453: Test 1 Respiratory Failure

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?

True or False:
Respiratory failure can be caused by abnormalities in the airways, alveoli, CNS, PNS, respiratory muscles, and chest wall

Insufficient O2 transferred to the blood
Can be acute or chronic

Inadequate CO2 elimination
Can be acute or chronic

With ______ respiratory failure, PaCO2 is usually normal or low.

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.

________ respiratory failure is also referred to as oxygenation failure because the primary problem is inadequate O2 transfer between the alveoli and the pulmonary capillaries.

With hypoxemic respiratory failure common S/S are ______ Sa02, _______ Pa02 and increase RR

Treatment of hypoxemic respiratory failure

Hypoxemia is major threat to organ failure – and most common form of acute respiratory failure.
4 primary mechanisms of the etiology and pathophysiology are:

Volume of blood perfusing the lungs each minute (4-5L) fails to match the fresh gas that reaches the alveoli.

3 most common causes of ventilation-perfusion (V/Q) mismatch are

With a severe shunt! patient is often more hypoxemic than a VQ mismatch. Oxygen therapy is usually not enough to correct hypoxemia – can need _________

Blood exits heart without having participated in gas exchange. It is an exaggerated V/Q mismatch.

An example of an anatomic shunt is Ventricular/Septal defect. What happens to the blood in the heart with a VSD?

An example of an intrapulmonary shunt is ARDS, Pneumonia, Pulmonary edema. What happens with a intrapulmonary shunt?

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?

Alveolar Hypoventilation is a decrease in ventilation that results in an ______ in PaCO2 and ______ in PaO2.

Alveolar hypoventilation is generally seen first in hypercapnic respiratory failure. If not stopped, will lead to______ respiratory failure.

Etiologies of alveolar hypoventilation include

How is hypercapnia respiratory failure caused by airways and alveoli?

How is hypercapnia respiratory failure caused by a CNS issue?

How is hypercapnia respiratory failure caused by the chest wall?

How is hypercapnia respiratory failure caused by neuromuscular diseases?

Hypercapnic Respiratory Failure:
Nsg Dx: Ineffective Breathing Pattern
What are the Initial Signs and Symptoms (think of high circulating catecholamines)?

ABGs in Hypercapnic Respiratory Failure as severity progresses.
decerase or increase:
PaCO2
pH
SaO2
PaO2
RR

S/S of hypercapnia respiratory failure

In respiratory failure organ tissue need oxygen!
Major threat of organ failure, metabolic _______ and cell ______

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

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

What is the nurses goal considering oxygen therapy for a a patient in respiratory failure?

What are the options for a nurse to use in oxygen therapy for a patient experiencing acute respiratory failure in increasing severity?

With respiratory failure its important to mobilize secretions. How does the nurse encourage this?

Respiratory failure:
What kind of drug is used to relief bronchospasm?

Respiratory failure:
What kind of drug is used to relief airway inflammation?

Respiratory failure:
What kind of drug is used to relief airway pulmonary congestion?

What should these levels be for a healthy patient:
pH
PCO2
PO2
SaO2
HCO3

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?

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 ______.

Acid Base Initial chemical Compensator disorder change response

Resp. acidosis PCO2 HCO3-

Are these increased or decreased?

Acid Base Initial chemical Compensator disorder change response

Resp. alkalosis PCO2 HCO3-

Are these increased or decreased?

Acid Base Initial chemical Compensator disorder change response

Met. acidosis PCO2 HCO3-

Are these increased or decreased?

Acid Base Initial chemical Compensator disorder change response

Met. alkalosis PCO2 HCO3-

Are these increased or decreased?

What is this?
pH 7.27
PCO2 55
PO2 62
SaO2 88
HCO3 22

What is this?
pH 7.31
PCO2 55
PO2 62
SaO2 88
HCO3 29

What is this?
pH 7.36
PCO2 55
PO2 62
SaO2 88
HCO3 33

What is this?
pH 7.47
PCO2 28
PO2 68
SaO2 90
HCO3 24

What is this?
pH 7.27
PCO2 45
PO2 70
SaO2 91
HCO3 18

What is this?
pH 7.35
PCO2 29
PO2 70
SaO2 93
HCO3 16

What is this?
pH 7.57
PCO2 35
PO2 72
SaO2 92
HCO3 29

The most common early clinical manifestations of ARDS that the nurse may observe are?

Maintenance of fluid balance in the patient with ARDS involves

Hypoxemic respiratory failure if a _____ PA02
Hypercapnic respiratory failure is _____ PaCO2

V/Q mismath
What would COPD/Pneumonia fall under?
What would a PE/pulmonary HTN for under?