Term
| What is Acute Respiratory Failure? |
|
Definition
| The pulmonary systed fails to maintain adequate gas exchange. It is the most common organ failure seen in the ICU. It usually occurs secondary to another disorder that has altered the normal function of the pulmonary system. |
|
|
Term
| What does Type I Acute Respiratory Failure look like? |
|
Definition
| Low O2 level (<60) and normal CO2 |
|
|
Term
| What does Type II Acute Respiratory Failure look like? |
|
Definition
| Low O2 level (<60) and High CO2 level (Hypercapnia) |
|
|
Term
| What is the hallmark sign of ARF? |
|
Definition
| Refractory Hypoxemia: no matter what you do you can't get the O2 to come up to a normal level. |
|
|
Term
| What are the main causes of hypoxemia in ARF patients? |
|
Definition
| 1. Alveolar Hypoventilation: not getting enough O2 to the alveoli. 2. V/Q mismatching 3. Intrapulmonary shunting: too much dead space. Pulmonary vasoconstriction. |
|
|
Term
| What happens if the hypoxemia in ARF patients is not corrected? |
|
Definition
| If hypoxemia is not corrected, can result in an oxygen supply/demand imbalance and tissure hypoxemia, which leads to development of lactic acidosis and MODS. |
|
|
Term
| What does an analysis of the ABG look like in ARF? |
|
Definition
PaO2 <60 mm Hg
PaCO2 >45 mm Hg
pH <7.35 mm Hg (in COPD clients) |
|
|
Term
| What are some important S/S of Acute Respiratory Failure? |
|
Definition
| Restlessness, Agitation, Confusion, Tachycardia, Hypertension (systolic), Dysrhythmias, Tachypnea, Hyperventilation, Dyspnea, SOB, Decreased Urinary Output, Decreased bowel sounds, N/V, Pallor, Cyanosis, and Clammy. |
|
|
Term
| What are some other tests to check for ARF? |
|
Definition
| Chest X-ray, CT of Chest, and lung function studies (looks at TV, IRV, etc.) |
|
|
Term
| What is the Medical Management of ARF? |
|
Definition
| Treat the Underlying cause, promote adequate gas exchange (usually means putting patient on vent.), Correct acidosis by oxygenating patient until it is corrected, intitiate nutritional support, and prevent complications. |
|
|
Term
| When should nutrition be initiated in patients with ARF? |
|
Definition
| Nutrition should be initiated before the 3rd day in a healthy patient, and in 24 hours in a malnourished patient. |
|
|
Term
| Why is it important for the patient to recieve adequate nutrition? |
|
Definition
| The patient uses alot of energy trying to oxygenate the body; therefore, patients on ventilation takes alot of energy. |
|
|
Term
| How can we prevent complications like VAP, stress ulcers, DVTs, and GI bleeding? |
|
Definition
| H2 Blockers (Protonix) are ordered by the doctor to help prevent the ulcers and bleeding. The doctor may also order SCDs, TEDS, or Lovenox to prevent DVTs. Propylactic Antibiotics will help prevent VAP. |
|
|
Term
| As a nurse, what are we assessing in the patient with ARF? |
|
Definition
| Inspecting thorax for color and symmetry; palpating thorax for presence of subcutaneous emphysema or masses, and ausculating the chest anteriorly, posteriorly, and laterally: checking for bilateral breath sounds. |
|
|
Term
| What are 2 main Nursing Diagnoses of the patient with ARF? |
|
Definition
1. Impaired Gas Exchange r/t alveolar hypoventilation
2. Impaired gas exchange r/t V/Q Mismatching or intrapulmonary shunting. |
|
|
Term
| How do we optimize ventilation and oxygenation by positioning the patients? |
|
Definition
| Position patient "good lung down" to have optimal perfusion. For diffuse lung disease, lay patient on right side because the right lung is bigger (has more lobes). For alveolar hypoventilation: position patient semi-erect. |
|
|
Term
| How do we prevent desaturation in the ARF patient? |
|
Definition
| Limit their physical activity, provide rest & recovery between procedures, and monitor pulse oximetry. Remember to hyperoxygenate your patient before suctioning to prevent desaturation. |
|
|
Term
| What are the best ways to promote suction clearance in ARF patients? |
|
Definition
| Raise HOB 30-45 degrees; make sure the patient is hydrated (ARF patients should have IV fluids going), oxygen administered to patient should be humidified, and monitor need for suctioning. |
|
|
Term
| How do we provide comfort and emotional support for patients with ARF? |
|
Definition
| Ventilator Clients: provide hygeine, ROM exercises, provide a means of communications, explain all procedures and interventions. Allow family to visit at appropriate/designated times. Reassure the client. Ensure nutritional intake, monitor for complications, adn provide client education. |
|
|
Term
| What are some things we should teach a patient with ARF? |
|
Definition
| Patho of disease, specific cause, precipitating factor modification, importance of taking meds, breathing techniques, energy conservation techniques, measure to prevent pulmonary infections, s/s of pulmonary infection, and cough enhancement techniques. |
|
|
Term
| How do you evaluate a client's progress who has ARF? |
|
Definition
| Through Assessment, ABGs, and lab values |
|
|
