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Nursing 272: Final Semester > Unit 2: Acute Respiratory Failure > Flashcards

Unit 2: Acute Respiratory Failure Flashcards

1
Q

Acute Respiratory Failure

A

when one or both of the gas exchange functions (oxygenation or ventilation/CO2 removal) of the lungs are compromised
-life-threatening/ high mortality

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2
Q

Gas Exchange Functions of the Lungs

A
  • Oxygenation

- Ventilation/ CO2 removal

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3
Q

Compromise of the Gas exchange functions of the lungs leads to?

A

hypoxemia and/or hypercapnia/hypercarbia (increased PaCO2)

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4
Q

Types of Respiratory Failure

A
  • Hypoxemic Respiratory Failure (Type I)

- Hypercapnic Respiratory Failure

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5
Q

Hypoxemic Respiratory Failure

A

-PaO2 less than 60 mmHg

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6
Q

Hypercapnic Respiratory Failure

A
  • respiratory acidosis
  • PaCO2 greater than 50 mmHg
  • pH less than 7.35
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7
Q

Risk Factors for Hypoxemic Respiratory Failure (Type I)

A

include disease processes that produce a V/Q mismatch (ventilation/ perfusion) or impair oxygen diffusion at the alveolar level

  • pneumonia
  • pulmonary edema
  • PE
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8
Q

Risk Factors for Hypercapnic Respiratory Failure (Type II)

A

include diseases that impair ventilation or cause hypoventilation
>seen in patients with impaired chest-wall movement and thus impaired ventilation
-acute asthma
-narcotic overdose
-peripheral nervous system disorders

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9
Q

Risk Factors for Acute Respiratory Failure

A

> Impaired Ventilation (Hypoventilation):

  • airway obstruction
  • respiratory muscle weakness/paralysis that can occur w/ neuromuscular disease (myasthenia gravis)
  • chest-wall injury
  • anesthesia
  • opioid administration

> Ventilation-perfusion Mismatch (V/Q mismatch):

  • COPD
  • Restrictive lung diseases (pulmonary fibrosis)
  • Atelectasis
  • Pulmonary embolus (PE)
  • Pneumothorax
  • ARDS

> Impaired Diffusion (Alveolar):

  • Pulmonary Edema
  • ARDS
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10
Q

Early Clinical Manifestations of Acute Respiratory Failure

A
  • dyspnea
  • restlessness
  • anxiety
  • fatigue
  • increased BP from baseline
  • tachycardia
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11
Q

Intermediate Clinical Manifestations of Acute Respiratory Failure

A
  • confusion
  • lethargy (d/t increased CO2)
  • pink skin coloration (d/t increased CO2)
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12
Q

Late Clinical Manifestations of Acute Respiratory Failure

A
  • cyanosis

- coma

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13
Q

Laboratory and Diagnostic Tests

A
  • ABGs
  • Venous Oxygen Saturation
  • Hemoglobin and Hematocrit
  • Chest x-ray
  • Sputum cultures
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14
Q

ABGs

A

assess oxygenation and ventilation in the lungs

  • hypoxemic respiratory failure has an initial respiratory alkalosis d/t hyperventilation along w/ hypoxemia
  • once initial blood gases analyzed and treatment initiated, pulse oximetry is used to monitor oxygenation ( SpO2 greater than 94%; PaO2 of 80 mmHg)
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15
Q

Hemoglobin and Hematocrit

A
  • analyzed to make certain there is enough binding sites for oxygen to ensure adequate oxygen-carrying capacity
  • RBCs carry oxygen to the cells for cellular oxygenation; if not sufficient RBCs, the oxygen carrying capacity of the blood is diminished
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16
Q

Chest X-ray

A
  • show underlying pathology

ex: heart failure, pulmonary congestion, pneumonia, or pneumothorax

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17
Q

Sputum Culture

A

to r/o a pathogenic (i.e. bacterial or viral) cause of failure

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18
Q

Respiratory Failure

A

not a disease

  • condition caused by another disease or disorder
  • treat failure and underlying cause
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19
Q

Treatment for Acute Respiratory Failure

A
  • begins w/ oxygen
  • based on severity: start with Nasal cannula or Venturi Mask
  • in acute respiratory failure, placed on nonrebreather mask w/ 100% FiO2
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20
Q

Treatment for Cases of severe V/Q mismatch

A
  • Noninvasive positive-pressure ventilation (BIPAP or CPAP)
  • Invasive positive-pressure ventilation: requires an advanced airway such as an endotracheal tube (ETT) and mechanical ventilation
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21
Q

Medications used

A
  • inhaled bronchodilators
  • inhaled steroids
  • diuretics
  • sedation
  • antibiotics
22
Q

Inhaled Bronchodilators

A

open the airways by stimulating beta-2 receptor within the lungs
-helps to improve airflow b/c of an increase in the diameter of the airways

23
Q

Inhaled Steroids

A

help decrease the inflammatory response

  • decreases bronchoconstriction
  • increasing airway diameter
  • can be used synergistically w/ bronchodilators
24
Q

Diuretics

A

to decrease pulmonary congestion

25
Q

Sedation

A
  • to control agitation and anxiety that increase the work of breathing and oxygen consumption
  • needed if patient requires mechanical ventilation
26
Q

Antibiotics

A
  • initially broad spectrum to treat a suspected pneumonia

- adjusted if sputum culture is positive for bacterial infection

27
Q

Complications of Acute Respiratory Failure

A

if supplemental oxygen, mechanical ventilation, and medications do not halt the progression of respiratory failure at high risk for cardiac failure, multiple organ dysfunction, and death

28
Q

Nursing Management: Assessment and Analysis

A

clinical manifestations d/t hypoxemia and hypercapnia of acute respiratory failure

  • ABGs = decreasing oxygenation status and/or increased CO2 levels
  • Changes in mental status d/t decrease in cerebral perfusion
  • Agitation indicates hypoxia
  • Somnolence indicates hypercarbia
  • New-onset dyspnea, increased work of breathing, and tachypnea = early indicators of impending respiratory compromise
  • Tachycardia and Hypertension present initially as a compensatory response
29
Q

Nursing Diagnoses

A
  • Impaired gas exchange r/t alveolar hypoventilation, V/Q mismatching, and/or intrapulmonary shunting
  • Ineffective breathing pattern r/t muscular fatigue and/or neurological impairment
30
Q

Nursing Assessments

A
  • Airway
  • Vital Signs and Oxygen Saturation
  • ABGs
  • Cardiac Monitoring
  • Neurological Assessment (Agitation vs Somnolence)
  • Breath Sounds
  • Skin Coloration
31
Q

Assessments: Airway

A
  • airway patent?
  • breathing comfortably?
  • is there increased work of breathing?
  • does patient require suctioning or assistance w/ airway secretions?
32
Q

Assessments: Vital Signs and Oxygenation Saturation

A
  • BP, Pulse, and Respiratory rate increase as compensatory mechanisms to increase oxygenation in presence of hypoxemia
  • Fever may develop b/c of inflammation and/or infection
  • Pulse oximetry decreases from baseline b/c of V/Q mismatch, impaired diffusion, and/or alveolar hypoventilation
33
Q

Assessments: ABGs

A
  • Hypoventilation of type II failure results in CO2 retention, acidosis, and decrease PaO2
  • V/Q mismatch or diffusion defects of type I failure result in decreased PaO2
34
Q

Assessment: Cardiac Monitoring

A

-hypoxia and increased oxygen demand d/t tachycardia may lead to dysrhythmias

35
Q

Assessment: Neurological Assessment

A

change in mental status = early indication of impending respiratory failure

  • Agitation caused by hypoxemia
  • Somnolence caused by hypercapnia
36
Q

Assessment: Breath Sounds

A

underlying cause of respiratory failure may result in
>Crackles (pulmonary edema)
>Rhonchi (pneumonia, COPD)
>Diminished/Absent (hypoventilation)

37
Q

Assessment: Skin Coloration

A
  • Cyanosis: visible in nail beds and around the mouth in initial stages of hypoxemia
  • Central cyanosis: body takes on a blue or gray tinge
  • Deep pink coloration of skin: increased CO2 levels
38
Q

Nursing Actions

A
  • Administer oxygen (w/ humidity) as ordered
  • Medications (brochodilators, steroids, diuretics, sedation)
  • Elevate HOB; sit up in chair
  • Position patient w/ “good lung down”
  • Chest physical therapy and suctioning; ambulate as able
  • Administer IV fluids/hydration
  • Nutritional support
  • Be prepared for noninvasive or invasive positive-pressure ventilatory support
39
Q

Administer Oxygen w/ Humidity

A
  • supplemental oxygen necessary to treat hypoxemia
  • humidity helps prevent mucosal drying; helps keep secretions thin so that they can be more easily coughed or suctioned up
40
Q

Administer Bronchodilating meds as ordered

A

bronchial smooth muscle relaxants help open the airways

41
Q

Administer Steroids as ordered

A

-reduce inflammation
-synergistic effect w/ bronchodilators
>administer bronchodilator first, then inhaled steroids to allow the steroids to be inhaled more easily into bronchial tree

42
Q

Administer Diuretics as Ordered

A

helps decrease pulmonary congestion that impairs ventilation

43
Q

Administer Sedation as ordered

A
  • helps decrease anxiety and agitation
  • helps decrease work of breathing and oxygen consumption
  • usually for mechanical ventilated patients
44
Q

Elevated HOB; Sit patient up in bed

A
  • optimizes gas exchange
  • aids in the work of breathing
  • decreases risk of aspiration
45
Q

Position patient with “good lung down”

A

if underlying disease is unilateral, positioning w/ the good lung down improves gas exchange by optimizing the V/Q ratio
-gravity ensures the healthy lung maintains adequate blood flow to optimize ventilation to perfusion

46
Q

Chest Physical Therapy and suctioning; ambulate as able

A

-if excessive sputum is part of the underlying cause, positioning, postural therapy, percussion, vibration, and ambulation combined w/ assisted coughing or suctioning help mobilize and clear secretions

47
Q

Administer IV fluids/Hydration

A
  • decreases viscosity of secretions

- helps maintain intravascular volume

48
Q

Administer Nutritional Support

A

metabolic needs must be met to promote healing

49
Q

Be prepared for noninvasive or invasive positive-pressure ventilatory support

A

a severe V/Q mismatch may require the addition of positive pressure to adequately promote gas exchange

50
Q

Nurse Teachings

A
  • Disease process
  • Medications
  • Pulmonary Rehabilitation (breathing techniques, energy conservation, exercise)
  • Infection prevention
  • Diet and adequate hydration
  • Smoking Cessation
51
Q

Evaluating Care Outcomes

A

Goal: improve gas exchange

  • pulmonary rehabilitation in the form of exercise training, nutritional counseling, and breathing strategies to assist in recovery
  • successfully tx = able to return to baseline respiratory function
  • except in cases where the use of supplemental oxygenation use is the patients norm, a well-managed patient should not require supplemental oxygenation upon discharge
  • patient should be able to return to baseline activities of daily living, work, and social commitments

Nursing 272: Final Semester (79 decks)

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