Acute Respiratory Failure (ARF) - Failure of? - Altered gas exchange (room air)

- Failure Oxygenation Ventilation Both of the above - Altered gas exchange (room air) PaO2 50 mm Hg pH ≤ 7.30

Intrapulmonary Shunting - What is it? - Causes - Why does administration of higher levels of oxygen not help in shunt disorders?

- 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

V/Q Mismatch - Most common cause of? - A mismatch occurs if? - What are the causes of this condition?

- 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

- Diffusion of O2 and CO2 does not occur Fluid in alveoli Pulmonary fibrosis

- Hemoglobin necessary to transport oxygen - 95% of oxygen is bound to hemoglobin - Low hgb=low oxygenation

Topic 6 Ch. 15 Flashcards by Chantelle Smith

Acute Respiratory Failure (ARF)

Failure of?
Altered gas exchange (room air)

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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Failure of Oxygenation (7 Causes)

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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Hypoventilation (3 Causes)

Drug overdose
Neurological disorders
Abdominal or thoracic surgery

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Intrapulmonary Shunting

What is it?
Causes
Why does administration of higher levels of oxygen not help in shunt disorders?

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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V/Q Mismatch

Most common cause of?
A mismatch occurs if?
What are the causes of this condition?

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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Diffusion Defects

Diffusion of O2 and CO2 does not occur
- Fluid in alveoli
- Pulmonary fibrosis

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Low Cardiac Output

-normal delivery

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

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Low Hemoglobin

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

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Failure of Ventilation can cause?

-Related to?

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

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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

B. Neuromuscular disease

Anxiety (hyperventilation)
pulm emb- perfusion

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Assessment of Respiratory Failure

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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Interventions for ARF (6)

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

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

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Nursing Diagnoses (11)

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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Medical Management of ARF (8)

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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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.

D. Reposition patient every 2 hours

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Treatment of ARDS (7)

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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ARDS

- Be alert for complications (4):

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

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

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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)

Medical Management of ARF in COPD

Correct hypoxemia includes:
Medications:

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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

Pharmacologic Therapy (4)

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

Ventilatory Assistance (4)

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NPPV
Intubation
End-of-life issues
Advance directives

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

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

Exacerbation of Asthma

Causes
Effects

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Causes
- Bronchodilators no longer working
- Noncompliance with medications
Effects
- Hyperventilation with air trapping results in respiratory acidosis
- Severe hypoxemia

Medical Management (4)

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

Pneumonia - Types (4) - Who is at increased risk of developing pneumonia?

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

Pathophysiology Pneumonia - What is it? - Causes

- Organisms in lower respiratory tract to overwhelm defense mechanisms - Causes * Aspiration * Inhalation * Spread from another infected area - Impaired mucociliary clearance

Prevention of Pneumonia (2)

- 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

Presentation of Pneumonia (7)

- Fever - Cough - Purulent sputum - Hemoptysis - Dyspnea/tachypnea - Chest pain (pleuritic) - Adventitious breath sounds

Ventilator- Associated Pneumonia (VAP)

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

VAP Bundle (5)

- 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

Prevention of VAP (7)

- 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

Treatment of VAP

Bacteria-specific antibiotic therapy

ARF: Pulmonary Embolus (PE)

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

PE Assessment

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

Diagnosis of PE

- 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

Prevention of PE

- 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

Complications of PE

- Heart failure - Obstructive shock - Death

Treatment for PE

- ABCs; oxygen - Thrombolytics (dissolve the clots) - Heparin - Monitor laboratory results for * Bleeding * Thrombocytopenia - Surgical procedures * Embolectomy * Vena cava umbrella (prevention)

Cystic Fibrosis

- 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

Cystic Fibrosis | - Cornerstones of care for a patient with CF

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

Transplant for CF

One treatment for CF is lung transplantation

ARDS Patho

- microatelectasis | - decreased

Topic 6 Ch. 15 Flashcards

(43 cards)