453: Test 1 Respiratory Failure

brittny beauford
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Flashcards on 453: Test 1 Respiratory Failure , created by brittny beauford on 01/29/2017.

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brittny beauford
Created by brittny beauford almost 3 years ago
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Question Answer
1.Sudden and life-threatening deterioration of one or both of the gas exchange functions of the lung. 2. What are those gas exchange functions? 1. Respiratory Failure 2. Oxygenation and carbon dioxide elimination
True or False: Respiratory failure can be caused by abnormalities in the airways, alveoli, CNS, PNS, respiratory muscles, and chest wall True
Insufficient O2 transferred to the blood Can be acute or chronic Hypoxemic
Inadequate CO2 elimination Can be acute or chronic Hypercapnic
With ______ respiratory failure, PaCO2 is usually normal or low. hypoxemic (PaO2 < or = to 60%)
With ________ respiratory failure, hypoxemia is common in those breathing room air. pH is dependent on amount of _______ which is generally dependent on duration of hypercapnia. 1. hypercapnic (PaCO2 > 45) bicarb (22-28)
________ respiratory failure is also referred to as oxygenation failure because the primary problem is inadequate O2 transfer between the alveoli and the pulmonary capillaries. hypoxemic Nsg Dx: Impaired Gas Exchange
With hypoxemic respiratory failure common S/S are ______ Sa02, _______ Pa02 and increase RR Decreased Decreased *Sa02= pulse ox, a percentage *Pa02= partial pressure of o2 in blood, the peripheral capillary saturation more invasive
Treatment of hypoxemic respiratory failure O2 Therapy & Treatment of Underlying Cause priorities!
Hypoxemia is major threat to organ failure – and most common form of acute respiratory failure. 4 primary mechanisms of the etiology and pathophysiology are: 1. Ventilation-perfusion (V/Q) mismatch 2. Shunt 3. Diffusion Limitation 4. Hypoventilation
Volume of blood perfusing the lungs each minute (4-5L) fails to match the fresh gas that reaches the alveoli. Ventilation-perfusion (V/Q) mismatch
3 most common causes of ventilation-perfusion (V/Q) mismatch are COPD Pneumonia Pulmonary embolism
With a severe shunt! patient is often more hypoxemic than a VQ mismatch. Oxygen therapy is usually not enough to correct hypoxemia – can need _________ mechanical ventilation.
Blood exits heart without having participated in gas exchange. It is an exaggerated V/Q mismatch. Shunt
An example of an anatomic shunt is Ventricular/Septal defect. What happens to the blood in the heart with a VSD? Oxygen-rich blood and Oxygen-poor blood become mixed An anatomic shunt occurs when blood passes through an anatomic channel in the heart (e.g., a ventricular septal defect) and bypasses the lungs.
An example of an intrapulmonary shunt is ARDS, Pneumonia, Pulmonary edema. What happens with a intrapulmonary shunt? Alveoli become filled with fluid. An intrapulmonary shunt occurs when blood flows through the pulmonary capillaries without participating in gas exchange.
Diffusion limitation= Gas exchange is compromised or limited because a process has thickened or destroyed the alveolar membrane. 1. What are reasons this happens? 2. What is the classic sign this is happening? 1. Severe COPD Recurrent pulmonary emboli Pulmonary fibrosis 2. hypoxemia during exercise but not at rest (your breathing in more of it but gas exchange is not occurring)
Alveolar Hypoventilation is a decrease in ventilation that results in an ______ in PaCO2 and ______ in PaO2. increase, decrease
Alveolar hypoventilation is generally seen first in hypercapnic respiratory failure. If not stopped, will lead to______ respiratory failure. hypoxemic
Etiologies of alveolar hypoventilation include Restrictive lung disease CNS disease or meds Chest wall dysfunction Neuromuscular disease Obesity
How is hypercapnia respiratory failure caused by airways and alveoli? obstruction of airflow and increased dead space *Dead space=s the volume of air which is inhaled that does not take part in the gas exchange
How is hypercapnia respiratory failure caused by a CNS issue? suppressed drive to breathe (OD, brainstem infarct, high level spinal cord injury)
How is hypercapnia respiratory failure caused by the chest wall? prevention of normal movement of chest wall (fractures, flail, restriction)
How is hypercapnia respiratory failure caused by neuromuscular diseases? weakness of resp muscles (ALS, MS, GB, nm-blockers)
Hypercapnic Respiratory Failure: Nsg Dx: Ineffective Breathing Pattern What are the Initial Signs and Symptoms (think of high circulating catecholamines)? Mental status changes Increased heart rate Increased respiratory rate Mild hypertension
ABGs in Hypercapnic Respiratory Failure as severity progresses. decerase or increase: PaCO2 pH SaO2 PaO2 RR ↑PaCO2 ↓pH ↓SaO2 ↓PaO2 ↓↑ RR
S/S of hypercapnia respiratory failure Morning headaches and Tripoding Rapid, shallow breathing Paradoxical breathing (when your chest moves inward during inhalation instead of moving outward.) Retractions Nasal flaring LATE SIGN – cyanosis PaO2<45mm
In respiratory failure organ tissue need oxygen! Major threat of organ failure, metabolic _______ and cell ______ (metabolic) acidosis (cell) death
Respiratory failure can be because theres not enough 02, inability of tissue to use or extract the 02 or the stress response of he body because there is an increased tissue consumption of 02
Diagnosis of respiratory failure include: CXR, consider spiral CT, MRI CBC, sputum/blood cultures, electrolytes, clotting studies, trops, d-dimer, lactate ECG, Urinalysis, V/Q lung scan Pulmonary artery catheter (severe cases) and most importantly ABG analysis
What is the nurses goal considering oxygen therapy for a a patient in respiratory failure? Maintain PaO2 at 55 to 60 mm Hg or more and SaO2 at 90% or more at the lowest O2 concentration possible
What are the options for a nurse to use in oxygen therapy for a patient experiencing acute respiratory failure in increasing severity? Nasal canula fenestrated face mask non rebreather ambu bag intubation (by physician)
With respiratory failure its important to mobilize secretions. How does the nurse encourage this? Hydration and humidification Chest physical therapy Airway suctioning Effective coughing and positioning
Respiratory failure: What kind of drug is used to relief bronchospasm? Bronchodilator
Respiratory failure: What kind of drug is used to relief airway inflammation? Corticosteroids
Respiratory failure: What kind of drug is used to relief airway pulmonary congestion? Diuretics, nitrates if heart failure present mucolytics
What should these levels be for a healthy patient: pH PCO2 PO2 SaO2 HCO3 pH 7.35 – 7.45 PCO2 35 - 45 PO2 **(60)80- 100 (go with the 60) (if less then 60 say they are hypoximic) SaO2 93 - 99% HCO3 22 - 26
When evaluating ABGs look at the H&P to establish a baseline. The 2 specific values of the ABGs are going to determine the culprit of the abnormal acid-base balance? Co2 and bicarb
Once the initial chemical change and the compensatory response is distinguished, then identify the specific disorder.        - If PCO2 is the initial chemical change, then process is _______.       -  if HCO3- is the initial chemical change, then process is ______. respiratory metabolic
Acid Base Initial chemical Compensator disorder change response Resp. acidosis PCO2 HCO3- Are these increased or decreased? PCO2 increased HCO3- increased
Acid Base Initial chemical Compensator disorder change response Resp. alkalosis PCO2 HCO3- Are these increased or decreased? PCO2 decreased HCO3- decreased
Acid Base Initial chemical Compensator disorder change response Met. acidosis PCO2 HCO3- Are these increased or decreased? PCO2 decreased HCO3- decreased
Acid Base Initial chemical Compensator disorder change response Met. alkalosis PCO2 HCO3- Are these increased or decreased? PCO2 increased HCO3- increased
What is this? pH 7.27 PCO2 55 PO2 62 SaO2 88 HCO3 22 uncompensated respiratory acidosis
What is this? pH 7.31 PCO2 55 PO2 62 SaO2 88 HCO3 29 respiratory acidosis with partial compensation
What is this? pH 7.36 PCO2 55 PO2 62 SaO2 88 HCO3 33 Full compensated respiratory acidosis
What is this? pH 7.47 PCO2 28 PO2 68 SaO2 90 HCO3 24 uncompensated respiratory alkalosis
What is this? pH 7.27 PCO2 45 PO2 70 SaO2 91 HCO3 18 Uncompensated Metabolic acidosis
What is this? pH 7.35 PCO2 29 PO2 70 SaO2 93 HCO3 16 fully compensated metabolic acidosis
What is this? pH 7.57 PCO2 35 PO2 72 SaO2 92 HCO3 29 uncompensated metabolic alkalosis
The most common early clinical manifestations of ARDS that the nurse may observe are? dyspnea and tachypnea.
Maintenance of fluid balance in the patient with ARDS involves fluid restriction and diuretics as necessary.
Hypoxemic respiratory failure if a _____ PA02 Hypercapnic respiratory failure is _____ PaCO2 less then or equal to 60 mm Hg above >45 mm Hg
V/Q mismath What would COPD/Pneumonia fall under? What would a PE/pulmonary HTN for under? COPD/Pneumonia=ventilation PE/Pulmonary HTN=perfusion