Unit 1: ARF & ARDs

Question 1

Hypoxemia is defined as a PaO2 of <__ mm Hg.

Answer 1

PaO2 <80 mm Hg

Question 2

Respiratory Failure is defined as a PaO2 <__ mmHg OR a PaCO2 of >__ mmHg

Answer 2

PaO2 <80 mmHg (book says <60 mmHg p. 593)
OR
PaCO2 of >45 mmHg

Question 3

Acute Respiratory Failure (ARF) can be ______ failure, _____ failure, or a combo of both.

Answer 3

Ventilatory or Oxygenation/Perfusion (gas exchange) failure

Question 4

What would indicate that Acute Respiratory Failure (ARF) is both a ventilatory and oxygenation failure?

Answer 4

An abnormal pH

Question 5

Causes of Ventilation failure?

Answer 5

Problem with chest &/or lungs, Injury to respiratory control center, or Inability to control respiratory muscles
1. Chest trauma (rib fractures)
2. Drug Overdose
3. Pneumothorax
4. Pulmonary edema
5. Airway obstruction
6. Paralysis
7. Spinal cord injury

Question 6

Causes of Oxygenation/Perfusion failure?

Answer 6

Poor lung blood flow
1. Pneumonia
2. PE
3. Hypovolemic Shock

Question 7

Causes of BOTH Ventilation/Perfusion failure?

Answer 7

1. COPD
2. Asthma
3. CF
4. ARF
   *Starts as a ventilation failure, but progresses to both

Question 8

The S/S of ARF are r/t the systemic effects of ____, ____, and _____.

Answer 8

1. Hypoxia
2. Hypercapnia
3. Acidosis

Question 9

What is the hallmark finding for ARF?

Answer 9

Dyspnea

Question 10

How do we evaluate/grade the intensity of the dyspnea r/t ARF?

Answer 10

How breathless the patient becomes while performing common tasks like talking, lying down (orthopnea) or on exertion.

Question 11

Pulse oximetry (SpO2) can be used to evaluate ARF, but it’s not always accurate.
What should we assess instead for more accuracy?

Answer 11

End-tidal CO2 (ET-CO2)

The pulse ox may show an adequate SpO2 result, but also an increased ETCO2 indicating respiratory failure
(Also helps R/O a PE if the ETCO2 is >36)

Question 12

What S/S would we see once hypoxia sets in r/t Acute Respiratory Failure (ARF)?

Answer 12

Alkalosis due to hyperventilation:
1. Restlessness, agitation, irritability
2. Confusion
3. Changes in LOC (hypercapnia)

Question 13

What S/S would we see once hypoxemia sets in r/t Acute Respiratory Failure (ARF)?

Answer 13

Acidosis has set in:
1. Hypotension
2. Bradycardia
3. Weak pulses

Question 14

Interventions for ARF:

Answer 14

1. Treat underlying cause
2. Oxygen
3. Positioning (High-Fowlers)
4. Anxiety Mx
5. Energy-conserving measures

Question 15

Acute Respiratory Distress Syndrome (ARDS) is Acute Respiratory Failure with:

Answer 15

1. Persistent Hypoxemia even with 100% O2
   (aka Refractory hypoxemia)
2. Decreased pulmonary compliance (fibrosis)
3. Dyspnea
4. Pulmonary edema (bilateral + non-cardiac-related)
5. Diffuse pulmonary infiltrates (CXR = ground-glass)

Question 16

ARDS often occurs after an ‘Acute Lung Injury’ (ALI) from a systemic inflammatory response caused by:

Answer 16

1. Sepsis
2. Pancreatitis
3. Trauma
4. Transfusions (TRALI)

Question 17

What are two causes of ARDS that result from direct injury to the lungs?

Answer 17

1. Aspiration
2. Pneumonia

Question 18

S/S of ARDS

Answer 18

1. Increased work of breathing (that’s painful to watch)
2. Loud breathing/lung sounds (washing machine)
3. Cyanosis
4. Accessory muscle use
5. Confusion

Question 19

Diagnostics for ARDS

Answer 19

1. ABG
2. CXR (ground glass appearance)
3. Sputum culture (to R/O infection)

Question 20

What types of continuous monitoring should we have going for a pt with ARDS?

Answer 20

1. Cardiac monitoring
2. SpO2
3. ETCO2 if intubated

Question 21

What is the P/F ratio? Normal range?

Answer 21

PaO2/FiO2 (the arterial O2 pressure vs the % of O2 were giving the patient)
>=400

Question 22

What P/F ratio would indicate ARDS?

Answer 22

P/F ratio <300

Question 23

Interventions for ARDS:

Answer 23

1. Mechanical Ventilation/PEEP
   - Sedation
   - Paralytics
   - Analgesics
2. Proning
3. Mobility (depending on work needed to breathe)
4. ECMO

Question 24

What should we do prior to proning an ARDS pt?

Answer 24

1. Obtain an ABG to establish a baseline
2. Sedate
3. Paralyze

Question 25

What is PEEP? What does it promote?

Answer 25

Peak Expiratory End Pressure
”Recruiting” – allows gas exchange to occur (keeps the reserve volume left over following expiration oxygenated, making it easier to start ventilation sequence)

Question 26

What about IV fluids?

Answer 26

it depends on the cause! Are they hypotensive?

Question 27

What about nutrition?

Answer 27

Enteral nutrition (tube feeding/TPN)