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Critical Care Nursing > Topic 6 Ch. 15 > Flashcards

Topic 6 Ch. 15 Flashcards

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1
Q

Acute Respiratory Failure (ARF)

  • Failure of?
  • Altered gas exchange (room air)
A
  • Failure
    • Oxygenation
    • Ventilation
    • Both of the above
  • Altered gas exchange (room air)
    • PaO2 < 60 mm Hg
    • PaCO2 > 50 mm Hg
    • pH ≤ 7.30
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2
Q

Failure of Oxygenation (7 Causes)

A
  • Hypoventilation
  • Intrapulmonary shunting
  • Ventilation-perfusion mismatch
  • Diffusion defects
  • Decreased barometric pressure
  • Low cardiac output (nonpulmonary hypoxemia)
  • Low hemoglobin level (nonpulmonary hypoxemia)
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3
Q

Hypoventilation (3 Causes)

A
  • Drug overdose
  • Neurological disorders
  • Abdominal or thoracic surgery
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4
Q

Intrapulmonary Shunting

  • What is it?
  • Causes
  • Why does administration of higher levels of oxygen not help in shunt disorders?
A
  • Blood shunted from right to left side of heart without oxygenation
  • Qs/Qt disturbance
  • Causes: atrial or ventricular septal defect, atelectasis, pneumonia, pulmonary edema
  • The increased oxygen is unable to reach the alveoli.
    • Treatment directed toward opening alveoli and improving ventilation
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5
Q

V/Q Mismatch

  • Most common cause of?
  • A mismatch occurs if?
  • What are the causes of this condition?
A
  • Most common cause of low O2
    • Normal ventilation (V) is 4 L/min
    • Normal perfusion (Q) is 5 L/min
    • Normal V/Q ratio is 4/5 or 0.8
  • A mismatch occurs if either
    • V is decreased or
    • Q is decreased
  • Causes: Respiratory failure, pneumonia, pulmonary edema, pulmonary embolism
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6
Q

Diffusion Defects

A
  • Diffusion of O2 and CO2 does not occur
    • Fluid in alveoli
    • Pulmonary fibrosis
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7
Q

Low Cardiac Output

-normal delivery

A
  • Cardiac output must be adequate to maintain tissue perfusion
  • Normal delivery is 600 to 1000 mL/min of oxygen
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8
Q

Low Hemoglobin

A
  • Hemoglobin necessary to transport oxygen
  • 95% of oxygen is bound to hemoglobin
  • Low hgb=low oxygenation
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9
Q

Failure of Ventilation can cause?

-Related to?

A
  • Hypercapnia
  • Related to:
    • Alveolar hypoventilation—decrease in ventilation and hypoxemia
    • V/Q mismatch
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10
Q

The nurse suspects respiratory failure secondary to hypoventilation in a patient with:
A. Anxiety
B. Neuromuscular disease
C. Pulmonary embolism
D. Volume A/C ventilation at rate of 20 breaths/min

A

B. Neuromuscular disease

  • Anxiety (hyperventilation)
  • pulm emb- perfusion
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11
Q

Assessment of Respiratory Failure

A
  • Neurological— shows earliest signs of hypoxemia and hypercapnia
  • Respiratory
  • Cardiovascular
  • Nutrition
  • Psychosocial
  • Chest x-ray
  • Pulmonary function tests
  • Laboratory studies
  • Arterial blood gases (ABGs)
  • Pulse oximetry and end-tidal CO2
  • Elderly less sensitive chemoreceptors and CNS
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12
Q

Interventions for ARF (6)

A
  • Maintain a patent airway
  • Optimize O2 delivery
  • Minimize O2 demand (rest)
  • Identify and treat the cause of ARF
  • Prevent complications
  • 100% non rebreather is the highest level (resevior bag must be inflated). If they can’t breath you do a bag valve mask (breath for them)
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13
Q

What nursing interventions assist in reducing oxygen demands? (5)

A

Keep quiet, rest, calm, sedation, reduce their anxiety

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14
Q

Nursing Diagnoses (11)

A
  • Impaired ventilation
  • Ineffective airway clearance
  • Infection
  • Anxiety
  • Impaired skin integrity (risk for pressure ulcers)
  • Ineffective coping
  • Ineffective breathing pattern
  • Impaired gas exchange
  • Impaired breathing pattern
  • Fluid volume excess (maybe left sided HF)
  • Altered nutrition
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15
Q

Medical Management of ARF (8)

A
  • Oxygen
  • Bronchodilators (are they bronchoconstricted? asthma, COPD, emphysema)
  • Corticosteroids
  • Sedation (ativan due to anxiety, air hunger, expending energy)
  • Transfusions (whats their HgB)
  • Therapeutic paralysis (if they are fighting it)
  • Nutritional support (are they ventilated?)
  • Hemodynamic monitoring
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16
Q 
A nursing intervention to maximize airway clearance is which of the following?
A. Administer supplemental oxygen.
B. Elevate the head of bed.
C. Provide oral care every 4 hours.
D. Reposition patient every 2 hours.
A

D. Reposition patient every 2 hours

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17
Q

Treatment of ARDS (7)

A
  • Comfort
    • Sedation
    • Pain relief
    • Neuromuscular blockade
  • Decrease O2 consumption
  • Positioning
    • Prone positioning
    • Continuous lateral rotation therapy
  • Fluid and electrolyte balance
  • Adequate nutrition
  • Pharmacologic intervention
  • Psychosocial support
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18
Q

ARDS

- Be alert for complications (4):

A
  • Multiple organ dysfunction syndrome
  • Renal failure
  • Disseminated intravascular coagulation
  • Long-term pulmonary effects associated with high oxygen and other therapies
19
Q

ARF in Chronic Obstructive Pulmonary Disease (COPD) Assessment (10)

A
  • Dyspnea
  • Chronic cough
  • Sputum production
  • Postbronchodilator spirometry limitations
  • Pulmonary function studies
  • Chest wall changes (barrel chest)
  • Accessory muscles used for breathing
  • Clubbing of the fingers
  • Wheezing and crackles
  • ABG (hypoxemia and hypercapnia)
20
Q

Medical Management of ARF in COPD

  • Correct hypoxemia includes:
  • Medications:
A
  • Correct hypoxemia
    • Cautious administration of O2
    • Noninvasive positive-pressure ventilation
    • Ventilatory assistance
  • Medications
    • Beta2 agonists (bronchodilators)
    • Corticosteroids
    • Antibiotics (depends on cause)
    • Cautious administration of sedatives
21
Q

Pharmacologic Therapy (4)

A

1) Short-acting inhaled beta2-agonists
2) Long-acting beta2-agonists
3) Corticosteroids (prednisone)
4) Antibiotics

22
Q

Ventilatory Assistance (4)

A
  • NPPV
  • Intubation
  • End-of-life issues
  • Advance directives
23
Q

Exacerbation of Asthma symptoms. What will the patient present with? (7)

A
  • Wheezing
  • Dyspnea
  • Chest tightness
  • Use of accessory muscles
  • Nonproductive cough
  • Hyperventilation initially
  • Peak expiratory flow reading is less than 50% of normal values
24
Q

Exacerbation of Asthma

  • Causes
  • Effects
A
  • Causes
    • Bronchodilators no longer working
    • Noncompliance with medications
  • Effects
    • Hyperventilation with air trapping results in respiratory acidosis
    • Severe hypoxemia
25
Q

Medical Management (4)

A
  • Oxygen; ventilation in severe cases
  • IV corticosteroids
  • Inhaled bronchodilators; rapid-acting beta2-agonists
  • Teaching
26
Q

Pneumonia

  • Types (4)
  • Who is at increased risk of developing pneumonia?
A

1) Community-acquired
2) Health care–acquired
3) Hospital-acquired
4) Ventilator-associated
- Increased risk: elderly, alcoholic, smokers, chronic diseases, head injury, immunosuppression

27
Q

Pathophysiology Pneumonia

  • What is it?
  • Causes
A
  • Organisms in lower respiratory tract to overwhelm defense mechanisms
  • Causes
    • Aspiration
    • Inhalation
    • Spread from another infected area
  • Impaired mucociliary clearance
28
Q

Prevention of Pneumonia (2)

A
  • Influenza vaccine
    • All persons over 6 months
    • People at high risk for complications of influenza
    • People in contact with those at high risk
    • Health care providers
  • At age 65, pneumococcal vaccination to prevent Streptococcus or pneumococcus
    • Conjugate dose
    • Polysaccharide dose
29
Q

Presentation of Pneumonia (7)

A
  • Fever
  • Cough
  • Purulent sputum
  • Hemoptysis
  • Dyspnea/tachypnea
  • Chest pain (pleuritic)
  • Adventitious breath sounds
30
Q

Ventilator- Associated Pneumonia (VAP)

A
  • Aspiration of bacteria from oropharynx or gastrointestinal tract
  • Many potential causes
  • Controversies about best way to diagnose—no “gold standard”
31
Q

VAP Bundle (5)

A
  • Elevate head of bed 30 to 45 degrees
  • Awaken daily and assess readiness to wean and extubate
  • Stress ulcer disease prophylaxis
  • Venous thromboembolism (VTE) prophylaxis
  • Oral care
32
Q

Prevention of VAP (7)

A
  • Hand washing and standard precautions
  • Surveillance
  • Ventilator bundle
  • Prevent transmission
    • Sterile water in circuit
    • Drain condensate AWAY from patient
    • Avoid normal saline during suctioning
  • Prevent infection and aspiration
    • Avoid reintubation
    • Oral intubation
    • ETT with continuous aspiration of subglottic secretions
    • Sedation and weaning protocols
    • Aseptic suctioning of endotracheal tube (ETT)
  • Nutrition
  • Mobilization
33
Q

Treatment of VAP

A

Bacteria-specific antibiotic therapy

34
Q

ARF: Pulmonary Embolus (PE)

A
  • Virchow’s triad
    • Venous stasis
    • Altered coagulability
    • Damage to vessel wall
  • Embolus results in a lack of perfusion to ventilated alveoli (V/Q mismatch)
35
Q

PE Assessment

A
  • Symptoms of deep venous thrombosis
  • Chest pain (worse on inspiration)
  • Dyspnea
  • Tachycardia
  • Tachypnea
  • Cough; hemoptysis
  • Crackles, wheezes
  • Hypoxemia
36
Q

Diagnosis of PE

A
  • Clinical signs and symptoms
  • D-dimer assay (positive)
  • V/Q scan with high probability of PE
  • Duplex ultrasound (DVT)
  • High-resolution multidetector computed tomography angiography (MDCTA; spiral CT)
  • Pulmonary angiogram
37
Q

Prevention of PE

A
  • Medications
    • Heparin, low–molecular weight heparin
  • Mechanical
    • Sequential compression devices
    • Foot pumps
    • Compression stockings
  • Position changes
  • Treatment of atrial dysrhythmias
  • Prophylactic anticoagulant therapy
    • Warfarin; long-term prevention
38
Q

Complications of PE

A
  • Heart failure
  • Obstructive shock
  • Death
39
Q

Treatment for PE

A
  • ABCs; oxygen
  • Thrombolytics (dissolve the clots)
  • Heparin
  • Monitor laboratory results for
    • Bleeding
    • Thrombocytopenia
  • Surgical procedures
    • Embolectomy
    • Vena cava umbrella (prevention)
40
Q

Cystic Fibrosis

A
  • Genetic disorder
  • Mutation in chloride transport results in “sticky” mucus that obstructs glands:
    • Lungs (greatest effect)
    • Pancreas
    • Liver
    • Salivary glands
    • Testes
  • Thick mucus in lungs is medium for infection, chronic bronchitis, and ARF
  • Considered to be a disease of childhood
  • Improvements in care have prolonged life expectancy
41
Q

Cystic Fibrosis

- Cornerstones of care for a patient with CF

A
  • Antibiotic therapy
  • Airway clearance
  • Nutritional support
  • Ventilatory support
  • Pseudomonas aeruginosa is the most common pathogen found in adult patients with CF
42
Q

Transplant for CF

A

One treatment for CF is lung transplantation

43
Q

ARDS Patho

A
  • microatelectasis

- decreased

Critical Care Nursing (15 decks)

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