7482549
Description
Flashcards by brittny beauford, updated more than 1 year ago
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Created by brittny beauford
almost 8 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 |
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