T3: Respiratory Failure & ARDs

Question 1

Causes of ARDS

Answer 1

sepsis (infection), pneumonia, status asthmaticus

Question 2

what is one of the first things people present with in respiratory failure

Answer 2

altered level of consciousness

Question 3

hypoxemia

Answer 3

insufficient oxygen transferred to the blood

Question 4

how is hypoxemia reflected in ABGs

Answer 4

Decreased PaO2 and SaO2

Question 5

hypercapnia

Answer 5

inadequate CO2 removal

Question 6

how is hypercapnia reflected in ABGs

Answer 6

Increased PaCO2

Question 7

PaO2 level in hypoxemic patient

Answer 7

<60mmHg

Question 8

PaCO2 level in hypercapnic patient

Answer 8

> 50mmHg

Question 9

most common physiologic mechanisms of hypoxemic respiratory failure

Answer 9

-v/q mismatch
-shunting
-diffusion limitation
-alveolar hypoventilation

Question 10

V/Q mismatch

Answer 10

An imbalance in the amount of oxygen received in the alveoli and the amount of blood flowing through the alveolar capillaries

Question 11

shunting

Answer 11

through heart bypassing lungs OR through lungs without gas exchange

Question 12

diffusion limitation

Answer 12

Gas exchange across alveolar-capillary membrane is compromised, exchange of CO2 and O2 cannot occur because of the thickened alveolar-capillary membrane

Question 13

increased lactic acid. from hypoxemia can cause

Answer 13

metabolic acidosis

Question 14

respiratory manifestations of hypoxemia

Answer 14

-dyspnea, tachypnea, prolonged expiration
-nasal flaring
-intercostal muscle retraction
-use of accessory muscles
-decreased SpO2 (less than 80%)
-paradoxic chest or abdominal wall movement with respiratory cycle (late)
-cyanosis (late)

Question 15

CNS clinical manifestations of hypoxemia

Answer 15

agitation; confusion; disorientation; restless, combative behavior; delirium; decreased level of consciousness; coma (late)

Question 16

CV clinical manifestations of hypoxemia

Answer 16

tachycardia; hypertension; skin cool, clammy, and diaphoretic; dysrhythmias (late); hypotension (late)

Question 17

Consequences of hypercapnia

Answer 17

-Slow changes allow CO2 allow compensation
-Arterial pH able to adjust
-Treat primary cause or patient’s condition will deteriorate

Question 18

Conditions causing impaired ventilation (hypercapnia)

Answer 18

-CNS problems
-neuromuscular conditions
-chest wall abnormalities
-conditions affecting the airway and/or alveoli

Question 19

respiratory clinical manifestations of hypercapnia

Answer 19

-dyspnea
-tripod position
-pursed-lip breathing
-decreased RR or rapid rate with shallow respirations
-decreased tidal volume
-decreased minute ventilation

Question 20

CNS clinical manifestations of hypercapnia

Answer 20

-morning headache
-disorientation, confusion
-progressive somnolence
-increased intracranial pressure
-coma (late)

Question 21

CV clinical manifestations of hypercapnia

Answer 21

tachycardia, HTN, dysrhythmias, bounding pulse

Question 22

neuromuscular clinical manifestations of hypercapnia

Answer 22

muscle weakness, decreased deep tendon reflexes, Tremors, seizures (late)

Question 23

decreased O2 manifestations

Answer 23

restlessness, confusion, agitation

Question 24

increased CO2 manifestations

Answer 24

morning headache, decreased RR, and decreased LOC

Question 25

early signs of compensation of the heart and lungs

Answer 25

Tachycardia, tachypnea, and mild HTN

Question 26

Late signs of inadequate compensation

Answer 26

-Cyanosis (unreliable indicator) -PaO2 less than or equal to 45 mm Hg

Question 27

position for acute respiratory failure

Answer 27

sit upright/tripod keep HOB up

Question 28

Work of breathing (WOB);

Answer 28

respiratory muscles effort needed to inhale/exhale

Question 29

what is a red flag in acute respiratory failure

Answer 29

Change from rapid to slow RR à severe muscle fatigue IMPENDING respiratory arrest

Question 30

how does morphine help with work of breathing (WOB)

Answer 30

it dilates the coronary artery so the heart is getting more blood supply which decreases the workload of breathing

Question 31

observation for acute respiratory failure

Answer 31

-Ability to speak à full or partial sentences, 2 to 3 word dyspnea -Pursed-lip breathing Increased expiratory time; prevents small bronchial collapse -Retraction of intercostal spaces or supraclavicular area -use of accessory muscles -Paradoxical breathing -diaphoresis

Question 32

breath sounds in ARF

Answer 32

fine or coarse crackles, absent (consolidation), pleural rub

Question 33

prevention for ARF

Answer 33

Deep breathing and coughing, incentive spirometry, and early ambulation

Question 34

goal of corticosteroids and bronchodilators

Answer 34

Reduce airway inflammation and bronchospasm

Question 35

goal of IV diuretics, Morphine, and Nitroglycerine

Answer 35

relieve pulmonary congestion

Question 36

goal of IV antibiotics

Answer 36

treat infections

Question 37

goal of Benzodiazepines and Opioids

Answer 37

Reduce anxiety, pain, and restlessness

Question 38

interventions to Mobilization Secretions

Answer 38

-Patient positioning- HOB 30, Side lying if Aspiration risk, -huff coughing -Chest physiotherapy- -Suctioning -Humidification- Thins secretions -Hydration- 2-3 L/day, IV fluids (check for overload)

Question 39

huff coughing

Answer 39

Inhale deeply while leaning forward Exhale sharply with a "huff" sound to help keep airways open while mobilizing secretions

Question 40

complications of suctioning

Answer 40

hypoxia, Hi ICP, Low BP, HTN, PVCs/Tachy/Bradycardia

Question 41

Positive pressure ventilation (PPV)

Answer 41

The provision of air under pressure by a mechanical respirator, a machine designed to improve the exchange of air between the lungs and the atmosphere.

Question 42

Noninvasive PPV must have...

Answer 42

spontaneous breathing, must be awake alert and have stable VS

Question 43

what are the two forms of positive pressure ventilation (PPV)

Answer 43

CPAP and BiPAP

Question 44

CPAP

Answer 44

continuous positive airway pressure

Question 45

BiPAP

Answer 45

bilevel positive airway pressure

Question 46

acute respiratory distress syndrome (ARDS)

Answer 46

a sudden and progressive form of acute respiratory failure in which the alveolar-capillary membrane becomes damaged and more permeable to intravascular fluid.

Question 47

What causes ARDS?

Answer 47

most common- sepsis direct lung injury indirect lung injury

Question 48

initial clinical manifestations of ARDS

Answer 48

Mild dyspnea, tachypnea, cough, restlessness -Chest auscultation may be normal or may reveal fine, scattered crackles -ABGs: Mild hypoxemia and respiratory alkalosis from hyperventilation ¡Chest x-ray : minimal interstitial infiltrates, progresses till lungs appear "whited out

Question 49

later signs of ARDS

Answer 49

-increased WOB -tachypnea and intercostal reatration -tachycardia, diaphoresis, changes in mental status, cyanosis, pallor -diffuse or coarse crackles with expiration -whiteout inflitrate on xray -REFRACORY HYPOXEMIA despite 100% FiO2 -hypercapnia

Question 50

what drugs are given with cardiac involvement of ARDS

Answer 50

-Norepinephrine -Dopamine -Dobutamine

Question 51

¡Strategies for prevention of VAP

Answer 51

-Good hand hygiene -Elevate HOB 30 to 45 degrees -Daily oral care with chlorhexidine (0.12%) solution -Daily assessment for readiness for extubation -Stress ulcer prophylaxis -Venous thromboembolism prophylaxis

Question 52

Positive end expiratory pressure (PEEP)

Answer 52

increased functional capacity; helps keep open/collapsed alveoli