Acute resp failure Flashcards by Danielle Ramsey

Parameters for Hypoxemia

PAO2<60 on 60% O2

focuses on Oxygenation

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Parameters for hypercapnia

PaCO2 >45
pH<7.35
Focuses on ventilation

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What can cause hypoxemia/oxygenation failure

Pneumonia, Pulmonary embolism, pulmonary edema, ARDS

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What can cause hypercapnic/ventilatory failure

Asthma
• COPD
• Pain
• Drug overdose
• Neurological disorders
– MG
– GB
– MS

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Failure of Oxygenation

Hypoxemic Failure Physiological changes

-Low CO
-Low HGB
-Ventilation-perfusion mismatch (V/Q
mismatch)
– Intrapulmonary shunting
– Increased dead space ventilation
• Diffusion defects

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High V/Q & ex

Deadspace

alveoli ventilated but not perfused, can occur with PE

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Low V/Q & ex

Shunt, alveoli perfused but not ventilated

Fluid in alveoli (pneumonia)

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Anatomic shunt

blood passes throughout an anatomic channel in the heart bypassing the lungs– ventricular septal defect

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Physiologic shunt

Blood flows through the pulmonary capillaries without participating in gas exchange Low VQ
Pneumonia/ards

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Diffusion limitations

thickened alveolar capillary membrane impairs gas exchange

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What can cause failure of ventilation/hypercapnic failure

Alveolar hypoventilation
• Respiratory muscle fatigue
• CNS depressants
• Head injury
• Chest wall abnormalities
• Neuromuscular conditions

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Signs of hypoxemia

Tachycardia/Tachypneia
Inc BP
Restlessness 
Confusion 
Anxiety

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Signs of hypercapnia

Tachycardiac/tachypneia
Headache
Dec LOC
Inc Somnolence
Dizzy (maybe pink)
Flushed

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Why do patients go into tripod position

Increases AP diameter &decreases work of breathing

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General Resp failure

Physical symptoms

Pursed-lip breathing
• Retractions
• Orthopnea
• Tripod position – increases AP
diameter – decreases work of
breathing
• Inability to speak in full sentences (severe asthma &amp; other resp failure)

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Diagnostic Blood work for resp failure

Blood work
– Arterial blood gases (severe distress only due to invasive nature)
– SvO2 (severe distress only due to invasive nature)
– Hbg & Hct
– Sputum cultures (infection)
Pulse ox

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Diagnostic imaging for resp failure

CXR

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Medical management of Respiratory distress & why

• Oxygen/Respiratory Management

Bronchodilators (ease and help movement of air in and out)
Corticosteroids (Dec inflammatory process)
Diuretics (excess volume)
Hydration (prevent secretions from getting dry, dry secretions are hard to cough up)
Nutrition
Treatment of underlying cause

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Respiratory management of Acute resp failure (oxygen delivery devices)

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Nasal cannula (2-4L)
Face mask (25-40% O2) if nasal cannula isnt doing the job
Venturi mask
Nonrebreather

Noninvasive PPV
BiPAP
CPAP

PPV

Non rebreather

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Pt with SOB, sats low
Provide 100% to patient
Turn O2 up high so that it fills up with O2.

When pt breathes they inhale O2 and prevents CO2 from being rebreathed

Venturi

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Color coded for FIO2

Bipap/CPAP

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Positive pressure ventilation in non invasive way, tightly fit.
CPAP: Helps keep lungs/alveoli inflated.Continuous pressure at all time.

Bipap: more pressure on inhalation to inflate alveoli less pressure on exhalation to help exhale

What assesments would you do as the nurse to for acute respiratory failure

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Vitals (SPO2)
ABGS/Svo2
Neurological assessment (hypercapnic/O2 failure LOC)
Breath sounds
Cardiac monitoring

Secretion managment

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Chest physical therapy
Airway suctioning/effective coughing
Positioning: HOB, OOB,
good lung down (optimize ventilation perfusion ratio)

How to Hydration and humification

Adequate fluid intake IV hydration Humidification devices

What is Pneumothorax/Hemothorax

collection of air/blood in the pleural space reduction in the negative thoracic pressure and poor lung expansion Reduction of gas exchange at the alveolar level resulting in hypoxemia

Manifestations of hemo/pneumo thorax

``` Dec O2 Tachypnea= Resp alkalosis Later=Resp acidosi Pain (CXR & ECG r.o MI) SOB Agitation, anxiety Later - Dec LOC ```

How do you treat hemo/pneumo thorax

Chest tube | Dry (water seal chamber, traps air)

What should you monitor as the nurse for a hemo/pneumo thorax (Chest tube considerations

Monitor vital signs/spo2 pain SOB, secure connections (chest tube & container & chest & any connections), (bubbling on expiration is good, and still air in pleural space that is being emptied) Continuous bubbling is a leak! tidaling in the water seal chamber (air move up and down in inspiration/exp no more bubbling but still disruption). Disruption healed, no movement. Monitor drainage to report if excessive If there is a break, place distal end, place in water to maintain sterile water seal

Positioning of a hemo/pneumo thorax drain

Hemo: low to drop by gravity Pneumo: up high bc air rises

What should you monitor as the nurse for a hemo/pneumo thorax (vitals)

Monitor vital signs/spo2 pain SOB,

What happens if there is a break in the chest tube system

If there is a break, place distal end, place in water to maintain sterile water seal, immediately hook the system back up, DONT CLAMP!!!! Can cause pressure on the heart (tension pneumothorax)

Risk factors DVT (PE)

Virchow’s triad • Venous stasis/prolonged immobility** • Vessel wall damage • Hypercoagulability

General PE risk factors

``` -DVT – Virchow’s triad • Venous stasis/prolonged immobility • Vessel wall damage • Hypercoagulability • Obesity • Smoking • Fracture (hip/leg) • Major surgery/trauma • Malignancy ```

Types of PE

``` -Blood clot • Fat embolus • Air embolus • Amniotic fluid • Tumor particles ```

PE Patho

``` Obstruction in Pulmonary Artery->Ventilation‐ Perfusion Mismatch (high V/Q/dead space ventilation)->Hypoxemia Local Vasoconstriction ```

Classification of PE

Massive submassive low risk

Massive PE

– Profound hypotension – R & L ventricular dysfunction – Shock/cardiac arrest

Submassive PE

--Normotensive – R ventricular dysfunction – Elevated cardiac markers

Low Risk

Normotensive/No ventricular dysfunction or elevation in cardiac markers

Initial PE Symptoms

-Dyspnea • Chest pain** • Tachypnea • Tachycardia

Submassive/Massive | PE symptoms

``` • R heart failure with JVD • Hypotension • Anxious/restless/confused • Hypoxia • Poor peripheral perfusion • Hemoptysis with pulmonary infarction ```

Diagnosis of PE

``` Imaging CXR r/o other causes CT Scan Lab Testing D-Dimer: Fibrin degredation? ABG Cardiac markers ```

Treatment/medical management of PE

Anticoagulation (factor X, hep, warfarin) • IVC filters - prevent recurrence • Cautious fluid management (careful of R heart failure) • Hemodynamically compromised (break down clot) – Thrombolytics – Embolectomy – Vasoactive/inotropic support

Tests that nurse should monitor PE

``` Oxyfenation Chest pain VS Labs: ABGs Lactate Coag studies, cardiac markers UO: marker for CO ```

Nursing actions for PE

``` Provide O2 • Elevate HOB • Medication Management • Fluid management • Bleeding precautions ```

Acute resp failure Flashcards

(46 cards)