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Respiratory Deterioration Flashcards

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1
Q

What is respiratory failure?

A

Where the respiratory system deteriorates due to impaired gas exchange

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2
Q

What is respiratory failure caused by?

A

Inability to oxygenate and eliminate CO2

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3
Q

What are the 2 types of respiratory failure?

A

Type 1: low oxygenation (hypoxaemia)- most common

Type 2: high CO2 (hypercapnia)

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4
Q

How would a patients body compensate and then deteriorate in respiratory failure?

A

Increased rr and expire CO2

This cant be maintained so pt will become tired- progressing to alveolar hypoventilation and increased CO2 retention

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5
Q

What is the best position to put a pt in when in respiratory failure?

A

Upright will assist w lung expansion

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6
Q

When should oxygen be administered?

A

When the pt is hypoxaemic and the O2 has been prescribed

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7
Q

What is a reservoir (non-rebreathe) face mask, how does it work and when is it used?

A

Highest amount of O2- 85% when set at 10-15L.
O2 flows into reservoir in 1 way valve, negative pressure inspiration causes the valve to open so the volume breathed is pure O2.
Used in severe respiratory depression and emergencies

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8
Q

How does a venturi facemask work and when is it used?

A

Jetting O2 through a narrow valve, O2 is diluted with a volume of air
Used when a known amount of O2 delivery is essential e.g. COPD pt

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9
Q

How does a simple face mask work?

A

Variable as O2 recieved depends on the volume the pt breathes.

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10
Q

When should nasal specs be used?

A

When wanting variable, more comfortable method of administering O2
Not suitable for mouth breathers

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11
Q

What is non-invasive ventilation?

A

Used when a mask isnt enough to support respiratory deterioration

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12
Q

What is high flow oxygen, how does it work and when is it used?

A

Via nasal cannula, requires humidification
Used in acute hypoxemic respiratory failure
60L/min
Reduces anatomical dead space, improves gaseous exchange, reduces work of breathing, provides CPAP and minimises room entrainment.
Comfortable.

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13
Q

How does CPAP work?

A

A tight fitting mask, nasal mask or mouthpiece
Deliveres a continuous positive pressure, positive end expiratory pressure (PEEP) is achieved through a PEEP valve.
Prevents alveolar collapse by creating a constant positive pressure thoughout inspiration and expiration
Increases functional residual capacity (FRC)
Improves gaseous exchange and oxygenation by improving O2 delievery to pulmonary capillaries
Recruit ateletactic areas and reduces the work of breathing

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14
Q

When is CPAP used?

A

Used in acute hypoxemic respiratory failure without hypercapnia
Treatment of pneumonia, ARDS, pulmonary fibrosis avoiding intubation and mechanical ventilation.

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15
Q

How does BiPAP work?

A

Same method of delivery as CPAP but difference is that it alternates between 2 pressure levels: IPAP (inspiratory pressure) and EPAP (Expiratory pressure) also known as CPAP
Assists w inspiratory breath, decreases work of breathing, increases tidal volume and decreases CO2

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16
Q

When is BiPAP used?

A

Used in type 2 respiratroy failure (hypercapnia)

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17
Q

What are the indications for NIV in COPD patients?

A

Acidosis
Increased pCO2
Increased RR

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18
Q

What are the indications for NIV in patients with neuromuscular disease?

A

Increased RR
Increased pCO2
Acidosis

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19
Q

What are the indications for NIV in patients with obesity?

A

Acidosis
Increased pCO2
Increased RR

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20
Q

When is NIV not indicated in patients with respiratory distress and what to do instead?

A

When they have asthma or pneumonia

Refer to ICU for consideration IMV due to increased RR/distress or acidosis/increased pCO2

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21
Q

What are some absolute contraindications for NIV?

A

Severe facial deformity
Facial burns
Fixed upper airway obstruction

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22
Q

What are the relative contraindications for NIV?

A

PH <7.15
GCS<8
Confusion/agitiation
Cognitive impairment

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23
Q

What are the settings for NIV?

A 
Mask
Initial pressure settings: 
EPAP: 3 or higher
IPAP in COPD/OHS/KS 15 (20 if pH <7.25)
IPAP in NM 10
Backup rate 16-20
I:E ratio:
COPD: 1:2 to 1:3
OHS, NM and CWD 1:1
Inspiratory time: 0.8-1.2 COPD
1.2-1.5 OHS, NM, CWD
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24
Q

What does an arterial blood gas measure?

A

PaCO2 and PaO2
Hypoxaemia
Hypercapnia
Changes in metabolic functions

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25
What does a venous blood gas measure?
SaO2 Hypercapnia Changes in metabolic functions
26
Positives and negatives to arterial and venous blood gases
Arterial: can see hypoxemia and partial pressures Venous: less painful
27
Why is it necassary for blood pH to be maintained?
Maintainence of cell membranes and enzyme activity
28
What is PaO2?
Conc of O2 in arterial blood
29
What is SaO2?
Amount of haemaglobin occupied by O2
30
What is PaCO2?
The concerntration of CO2 in the blood
31
What is HCO3?
The main base found in serum | Helps regulate pH because of ability to accept H+ ions
32
What is HCO3 regulated by?
The kidneys
33
Whay does changes in HCO3 reflect
A metabolic problem
34
What is the range for pH levels?
7.35-7.45
35
What is the range for PaCO2?
4.27-6.40
36
What are the ranges for PaO2?
11-14.4
37
What are the ranges for HCO3?
22-26mmol/L
38
What are the normal levels of lactate
0.5-1.6
39
What are the 4 possible primary acid-base disorders?
Respiratory acidosis- respiratory failure Respiratory alkalosis- hyperventilation Metabolic acidosis- low cardiac output Metabolic alkalosis- vomiting
40
How does PaCO2 and pH get affected by respiratory acidosis?
PaCO2 increases, pH decreases
41
How does PaCO2 and pH get affected by respiratory alkalosis?
PaCO2 decreases and pH increases
42
How does HCO3 and pH get affected by metabolic acidosis?
HCO3 and pH both decrease
43
How does HCO3 and pH get affected by metabolic alkalosis?
HCO3 and pH increase
44
What is the acronym to remember the change in PaCO2 HCO3 and pH?
ROME | Respiratory opposite, metabolic even
45
What is the kPa of PaCO2 that would class as respiratory failure?
>8kPa | <6.7kPa
46
Whats the difference between type 1 and type 2 respiratory failure?
Type 1: PaCO2 is low | Type 2: PaCO2 is high
47
what is an obstructive respiratory condition?
Cant get air out
48
What is a restrictive respiratory condition?
Cant get air in
49
Causes of a restrictive lung disorder
``` PAINT Pleural effusion ARDS Instititual- pulmonary fibrosis Neuromuscular- myasthenia gravis Thoracic- obesity, kyphoscoliosis ```
50
Causes of an obstructive lung disorder
``` Asthma COPD Chronic bronchitis Emphysema Bronchiectasis Cystic fibrosis ```
51
What is pneumonia?
Acute inflammation of the lungs Alveolar filling with exudate and debris= filling with neutrophils, leucocytes, erythrocytes and fibrins= a solid mass formed= consolidation of lungs.
52
What is ARDS?
Acute respiratory distress syndrome: Inflammation of lungs= cytokine-meditated activation with accumulation of neutrophils damaging endothelial cells and capillary epithelial= increased capillary permaebility= flooding of alveoli with proteinaceoud fluid.
53
What are some direct causes of ARDS?
Pneumonia | Aspiration
54
What are some indirect causes of pneumonia?
Burns, trauma and sepsis
55
How does the virus-SARS-COV-2 infect the body?
3 stages: 1: symptomatic- virus binds to nasal epithelial cells through aerosols 2: virus invades upper respiratory tract and infects ciliated cells in upper airway 3: virus spreads to lower respiratory tract via host receptor ACE-2 and starts to replicate This leads to the release of cytokines and inflammatory markers= inflammatory and lung injury Leading to direct injury of lung tissue from viral infection= mediated inflammatory response= cytokine storm
56
What is the treatment plan for acute respiratory problems?
``` Prone position of the pt rather than supine CV support Broad-spectrum antibiotics Fluid management Thromboprophylaxis ```
57
What are the 4 branches of nebulisers?
Bronchodilators Anticholinergics Steroids Mucolytics
58
How do bronchodilators work?
Relaxes smooth muscle and stops bronchospasms= widens airway
59
How do anticholiergics work?
Blocks cholinergic receptors= relaxation of bronchial smooth muscle
60
How do steroid nebulisers work?
Reduces inflammation and activity of immune system- widening airway
61
How do mucolytics work?
Assist with expectoration of sputum
62
How to care for a nebuliser
Single use Replace every 48 hours Label and keep dry Fill with sterile water to prevent contamination
63
What is V/Q mismatch?
Ventilation (O2 to alveolar) doesnt match blood flow going to alveolar
64
What factors affect the oxygen-haemoglobin association curve?
Temp PH CO2
65
What are some risk factors for respiratory deterioration?
Infection: viral and bacterial Cardiovascular: HF- congestion= affects gaseous exchange Acute exasterbation of LT conditions: asthma, COPD, cystic fibrosis, restrictive lung disease
66
What is respiratory failure?
Where the respiratory system deteriorates due to impaired gas exchange, caused by inability to oxygenate or eliminate CO2 Can be acute or chronic
67
Why is arterial O2 important to take in some cases?
Shows the O2 uptake, transfer and release throughout the body
68
What info can be recieved through blood gases?
``` PH PaCO2 PaO2 HCO3 Lactate Electrolytes Blood glucose Haemaglobin ```
69
If the primary problem of the body is metabolic, how will the body try to compensate?
Correct the pH by breathing faster= more O2 Lungs will compensate for metabolic abnormality within hours Kidneys compensate for a respiratory abnormality within 2-4 days
70
What are the symptoms for respiratory acidosis?
``` Increased PaCO2 Decreased pH Decreased ventilation Sensitive to pH changes Stimulated by a fall in pH Leads to hyperventilation= increasrd RR ```
71
What are the signs and symptoms of COPD?
``` SOB over years Chronic cough Impaired exercise tolerance Overinflated lungs, impaired gaseous exchange Flatterning of diaphragm on CXR ```
72
What is chronic bronchitis?
Inflammation of airways, oedema and hyperplasia of submucosal glands, excess mucus secretion into bronchial tree leading to airflow obstruction
73
What are the signs and symptoms of chronic bronchitis?
Chronic productive cough Increased sputum Prolonged expiration Wheezing
74
What are the causes of chronic bronchitis?
Smoking Air pollution Occupational exposure to nitrogen
75
What are the causes of emphysema?
Smoking | A1-antitrypsin deficiency
76
What is the pathophysiology of emphysema?
Breakdown of elastin by enzymes (protease) A1-antitrypsin usually protects lungs from destructive inflammatory cells Smoking stimulates inflammatory cells into lungs increasing protease= loss of elasticity Abnormal enlargement of airspaces distal to terminal bronchioles Destruction of alveolar walls Hyper-inflated lungs Increased total lung capacity Increased airway resistance, decreased lung elastic recoil
77
What are the signs and symptoms of emphysema?
``` Difficulty exhailing Nasal flaring Barrel chest Pulmonary hypertension Super-clavicular wasting ```
78
what is the management of AECOPD?
``` Optimal medical therapy Target SaO2 88-92% A- antibiotics B- beonchodilators C- corticosteriods Theophylline of no response ```
79
What are bronchodilators?
Medications that dilate the breathing passages through relaxation of the bronchial smooth muscle Can be short or long acting
80
What are the classifications of bronchodilators?
Adrenergic- against action Anticholinergic- antagonist action Bronchodilator carbonations Methylxanthines
81
Explain the pharmacology of bronchodilators
B-agonist causes receptor to respond Anticholenergic- antagonist- stops anti-muscarinic receptors from acting Normally muscorinic receptors= smooth muscle constriction as part of parasympathic response= inhibits action of musconaric receptors= stops constriction of smooth muscle= dilation Phosphodiesterase inhibitor- inhibits enzymes that allow relaxation of smooth muscle
82
Give 2 examples of selective beta2 agonists
Salbutamol, terabutaline
83
Give 2 examples of anti-muscarinic bronchodilators
Ipratropium bromide | Tiotropium
84
Give 2 examples of methyxanthines
Theophilline- beware of interactions | Aminophylline
85
When should NIV be started?
When acidotic and persistant hypercapnia
86
What are some lungs diseases that affect the pleura?
Pleural effusion Pneumothorax Pleurisy Haemothorax
87
What is a pneumothorax?
A collection of air between visceral and parietal pleura | Can be a critical condition depending on extension of lung collapse
88
What are the causes of a pneumothorax?
Trauma Surgery Spontanious rupture of air filled bleb- common in COPD Iatrogenic
89
What is a tension pneumothorax?
Life threatening causing a shift of the mediasteinum and haemodynamic instability
90
What are the symptoms of a pneumothorax?
``` Chest pain SOB Assymetrical lung expansion Hyperreasonance Decreased breath sounds Tachycardia Trachial denation Jugular venous distension Cardiac apical displacement ```
91
How do chest drains work?
Expiratory positive pressure from pt Gravity Suction
92
What are the causes of hospital aquired pneumonia?
Ventilation associated pneumonia Aspiration- intubated, post-op Immunosuppression- long term patients Causitive agent can be viral or bacterial
93
Name the lower respiratory tract infections from larynx to alveoli
``` Bronchitis Pneumonia Broncholitis Tuberculosis ARDS ```
94
What is the protocol for pts with suspected viral respiratory infections?
Place in a single isolations room Instruct pt to wear a mask if need to leave the room, Use disposable tissue to cover mouth and nose, Wash hands properly Nurses should: follow correct PPE guidelines

Acute Changes In Health Status (3 decks)

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