Acute Respiratory Failure (ARF) Overview
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Questions and Answers

What condition is indicated by a hypoxemic respiratory failure with a PF ratio less than 50?

  • Pleural effusion
  • Asthma exacerbation
  • Chronic obstructive pulmonary disease (COPD)
  • Acute respiratory distress syndrome (ARDS) (correct)

    • What does a pH less than 7.2 indicate in a patient with hypercapnic respiratory failure?

  • Compensated metabolic acidosis
  • Metabolic alkalosis
  • Uncompensated respiratory acidosis (correct)
  • Respiratory acidosis

    • What risk factor is critical to consider when preparing a patient for a thoracentesis?

  • History of hypertension
  • Previous lung surgery
  • Coagulation defects (correct)
  • Age above 60

    • What may indicate right mainstem intubation in an intubated patient?

    <p>Absent breath sounds on the left side</p> Signup and view all the answers

    What does a low bicarbonate (HCO3) level indicate regarding kidney function in a patient with respiratory distress?

    <p>Impaired kidney function</p> Signup and view all the answers

    Which nursing management strategy is essential for optimizing oxygenation and ventilation in ARD?

    <p>Positioning the patient</p> Signup and view all the answers

    What is the primary nursing diagnosis for a patient with acute respiratory distress?

    <p>Impaired gas exchange</p> Signup and view all the answers

    When is NIPPV not recommended for patients?

    <p>Patients with decreased level of consciousness</p> Signup and view all the answers

    What is the distinct difference between BiPAP and CPAP?

    <p>BiPAP delivers varying pressures for inhalation and exhalation</p> Signup and view all the answers

    Which statement about high flow nasal cannula is correct?

    <p>It provides heated and humidified oxygen</p> Signup and view all the answers

    What is one of the risks associated with NIPPV during treatment?

    <p>Increased risk for aspiration</p> Signup and view all the answers

    What is one of the goals of providing emotional support during ARD management?

    <p>To reduce anxiety and stress for the patient</p> Signup and view all the answers

    Which medication class helps to decrease stomach acid related to GI bleeding management?

    <p>H2 blockers</p> Signup and view all the answers

    What is a potential complication when using an endotracheal tube (ETT)?

    <p>Tracheal stenosis</p> Signup and view all the answers

    Which medication must a patient be sedated with before administering neuromuscular blocking agents?

    <p>Etomidate</p> Signup and view all the answers

    What is the purpose of using ECMO?

    <p>To oxygenate blood outside of the patient's body</p> Signup and view all the answers

    Which nursing intervention is crucial for maintaining an endotracheal tube?

    <p>Ensuring ETT is secure</p> Signup and view all the answers

    What can be a consequence of elevated PEEP during mechanical ventilation?

    <p>Decreased venous return to the heart</p> Signup and view all the answers

    Which of the following is a sign of barotrauma due to mechanical ventilation?

    <p>Asymmetrical chest expansion</p> Signup and view all the answers

    Which complication is associated with mechanical ventilation?

    <p>Self-extubation</p> Signup and view all the answers

    What is the primary use of neuromuscular blocking agents in the context of intubation?

    <p>To facilitate muscle paralysis for easier intubation</p> Signup and view all the answers

    What is a significant advantage of using a high-flow nasal cannula in patients with acute respiratory failure?

    <p>It matches a patient's inspiratory flow demands.</p> Signup and view all the answers

    When should intubation be considered for a patient?

    <p>The patient requires suctioning.</p> Signup and view all the answers

    What are essential items to have in a patient's room for airway management?

    <p>Suction equipment and oxygen supplies.</p> Signup and view all the answers

    What might cause high pressure alarms on a ventilator?

    <p>Condensation is collecting in the tubing.</p> Signup and view all the answers

    What is a vital step if a patient with a ventilator shows sudden drop in SpO2?

    <p>Disconnect the patient from the ventilator.</p> Signup and view all the answers

    Which airway device is suitable for conscious patients?

    <p>Nasal trumpet.</p> Signup and view all the answers

    Which condition necessitates the use of rapid sequence intubation?

    <p>The patient is tachypneic with resps in the 40s.</p> Signup and view all the answers

    What can be a complication sign indicating issues with ventilation?

    <p>Asymmetrical chest expansion and drop in O2 stat.</p> Signup and view all the answers

    What is the PaO2/FiO2 range that characterizes mild ARDS?

    <p>200-300 mm Hg</p> Signup and view all the answers

    What is a common cause of indirect injuries leading to ARDS?

    <p>Sepsis</p> Signup and view all the answers

    How is severe ARDS defined based on the PaO2/FiO2 ratio?

    <p>Less than or equal to 100 mm Hg</p> Signup and view all the answers

    Which of the following is a characteristic feature of hypoxemia in ARDS?

    <p>Blood oxygen levels do not improve with supplemental oxygen</p> Signup and view all the answers

    What is the normal range for HCO3 in blood gas measurement?

    <p>22-26</p> Signup and view all the answers

    Which option best describes the role of positive end-expiratory pressure (PEEP) in ARDS management?

    <p>Keeps alveoli open to improve oxygenation</p> Signup and view all the answers

    What chest radiography finding would suggest a left pneumothorax?

    <p>Shifting of the mediastinum to the right</p> Signup and view all the answers

    Which condition is considered a severe and life-threatening exacerbation of asthma requiring intubation?

    <p>Status asthmaticus</p> Signup and view all the answers

    What is a primary cause of hypoxemia related to intrapulmonary shunting?

    <p>Blood passing through the lungs that doesn't partake in gas exchange</p> Signup and view all the answers

    Which condition is commonly associated with a low V/Q ratio?

    <p>Pneumonia</p> Signup and view all the answers

    What is a significant symptom of early acute respiratory distress syndrome (ARDS)?

    <p>Clear chest X-ray</p> Signup and view all the answers

    What does refractory hypoxemia indicate about a patient's lung function?

    <p>Ineffective gas exchange due to lung damage</p> Signup and view all the answers

    Which of the following is NOT a typical diagnostic method for acute respiratory failure (ARF)?

    <p>Electrocardiogram (ECG)</p> Signup and view all the answers

    What characterizes respiratory acidosis?

    <p>High PaCO2 and low pH</p> Signup and view all the answers

    What does positive end-expiratory pressure (PEEP) achieve in mechanical ventilation?

    <p>Maintains airway patency at the end of expiration</p> Signup and view all the answers

    A chest X-ray showing 'whiteout' is indicative of what condition?

    <p>Severe pulmonary edema</p> Signup and view all the answers

    What may cause absent or diminished breath sounds on the left side during an intubation?

    <p>Right mainstem intubation</p> Signup and view all the answers

    Which acid-base component reflects renal function and is crucial during respiratory distress?

    <p>HCO3</p> Signup and view all the answers

    Which situation poses the highest risk when preparing a patient for thoracentesis?

    <p>Coagulation defects</p> Signup and view all the answers

    What factor can indicate the inappropriate use of ECMO in a patient?

    <p>Failure to correct underlying pathology</p> Signup and view all the answers

    What characteristic observation accompanies Kussmaul respiration in patients with DKA?

    <p>Deep and rapid breaths</p> Signup and view all the answers

    What is the primary purpose of corticosteroids in the management of ARDS?

    <p>Reduction of airway inflammation</p> Signup and view all the answers

    Which factor is critical in preventing Ventilator Associated Pneumonia (VAP)?

    <p>Maintaining a HOB position of 30-45 degrees</p> Signup and view all the answers

    What diagnostic test is most effective in determining the sensitivity of the organism causing pneumonia?

    <p>Sputum culture</p> Signup and view all the answers

    Which medication class is used to manage severe anxiety in ARDS patients?

    <p>Benzodiazepines</p> Signup and view all the answers

    What could be a complication of ARDS related to altered mental status?

    <p>Encephalopathy</p> Signup and view all the answers

    Which intervention aids in reducing pulmonary congestion in ARDS patients?

    <p>Implementing diuretics</p> Signup and view all the answers

    What is the role of enteral nutrition in ARDS management?

    <p>To support energy needs and promote healing</p> Signup and view all the answers

    What does poor hand hygiene increase the risk of in a hospital setting?

    <p>Ventilator Associated Pneumonia (VAP)</p> Signup and view all the answers

    Which of the following complications can arise from the use of an endotracheal tube (ETT)?

    <p>Tracheal stenosis</p> Signup and view all the answers

    Which medication must be administered to a patient before neuromuscular blocking agents?

    <p>Etomidate</p> Signup and view all the answers

    What is one major use of ECMO in clinical practice?

    <p>To support patients with severe respiratory failure</p> Signup and view all the answers

    Which of the following should be monitored closely to prevent complications during intubation?

    <p>Blood pressure every minute</p> Signup and view all the answers

    What significant complication can occur with mechanical ventilation related to intrathoracic pressure?

    <p>Decreased venous return to the heart</p> Signup and view all the answers

    What procedure is recommended to verify the correct placement of an endotracheal tube?

    <p>Auscultation and color change of CO2 detector</p> Signup and view all the answers

    What condition can result from the elevated settings of PEEP and tidal volume during mechanical ventilation?

    <p>Barotrauma (pneumothorax)</p> Signup and view all the answers

    What is a primary advantage of using high-flow nasal cannula (HFNC) for patients in acute respiratory failure?

    <p>It delivers high flow rates to match peak inspiratory flow demands.</p> Signup and view all the answers

    Which of the following medications is classified as a neuromuscular blocking agent?

    <p>Pancuronium bromide</p> Signup and view all the answers

    Which item is essential to have in a patient's room for airway management?

    <p>Suction equipment</p> Signup and view all the answers

    What is a primary benefit of using PEEP in patients with acute respiratory failure?

    <p>Improves oxygenation</p> Signup and view all the answers

    What complication may be indicated by asymmetrical chest expansion and a drop in O2 saturation?

    <p>Ventilator malfunction</p> Signup and view all the answers

    Which of the following is a negative effect of PEEP during ventilation?

    <p>Barotrauma causing subcutaneous emphysema</p> Signup and view all the answers

    What nursing intervention can help manage low cardiac output caused by PEEP?

    <p>Administer fluids and positive inotropes</p> Signup and view all the answers

    When is rapid sequence intubation indicated for a patient?

    <p>The patient shows signs of severe respiratory distress.</p> Signup and view all the answers

    Which statement is true regarding the use of oral airways before intubation?

    <p>They help maintain airway patency by preventing tongue obstruction.</p> Signup and view all the answers

    How does extracellular gas exchange work in managing severe acute respiratory failure?

    <p>It removes blood from the body, oxygenates it, and returns it.</p> Signup and view all the answers

    What should be done if a ventilated patient exhibits a sudden drop in SpO2 and shows signs of distress?

    <p>Disconnect the patient from the ventilator and use an ambu bag.</p> Signup and view all the answers

    What positioning technique is beneficial for optimizing ventilation in patients with ARF?

    <p>Prone positioning</p> Signup and view all the answers

    Which symptom indicates potential oxygen toxicity in patients being treated for respiratory failure?

    <p>Substernal chest pain increasing with deep breathing</p> Signup and view all the answers

    What is a likely cause of high-pressure alarms on a ventilator?

    <p>Condensation in the breathing circuit.</p> Signup and view all the answers

    What is the purpose of performing secretion clearance in the management of ARF?

    <p>To prevent desaturation</p> Signup and view all the answers

    Which airway device is appropriate for a conscious patient who requires airway support?

    <p>Nasal trumpet</p> Signup and view all the answers

    What is one of the least common methods for gas exchange within the body?

    <p>Intracorneal gas exchange</p> Signup and view all the answers

    What condition is characterized by blood passing through the lungs without participating in gas exchange?

    <p>Intrapulmonary shunting</p> Signup and view all the answers

    Which of the following is a significant early symptom of acute respiratory distress syndrome (ARDS)?

    <p>Non-productive cough</p> Signup and view all the answers

    What does a 'whiteout' on a chest film typically indicate?

    <p>Severe pulmonary edema</p> Signup and view all the answers

    What is the expected arterial blood gas (ABG) result in respiratory acidosis?

    <p>Low pH, high PaCO2</p> Signup and view all the answers

    Which factor contributes to refractory hypoxemia in ARF?

    <p>Ineffective gas exchange in damaged lungs</p> Signup and view all the answers

    What is a key characteristic of ARF shown in a chest X-ray?

    <p>Bilateral infiltration</p> Signup and view all the answers

    How does positive end-expiratory pressure (PEEP) benefit patients in mechanical ventilation?

    <p>Prevents airway collapse at end of expiration</p> Signup and view all the answers

    Which of the following findings would most likely indicate significant changes in acute respiratory failure?

    <p>Use of accessory muscles</p> Signup and view all the answers

    Study Notes

    Acute Respiratory Failure (ARF)

    • V/Q ratio: Should be 1:1. Imbalance is a common cause of hypoxemia.
      • V (ventilation): Amount of air entering and leaving alveoli.
      • Q (perfusion): Amount of blood flowing to alveolar capillaries.
    • V/Q imbalance: Ventilation and perfusion don't match.
      • Shunt: Normal perfusion, lack of ventilation (atelectasis, COPD, asthma, pneumonia, pneumothorax).
      • High V/Q: High ventilation, low perfusion (pulmonary embolism, sickle cell anemia, blood loss).
    • Acid-base balance: Hydrochloric acid combines with sodium bicarbonate to produce salt, water, and bicarbonate.
    • Acute Respiratory Failure (ARF) types:
      • Type 1 (hypoxemic normocapnic): Low oxygen (hypoxemia), normal carbon dioxide (normocapnic).
        • Causes: pneumonia, pulmonary edema, ARDS, high altitude, aspiration (foreign material in lungs), aspiration (vomitus).
        • Symptoms: cyanosis, shortness of breath (SOB), increased respiratory rate.
      • Type 2 (hypoxemic hypercapnic): Low oxygen (hypoxemia), high carbon dioxide (hypercapnia).
        • Causes: COPD, asthma, anything impairing ventilation, such as trauma, multiple blood transfusions, drug overdose.
        • Symptoms: headache, confusion, drowsiness, build up of CO2 affecting the brain, decreased level of consciousness (LOC), altered mental status, decreased respiratory rate.

    Acid-Base Balance

    • Hydrochloric acid combines with sodium bicarbonate to produce salt, water, and bicarbonate.
    • Three elements produced are salt, water, HCO3

    ARF Assessment

    • Hypoxemia: Intrapulmonary shunting (blood passing through lungs doesn't participate in gas exchange), low V/Q ratio.
    • Hypercapnia: High levels of carbon dioxide in the blood.
    • Acidosis: Respiratory acidosis (low pH, high PaCO2)- indicates an acid buildup from poor ventilation.
    • Early symptoms: Dyspnea, non-productive cough, restlessness, change in level of consciousness.
    • Later symptoms: Changes in CXR (chest X-ray), changes in respiratory rate, respiratory alkalosis (decrease in blood carbon dioxide),retractions, accessory muscles use, pallor, cyanosis, and abnormal breath sounds.

    Diagnostics and Medical Management

    • ABG analysis: Arterial blood gas analysis
    • CBC (complete blood count)
    • Chest X-ray
    • Pulse oximetry
    • Diagnostic tests (like sputum culture, V/Q scan, blood tests, etc.)
    • Oxygen therapy
    • Mechanical ventilation: (including positive end-expiratory pressure [PEEP])
    • Non-invasive ventilation (CPAP or BiPAP)
    • Drugs (e.g., antibiotics, bronchodilators, corticosteroids, synthetic surfactant, analgesics, antibiotics, antacids).
    • Nutrition support (enteral or parenteral)
    • Managing complications (e.g., encephalopathy, cardiac dysrhythmias, DVTs, ARDS, aspiration pneumonia, aspiration).
    • Treatment (e.g., intubation, ECMO if indicated, mechanical ventilation, and monitoring for complications).

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    Description

    This quiz covers the fundamentals of Acute Respiratory Failure (ARF), focusing on the V/Q ratio and its importance in hypoxemia. Different types of ARF, such as hypoxemic and hypercapnic conditions, are explored along with their causes and symptoms. Test your understanding of ventilation, perfusion, and acid-base balance related to ARF.

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