80%)
-paradoxic chest or abdominal wall movement with respiratory cycle (late)
-cyanosis (late)

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15
Q

CNS clinical manifestations of hypoxemia

A

agitation; confusion; disorientation; restless, combative behavior; delirium; decreased level of consciousness; coma (late)

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16
Q

CV clinical manifestations of hypoxemia

A

tachycardia; hypertension; skin cool, clammy, and diaphoretic; dysrhythmias (late); hypotension (late)

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17
Q

Consequences of hypercapnia

A

-Slow changes allow CO2 allow compensation
-Arterial pH able to adjust
-Treat primary cause or patient’s condition will deteriorate

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18
Q

Conditions causing impaired ventilation (hypercapnia)

A

-CNS problems
-neuromuscular conditions
-chest wall abnormalities
-conditions affecting the airway and/or alveoli

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19
Q

respiratory clinical manifestations of hypercapnia

A

-dyspnea
-tripod position
-pursed-lip breathing
-decreased RR or rapid rate with shallow respirations
-decreased tidal volume
-decreased minute ventilation

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20
Q

CNS clinical manifestations of hypercapnia

A

-morning headache
-disorientation, confusion
-progressive somnolence
-increased intracranial pressure
-coma (late)

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21
Q

CV clinical manifestations of hypercapnia

A

tachycardia, HTN, dysrhythmias, bounding pulse

22
Q

neuromuscular clinical manifestations of hypercapnia

A

muscle weakness, decreased deep tendon reflexes, Tremors, seizures (late)

23
Q

decreased O2 manifestations

A

restlessness, confusion, agitation

24
Q

increased CO2 manifestations

A

morning headache, decreased RR, and decreased LOC

25
Q

early signs of compensation of the heart and lungs

A

Tachycardia, tachypnea, and mild HTN

26
Q

Late signs of inadequate compensation

A

-Cyanosis (unreliable indicator)
-PaO2 less than or equal to 45 mm Hg

27
Q

position for acute respiratory failure

A

sit upright/tripod
keep HOB up

28
Q

Work of breathing (WOB);

A

respiratory muscles effort needed to inhale/exhale

29
Q

what is a red flag in acute respiratory failure

A

Change from rapid to slow RR à severe muscle fatigue IMPENDING respiratory arrest

30
Q

how does morphine help with work of breathing (WOB)

A

it dilates the coronary artery so the heart is getting more blood supply which decreases the workload of breathing

31
Q

observation for acute respiratory failure

A

-Ability to speak à full or partial sentences, 2 to 3 word dyspnea
-Pursed-lip breathing Increased expiratory time; prevents small bronchial collapse
-Retraction of intercostal spaces or supraclavicular area
-use of accessory muscles
-Paradoxical breathing
-diaphoresis

32
Q

breath sounds in ARF

A

fine or coarse crackles, absent (consolidation), pleural rub

33
Q

prevention for ARF

A

Deep breathing and coughing, incentive spirometry, and early ambulation

34
Q

goal of corticosteroids and bronchodilators

A

Reduce airway inflammation and bronchospasm

35
Q

goal of IV diuretics, Morphine, and Nitroglycerine

A

relieve pulmonary congestion

36
Q

goal of IV antibiotics

A

treat infections

37
Q

goal of Benzodiazepines and Opioids

A

Reduce anxiety, pain, and restlessness

38
Q

interventions to Mobilization Secretions

A

-Patient positioning- HOB 30, Side lying if Aspiration risk,
-huff coughing
-Chest physiotherapy-
-Suctioning
-Humidification- Thins secretions
-Hydration- 2-3 L/day, IV fluids (check for overload)

39
Q

huff coughing

A

Inhale deeply while leaning forward
Exhale sharply with a “huff” sound to help keep airways open while mobilizing secretions

40
Q

complications of suctioning

A

hypoxia, Hi ICP, Low BP, HTN, PVCs/Tachy/Bradycardia

41
Q

Positive pressure ventilation (PPV)

A

The provision of air under pressure by a mechanical respirator, a machine designed to improve the exchange of air between the lungs and the atmosphere.

42
Q

Noninvasive PPV must have…

A

spontaneous breathing, must be awake alert and have stable VS

43
Q

what are the two forms of positive pressure ventilation (PPV)

A

CPAP and BiPAP

44
Q

CPAP

A

continuous positive airway pressure

45
Q

BiPAP

A

bilevel positive airway pressure

46
Q

acute respiratory distress syndrome (ARDS)

A

a sudden and progressive form of acute respiratory failure in which the alveolar-capillary membrane becomes damaged and more permeable to intravascular fluid.

47
Q

What causes ARDS?

A

most common- sepsis
direct lung injury
indirect lung injury

48
Q

initial clinical manifestations of ARDS

A

Mild dyspnea, tachypnea, cough, restlessness
-Chest auscultation may be normal or may reveal fine, scattered crackles
-ABGs: Mild hypoxemia and respiratory alkalosis from hyperventilation
¡Chest x-ray : minimal interstitial infiltrates, progresses till lungs appear “whited out

49
Q

later signs of ARDS

A

-increased WOB
-tachypnea and intercostal reatration
-tachycardia, diaphoresis, changes in mental status, cyanosis, pallor
-diffuse or coarse crackles with expiration
-whiteout inflitrate on xray
-REFRACORY HYPOXEMIA despite 100% FiO2
-hypercapnia

50
Q

what drugs are given with cardiac involvement of ARDS

A

-Norepinephrine
-Dopamine
-Dobutamine

51
Q

¡Strategies for prevention of VAP

A

-Good hand hygiene
-Elevate HOB 30 to 45 degrees
-Daily oral care with chlorhexidine (0.12%) solution
-Daily assessment for readiness for extubation
-Stress ulcer prophylaxis
-Venous thromboembolism prophylaxis

52
Q

Positive end expiratory pressure (PEEP)

A

increased functional capacity; helps keep open/collapsed alveoli

NSG 430 - Critical Care (42 decks)

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