Respiratory failure (ARF)

Question 1

Acute respiratory failure is not a disease but a what ?

Answer 1

Symptom

Question 2

Why is acute respiratory failure a symptom?

Answer 2

because respiratory failure reflects insufficient lung function, usually being caused by an underlying condition

Question 3

As mentioned previously acute respiratory failure is usually a result from an underlying condition, remembers its a symptom, not a disease, can you give examples to what others systems can cause respiratory failure ?

Answer 3

cardiac system
Centeral nervous system

Question 4

how does respiratory failure occur ?

Answer 4

when oxygenation, ventilation or both are inadequate

Question 5

What is the term called when you do not have enough oxygen in the blood ?

Answer 5

Hypoxemia

Question 6

What is the term called when you have too much carbon dioxide in the blood called ?

Answer 6

hypercapnia

Question 7

what are the 2 ways you can get respiratory failure?

Answer 7

either from the lack of oxygen
or
from having too much carbon dioxide

Question 8

can patients have both types of respiratory failure at the same time ?

Answer 8

yes

Question 9

how does acute respiratory failure present itself in a patient?

Answer 9

usually tachycardia, low blood pressure, increase respiratory rate and confusion may occur

Question 10

how does chronic respiratory failure present itself in a patient?

Answer 10

develops slowly over days and weeks, generally starts off stable changes into changes that are no longer compensatory for the patient

Question 11

its very common sense to know that when a patient is having a hard time breathing because hypoxemic respiratory failures is the depletion of air, but do you think hypercapnic respiratory failure does the same for the patient?

Answer 11

no, its not from the lack of air, its from the lack of explection of air

Question 12

what are the 4 ways that hypoxemic respiratory failure occurs ?

Answer 12

V/Q mismatch
Shunt
Diffusion Impairment
Alevolar hypoventilation

Question 13

what is v/q mismatch for hypoxemic respiratory failure, explain to me what this is ?

Answer 13

v/q mismatch is when ventilation ( airflow ) or perfusion ( blood flow ) in the lungs is impaired,

meaning its preventing the lungs from optimally delivering oxygen to the blood

Question 14

what are some causes of v/q mismatch ?

Answer 14

lung disease
- COPD, asthma, atelectasis
Pain
- increased stress causes metabolic rate, meaning it increases the need of o2

atelectasis
pulmonary embolism

Question 15

what is the first treatment for v/q mismatch, or in general when a patient is experiencing hypoxemic respiratory failure?

Answer 15

sit them up, provide 02 and treat the underlying cause

Question 16

what are some common diagnostic methods we can use on a patient to see hypoxemic respiratory failure?

Answer 16

ABGs
pulse ox
LOC assessment
respiratory assessment

Question 17

what is a shunt in the terms of hypoxemic respiratory failure ?

Answer 17

blood leaves the heart without gas exchange - extreme v/q mismatch

in other terms, blood will leave the heart however it will not receive fresh oxygen and not get rid of the carbon when trying to make that exchange

Question 18

what’s the difference between shunt and a v/q mismatch?

Answer 18

v/q mismatch is the imbalance between ventilation and blood flow

shunt is from the result of reduced ventilation relate to blood Flow, leading to decreases oxygenation

Question 19

what are 3 main causes of shunting in hypoxemic respiratory failure?

Answer 19

anatomic shunt ( heart )
- ventricular septal defect

intrapulmonary/capillary shunt
- blood flows through pulmonary capillaries without exchanging gases
- pneumonia for example

mechanical ventilation with high levels of oxygen

Question 20

what is diffusion impairment of hypoxemic respiratory failure?

Answer 20

gas exchange across alveolar - capillary membrane is compromised by scarring of alveoli due to fibrosis or fluid in alveoli

gas exchange is happening so like oxygen and carbon dioxide are being able to change, however due to scarring in the alveoli, its preventing that, so think of like if scars were there, this wouldn’t be happening

Question 21

what is a classical sign of diffusion impairment ?

Answer 21

you are breathing fine when resting, but then the second you do any movement or exercise, hypoxemic

patho behind this is because when you move, cardiac output causes blood to flow faster to the heart and there is no time to diffusion

Question 22

what is alveolar hypoventilation in hypoxemic respiratory failure?

Answer 22

its a decreased ventilation learning to increase CO2 in the body
- mainly its associated with hypercapnic respiratory failure but since there is no air being pumped through, thats why its hypoxemic

Question 23

what are some main causes of hypoxemic alveolar hypoventalation?

Answer 23

CNS conditions
chest wall dysfunction
acute asthma
resitrictive lung disease

Question 24

what is the patho/ consequence of hypoxemia ?

Answer 24

when you dont have oxygen in your body, you become hypoxic ( not enough oxygen in your tissue ) learning to anaerobic metabolism

this releases lactic acid then causing your body to go into metabolic acidosis from how intense it is -> then cellular death

Question 25

can your oxygen levels be normal when you are hypercapnic ? if yes why ? if no why?

Answer 25

yes, because oxygen is being in your body and releasing, however its due to the fact that you have so much carbon in your body that you go into respiratory failure

Question 26

hypercapnic respiratory failure is considered a ____ failure and why ?

Answer 26

ventilatory failure because you literally can't vent out the carbon in you

Question 27

what are the 2 methods that hypercapnic respiratory failure occurs?

Answer 27

either in an increase of co2 production, that your body kinda creates or decrease in alveolar ventilation which allows for distribution of carbon to stay in the body for longer than needed

Question 28

what are the 4 causes of hypercpanic respiratory failure?

Answer 28

CNS problems neuromuscular conditions chest wall abnormalities conditions affected the airways and or alveoli

Question 29

can hypercapnic respiratory failure happen when you have normal lungs ?? can hypoxemic respiratory failure happen when you have normal lungs ?

Answer 29

yes no

Question 30

how does CNS problems cause / affect hypercpanic respiratory failure? can you provide examples and explain this ?

Answer 30

suppress the drive to breathe think of opioids, biggest thing to remember is the fact that it causes respiratory depression, the brain won't even recognize the increase of co2 cause you're not breathing it out

Question 31

how does neuromuscular problems cause/ effect hypercapnic respiratory failure ? can you provide an example of this ?

Answer 31

respiratory muscles can either be weak or paralysis causing difficultly exhaling CO2 GBS peripheral nerve damage

Question 32

how does chest wall abnormalities affect hypercapnic respiratory failure ? can provide examples of this?

Answer 32

it prevents normal movement of chest wall and or diagram and limit the lung expansion severe obesity flail chest

Question 33

how does airway and alveoli issues affect hyerpanic respiratory failure, there are 2 ways it does this ? can you also provide at least one example of this ?

Answer 33

increased work of breathing due to obstruction from increased airway resistance air trapping leads to respiratory muscle fatigue and ventilatory failure cystic fibrosis COPD asthma

Question 34

which do you think the body can tolerate more, having no oxygen or having too much carbon ?

Answer 34

having too much carbon because if you have no oxygen, you're a goner

Question 35

how can respiratory failure be different from one another, think of the fact of severity reasons ? (3)

Answer 35

either from the amount of little or too much carbon/oxygen in the body speed of change, acute vs chronic the ability to compensate, maybe easier for younger people than older

Question 36

what is the first sign of hypoxemic ARF ?

Answer 36

changes in mental status - agitation, restlessness, confusion

Question 37

what is the first sign of hypercapnic arf?

Answer 37

morning headache ( somnolence ) decreased RR decreased LOC sleepy, tired, confused

Question 38

what are some early signs of ARF, this applies to either hypoxemic or hypercapnic ?

Answer 38

tachycardia tachypnea pallor mild increased work of breathing

Question 39

what is a late sign of hypoxemia ?

Answer 39

cyanosis

Question 40

what are some main things to look out for symptoms wise with patients going into hypoxemia respiratory failure?

Answer 40

accessory muscles nasaling flairng spo2 less than 80% paradoxical chest movement ( late ) cyanosis ( late )

Question 41

what are some specific signs of hypercapnia symptoms wise ?

Answer 41

tripod position pursed-lip-breathing shallow respirations

Question 42

what is the main priority we need to do when a patient is not being able to breathe ? test questions what if you walk into the patients room and you see them struggling to breathe, what are you going to do ?

Answer 42

sit them up and provide oxygen

Question 43

some basic questions what are some assessment are we going to do with a patient with ARF?

Answer 43

position work of breathing ability to speak respiratory rates ausculate breathe sounds accessory muscles

Question 44

what are some diagnostic studies for arf?

Answer 44

chest x-ray ABG ct scan

Question 45

what are some factors we want to consider when taking care of patients who are experiencing arf?

Answer 45

age severity of onset underlying conditions most likely causes

Question 46

what do we want to encourage patients to be doing when having arf?

Answer 46

cough deep breathing incentive spirometry

Question 47

what do we want to prevent with patients who are having arf?

Answer 47

atelectasis pneumonia

Question 48

what are the 5 interventions of arf? MP!!! For ARF

Answer 48

oxygen mobilization of secretions positive pressure ventilation medication nutritions

Question 49

what's the goal of oxygen with arf?

Answer 49

maintain adequate o2 and correct acid-base

Question 50

notes start with the lowest possible amount of oxygen keep it at 90% pulse ox watch out for complications of oxygen toxicity and any anxiety

Question 51

why is oxygen dangerous with arf?

Answer 51

because too much oxygen can cause alveoli to collapse causing fluid to leak out causing pulmonary edema and other complications

Question 52

why do we need to be careful with patients who are having oxygen and have COPD?

Answer 52

because they already live at a low level of oxygen, giving them too much cuts their drive to breathe

Question 53

how can we help mobilize secretions ?

Answer 53

proper position - sitting up effecting coughing - quad cough suctioning should be the last thing hydration ambulation

Question 54

what are the 2 forms of positive pressure ventilation ?

Answer 54

CPAP BIPAP

Question 55

what type of medications will be using on arf patients ?

Answer 55

short acting bronchodilator corticosteroids diuretics morphine nitroglycerine opioids benzo

Question 56

why is nutrition a big thing in arf ?

Answer 56

because you burn a lot of calories trying to breathe

Question 57

notes gerontologic considerations - at increased risk for arf - decreased ventilatory capacity larger air spaces loss of surface area for gas exchange decreased lung compliance poor nutritional status