Acute Respiratory Failure Quiz

Acute Respiratory Failure (ARF)

• ARF is a critical care disorder where the lungs fail to adequately exchange oxygen and remove carbon dioxide.
• ALI (acute lung injury) and ARDS (acute respiratory distress syndrome) are severe forms of ARF, characterized by diffuse alveolar damage and profound hypoxia.
• Nurses must differentiate between ventilation (mechanical air movement) and respiration (gas exchange).

Types of Respiratory Failure

• Type I (hypoxemic): Impaired O2 transport from alveoli to blood. Causes include pneumonia, cardiogenic edema, ARDS, aspiration, and atelectasis. Associated with Impaired Gas Exchange.
• Type II (hypoxemic hypercapneic): Insufficient ventilation, often due to lung disease (COPD), neurological issues (narcotic overdose, head injury), muscular weakness, or skeletal abnormalities. CO2 builds up (hypercapnea) alongside low oxygen (hypoxemia).

Oxygen Therapy Devices

• Nasal cannula: Simple, low-flow device. Delivers O2 up to 6 LPM, but FiO2 (fractional inspired oxygen) is unpredictable.
• Simple face mask: Delivers higher FiO2 (8-12 LPM), but FiO2 is still affected by patient breathing.
• High-flow devices: Deliver oxygen at a rate exceeding the patient's inspiratory flow. Room air is mixed in less. Can create an oxygen reservoir. Includes wide nasal cannulas, nasal pillows, and face masks.

Mechanical Ventilation

• Mechanical ventilation assists individuals unable to breathe independently.
• Noninvasive (NIV) and invasive methods exist.
• NIV shows gas exchange improvement within 15 minutes.
• Invasive mechanical ventilation uses positive pressure via tubes (nasotracheal, endotracheal, tracheostomy).

Intubation Procedure

• Nasotracheal/Endotracheal tubes establish a patent airway.
• Monitoring O2 saturation (SaO2) during intubation is key. SaO2 below 90% halts the procedure, requiring manual ventilation.
• Post-intubation, auscultation ensures proper tube placement (air should be heard bilaterally).

Tracheostomy

• A tracheostomy is for patients requiring long-term ventilation (>21 days) or airway protection.

Complications of Mechanical Ventilation

• Ventilator-Associated Pneumonia (VAP): A significant complication, preventable by nursing interventions.
• Ventilator-Induced Lung Injury (VILI): Caused by excessive pressure (barotrauma) or excessive volume (volutrauma).

Nutrition in Critical Care

• Early enteral nutrition is preferred over parenteral nutrition.
• Special nutritional formulas may be necessary to address compromised organ systems (protein supplements and probiotics).

Oxygen Therapy: General Information

• Oxygen is essential for cell metabolism and tissue oxygenation.
• Oxygen is used to maintain cellular oxygenation and treat acute/chronic respiratory conditions.
• Oxygen delivery methods vary based on the patient's needs.

Hypoxemia and Related Symptoms

• Hypoxemia is inadequate blood oxygen levels. Causes include hypovolemia, hypoventilation, and issues with arterial flow.
• Cyanosis (bluish skin/mucous membranes) is caused by low blood oxygen.
• Breathlessness can be caused by various diseases (asthma, pulmonary embolism, cardiac insufficiency), high altitudes, anemia, lung diseases (pulmonary edema, pneumonia), and other conditions.

Signs and Symptoms of Respiratory Distress & Hypoxemia

• Early signs: Tachypnea, restlessness, pallor, anxiety.
• Late signs: Confusion, cyanosis, bradycardia, hypotension, cardiac dysrhythmias.

Nursing Interventions for Oxygen Therapy

• Assess and monitor for hypoxemia signs and symptoms.
• Apply oxygen delivery devices per order.
• Monitor O2 saturation (SaO2).
• Position patient for optimal breathing.
• Maintain good oral hygiene.
• Document the patient's response.
• Monitor skin integrity and provide appropriate care.
• Educate patient and family.