Nr202 Test 4 Respiratory Failure + Mechanical Ventilation, Abgs

Front 1

What causes the acid base balance of a PaCO2 below 35

Back 1

Hyperventilation

Front 2

What causes the acid base balance of a PaCO2 above 45

Back 2

Pulmonary Edema, Asthma, COPD, Code

Front 3

What causes the acid base balance when HCO3 is below 22,

Back 3

Lactic acidosis, DKA, Renal Failure, Diarrhea

Front 4

What causes the acid base balance of HCO3 above 26

Back 4

Vomiting, Gastric Suction, Hypokalemia, Excess Bicarbonate

Front 5

What is typical for the initial stage of ARDS

Back 5

A pH of 7.48, a PaCO2 of 32, a HCO3 of 23, a PaO2 of 65, an O2 saturation of 84%.
This indicates the initial response to hypoxemia with a low PO2 and respiratory alkalosis due to tachypnea.

Front 6

When is mechanical ventilation needed-what are the typical ABGS?

Back 6

Acid 7.31, PaCO2 55, HCO3 24...
In ARDS this is the typical indication that there is less gas exchange and ABG results may be used to determine the need for mechanical ventilation

Front 7

What happens in the late stage of ARDS

Back 7

When the FIO2 has been at 100% without an elevation of PaO2, hypoxia results in lactic acidosis. Eventually, the body no longer gets enough perfusion of oxygen to the tissues to maintain aerobic metabolism. When the metabolism changes to anaerobic there is lactic acid produced and will cause an ABG that indicates combined metabolic and respiratory acidosis. The identifying characteristics of this combined or mixed imbalance is that pH, PaCO2 and HCO3 all indicate acid values. For example, the pH would be 7.18, the PaCO2 would be 72, and the HCO3 would be 18

Front 8

Intubation supplies

Back 8

E-T tube (normal adult about 8-8.5)
Laryngoscope with light (blades are curved or straight)
10 cc syringe for inflating cuff
Stethoscope
Tape or velcro band
Patient with head hyperextended
Hyperventilate with 100% O2

Front 9

Vintilator Settings Ordered (Volume cycled ventilator)

Back 9

Fraction of inspired oxygen (FIO2)-50%
Tidal Volume 700 ml
Assist Control Mode
Rate 16 breaths per min
PEEP at 5 mmHg
Inspiratory/Expiratory Ratio

Front 10

Vent Modes

Back 10

Assist control-If patient initiates a breath then all the tidal volume goes in.
SIMV-if patient initiates a breath those extra breaths are at volume patient controls-used in weaning
Pressure Support-Decreases the work of breathing-Makes respirations deeper-Less likely to have a pneumothorax because pressure does not vary much

Front 11

Goals in ARDS

Back 11

Maintain adequate ventilation
FIO2 is set at the lowest possible level to maintain a PO2 higher than 60 mmHg and O2 saturation of approximately 90%
Avoid PEEP complications
Decreases cardiac output
Increases risk of barotrauma-pneumothorax

Front 12

Acute Respiratory Distress Syndrome

Back 12

AKA noncardiac pulmonary edema
Progressive refractory hypoxemia
does not improve with oxygen administration
Mortality rate 50% or greater.

Front 13

High pressure Alarms-when do they occur?

Back 13

Kinked tubing-needs to be straightened
Secretions present-needs suctioning
Patient coughing-question suctioning-maybe
Fighting ventilator-Sedation or change vent settings
Bronchospasm-happening from bronchodilators
Compliance changes (Pneumothorax or atelectasis) -chest x-ray is needed
Condensation of humidity in tubing

Front 14

Low pressure alarms-when do they go off?

Back 14

Check for leaks or disconnects
Listen for air escaping
Consider leak around cuff or low pressure in cuff
Temperature probe off.

Front 15

BIPAP option

Back 15

Support Ventilation
Tight fitting mask
Must have cooperative Patient
No ability to suction
Orders
-Peak inspiratory pressure
-Expiratory pressure (Compares with PEEP)
-Rate

Front 16

Define Acute respiratory distress syndrome ARDS

Back 16

ARDS is characterized by noncardiac pulmonary edema and progressive refractory hypoxemia

Front 17

Conditions associated with the development of ARDS

Back 17

Shock-Hemorrhagic shock, septic shock
inhilation injuries-NEAR DROWNING, oxygen toxicity, smoke and toxic gases
infections-Gram negative sepsis, viral pneumonias, miliary tuberculosis
drug overdose-heroin, methadone, aspirin,

trauma-burns, head injury, lung contusion, fat emboli
pancreatitis, multiple transfusions,

open heart surgery w/ cardiopulmonary bypass

Front 18

Nursing diagnoses for Respiratory Failure

Back 18

Impaired Spontaneous ventilation
Dysfunctional ventilatory weaning response
Ineffective airway clearance
Impaired Gas exchange

Front 19

Nursing interventions for Respiratory Failure

Back 19

Respiratory monitoring
Artificial Airway Management
Mechanical ventilation
Anxiety reduction
Mechanical ventilatory weaning
Energy management
Airway suctioning
Airway insertion and stabilization
Oxygen therapy

Front 20

Cause of respiratory failure:Impaired Ventilation

Back 20

Airway obstruction-Laryngospasm, foreign body, aspiration, airway edema,

Respiratory disease-Asthma, COPD
Neurologic causes-Spinal cord injury, poliomyelitis, Guillain-Barre Syndrome, drug overdose, stroke,
Chest wall injuy-Flail chest, pneumothorax

Front 21

Cause of Respiratory Failure: Impaired Diffusion

Back 21

Alveolar disorders: Pneumonia, pneumonitis, COPD, Heart Failure, Acute respiratory distress syndrome (ARDS), near-drowning

Front 22

Cause of respiratory failure: ventilation-perfusion mismatch

Back 22

Pulmonary embolism

Front 23

Describe respiratory failure and it's relation

Back 23

Respiratory failure is not a disease but a consequence of severe respiratory dysfunction. It is often defined by arterial blood gas values. An arterial carbon dioxide level PO2 of less than 50-60 and an arterial carbon dioxide level of PCO2 of greater than 50 mmHg are generally accepted as indicators of respiratory failure
Except for COPD patients, which may be their normal values.

Front 24

Pathophysiology of respiratory failure

Back 24

Respiratory failure may be characterized by primary hypoxemia or a combination of hypoxemia and hypercapnia.
Hypoxemia manifestations: Dyspnea, tachypnea, cyanosis, restlessness, apprehension, confusion, impaired judgment, Tachycardia, dysrhythmias, hypertension, Metabolic acidosis
Hypercapnia Manifestations: Dyspnea-respiratory depression, headache, papilledema, tachycardia, hypertension, drowsiness, coma, systemic vasodilation, heart failure, respiratory acidosis

Front 25

drugs used in treating respiratory failure

Back 25

Beta adrenergic (sympathomimetic) or anticholinergic medications may be administered by inhilation to promote bronchodilation.

Methyxanthine bronchodilators (theophylline derivatives) may be given intravenously.

Corticosteroids administered by inhalation or intravenously, may be ordered to reduce airway edema.

Antibiotics are given to treat any underlying infection
Sedation and analgesia often are required during mechanical ventilation to decrease pain and anxiety.

Benzodiazepines such as diazepam (Valium), Ativan, or Versed may be used for sedation to inhibit respiratory drive.
IV morphine or fentanyl provide analgesia and also inhibit the respiratory drive allowing more effective mechanical ventilation.

Front 26

Neuromuscular blockers: name and describe effect.

Back 26

Rocuronium (Zemuron)
Pancuronium bromide (Pavulon)
Atracurium besylate (tracrium)
Cisatracurium (Nimbex)
These drugs competitively block the action of acetycholine (ACh) at skeletal muscle receptors, preventing muscle depolarization and contraction. Complete muscle paralysis is achieved within minutes.

Front 27

Advantages and Disadvantages + potential complications of Oral Endotracheal tube

Back 27

More easily inserted
Larger tube can be used, facilitating work of breathing, suctioning
Disadvantages: More difficult to secure, Can be obstructed by biting, Communication and mouth care more difficult
Increased risk of lower respiratory infection
Potential Complications:
Obstruction or displacement
Pressure necrosis of lip
Tracheoesophageal fistula

Front 28

Advantages, disadvantages, and potential complications of a nasal endotracheal tube

Back 28

Advantages:
More easily secured and stabilized
Well tolerated by client
Facilitate communication and oral hygiene
Disadvantages
Necessitate smaller tube which may impede removal of secretions
Increased risk of lower respiratory infection
Potential complications:
Obstruction or displacement, Pressure necrosis of nares, Obstructive of sinus drainage, possible sinusitis, Tracheoesphageal fistula

Front 29

Advantage, disadvantages, and potential complications of a tracheostomy

Back 29

Advantages:
Easily secured and stabilized
Enable swallowing, speech, and oral hygiene,
Avoid upper airway complicatons
Disadvantages:
Requires surgical incision
Increased risk of lower respiratory infection
Potential Complications:
Hemorrhage due to incision or vessel erosion by tube
Wound infection
Subcutaneous emphysema