Topic 6 Ch. 15 Flashcards
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
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)
3
Q
Hypoventilation (3 Causes)
A
- Drug overdose
- Neurological disorders
- Abdominal or thoracic surgery
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
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
6
Q
Diffusion Defects
A
- Diffusion of O2 and CO2 does not occur
- Fluid in alveoli
- Pulmonary fibrosis
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
8
Q
Low Hemoglobin
A
- Hemoglobin necessary to transport oxygen
- 95% of oxygen is bound to hemoglobin
- Low hgb=low oxygenation
9
Q
Failure of Ventilation can cause?
-Related to?
A
- Hypercapnia
- Related to:
- Alveolar hypoventilation—decrease in ventilation and hypoxemia
- V/Q mismatch
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
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
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)
13
Q
What nursing interventions assist in reducing oxygen demands? (5)
A
Keep quiet, rest, calm, sedation, reduce their anxiety
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
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
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
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
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
