Respiratory Failure Overview Quiz
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Questions and Answers

What primarily causes acute respiratory failure (ARF)?

  • Inadequate ventilation and/or oxygenation leading to ventilation-perfusion mismatch (correct)
  • Infection leading to increased respiratory rate
  • Excessive perfusion to the pulmonary capillary bed
  • Alveolar dilation and increased lung elasticity

Which condition can lead to oxygenation failure?

  • Pulmonary embolism (correct)
  • Cystic fibrosis
  • Chronic bronchitis
  • Pneumothorax

How do age-related changes in the lungs affect older adults in the context of respiratory failure?

  • Increased lung elasticity
  • Improved pulmonary reserve due to thicker alveoli
  • Decreased pulmonary reserves, leading to quicker decompensation (correct)
  • Enhanced respiratory muscle function

Which of the following symptoms is most likely to occur due to combined ventilatory and oxygenation failure?

<p>Profound hypoxemia (D)</p> Signup and view all the answers

Which factor does NOT contribute to ventilatory failure?

<p>Excessive pulmonary capillary perfusion (B)</p> Signup and view all the answers

What is a primary consequence of the systemic inflammatory response in ARDS?

<p>Compression of terminal airways (D)</p> Signup and view all the answers

Which factor primarily leads to fluid accumulation in the alveoli during ARDS?

<p>Increased permeability of the alveolar-capillary membrane (C)</p> Signup and view all the answers

What characterizes Severe Acute Respiratory Syndrome (SARS)?

<p>Resulting from a viral infection of coronaviruses (D)</p> Signup and view all the answers

What effect does a reduction in surfactant have on the alveoli?

<p>It leads to alveolar collapse or fluid filling. (C)</p> Signup and view all the answers

How is the SARS virus primarily transmitted?

<p>Airborne droplets from sneezing or coughing (C)</p> Signup and view all the answers

Which condition can be classified as a cause of combined ventilatory and oxygenation failure?

<p>Pneumonia (B), Pulmonary embolism (C), Chronic bronchitis (D)</p> Signup and view all the answers

What is a significant risk factor for developing acute respiratory distress syndrome (ARDS)?

<p>History of smoking (A)</p> Signup and view all the answers

Which of the following conditions is associated with ventilatory failure?

<p>Pneumothorax (C)</p> Signup and view all the answers

What inherent characteristic of patients with severe asthma could lead to oxygenation failure?

<p>Low concentrations of oxygen in blood (C)</p> Signup and view all the answers

Which factor is NOT typically a risk for ventilatory failure?

<p>High altitude exposure (B)</p> Signup and view all the answers

Which of the following is a common symptom of acute respiratory failure?

<p>Dyspnea (B)</p> Signup and view all the answers

Which finding is typically associated with acute respiratory distress syndrome (ARDS)?

<p>Reduced lung compliance (A)</p> Signup and view all the answers

What is a characteristic x-ray finding in a patient with ARDS?

<p>Dense patchy bilateral pulmonary infiltrates (B)</p> Signup and view all the answers

Which symptom is indicative of severe hypoxemia even when 100% oxygen is administered?

<p>Cyanosis (B)</p> Signup and view all the answers

Which of the following symptoms may indicate elevated carbon dioxide levels in the blood?

<p>Confusion (A)</p> Signup and view all the answers

Which symptom is a common indication of severe COVID-19 illness?

<p>Irregular heartbeat (C)</p> Signup and view all the answers

What serious complication may arise from severe COVID-19 illness?

<p>Cyanosis (A)</p> Signup and view all the answers

Which of the following is NOT commonly associated with mild to moderate COVID-19 symptoms?

<p>Unrelenting pressure in the chest (A)</p> Signup and view all the answers

What level of consciousness alteration might indicate severe COVID-19 progression?

<p>Altered level of consciousness (B)</p> Signup and view all the answers

Which symptom may indicate the presence of acute respiratory distress syndrome (ARDS) in a COVID-19 patient?

<p>Severe, unrelenting pressure in the chest (B)</p> Signup and view all the answers

What PaO2 level is commonly associated with hypoxemia in patients with respiratory failure?

<p>PaO2 less than 60 mm Hg (D)</p> Signup and view all the answers

Which laboratory test is specifically used to confirm and monitor ARDS?

<p>Brain natriuretic peptide (BNP) (B)</p> Signup and view all the answers

In the context of respiratory failure, what combination of ABG results indicates combined ventilatory and oxygenation failure?

<p>PaCO2 greater than 50 mm Hg and pH less than 7.35 (D)</p> Signup and view all the answers

Which laboratory marker can indicate inflammation in a patient suspected of having SARS?

<p>Lactate dehydrogenase (D)</p> Signup and view all the answers

What condition is indicated by a SaO2 level less than 90% in a patient being evaluated for respiratory failure?

<p>Acute respiratory failure (A)</p> Signup and view all the answers

What is the preferred diagnostic test for SARS-CoV-2 infection?

<p>Nucleic acid amplification test (NAAT) (B)</p> Signup and view all the answers

Which finding is NOT associated with a chest x-ray in patients with SARS?

<p>Scattered ground glass opacities (C)</p> Signup and view all the answers

What does a positive result from a rapid antigen test indicate regarding SARS-CoV-2 infection likelihood?

<p>High likelihood of infection (C)</p> Signup and view all the answers

Which of the following nursing actions is crucial after a chest x-ray?

<p>Communicate the results to the appropriate personnel (B)</p> Signup and view all the answers

What is the primary characteristic of the nucleic acid amplification test (NAAT) for diagnosing SARS-CoV-2?

<p>High sensitivity (A)</p> Signup and view all the answers

What is the typical range for pulmonary capillary wedge pressure in patients with ARDS?

<p>4 to 12 mm Hg (B)</p> Signup and view all the answers

Which nursing action is essential during the placement of a central venous pressure catheter?

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

What is a key reason for continuous hemodynamic monitoring in patients with ARDS?

<p>To manage fluid administration (C)</p> Signup and view all the answers

What method can be used to confirm the proper placement of a central venous catheter?

<p>Chest x-ray confirmation (D)</p> Signup and view all the answers

Why is it important to have resuscitation medications and equipment readily available during hemodynamic monitoring?

<p>To respond quickly to potential emergencies (A)</p> Signup and view all the answers

What is the primary reason for oxygenating a patient before suctioning their secretions?

<p>To prevent further hypoxemia (C)</p> Signup and view all the answers

What is a common indicator that a patient may need suctioning?

<p>Presence of coarse crackles over the trachea (A)</p> Signup and view all the answers

How can a nurse prevent aspiration during enteral feedings?

<p>By elevating the head of the bed 30° to 45° (B)</p> Signup and view all the answers

What is an essential nursing action when using a mechanical ventilator?

<p>Document ventilator settings according to facility protocol (D)</p> Signup and view all the answers

Which nursing intervention is critical when repositioning a patient on mechanical ventilation?

<p>Immediately check for signs of hypoxemia (B)</p> Signup and view all the answers

What is the purpose of maintaining continuous ECG monitoring in a patient on mechanical ventilation?

<p>To monitor for changes indicating increased hypoxemia (B)</p> Signup and view all the answers

Which measure should be taken to ensure safety when providing oral care for patients at risk of infection?

<p>Wear protective clothing when appropriate (A)</p> Signup and view all the answers

What intervention can help provide emotional support to clients and their families during critical care?

<p>Provide alternative communication means like dry erase boards (B)</p> Signup and view all the answers

What is a primary action of benzodiazepines in patient care?

<p>Reduces anxiety and oxygen consumption (D)</p> Signup and view all the answers

Which nursing action is essential when administering propofol?

<p>Ensure patient is intubated and ventilated (D)</p> Signup and view all the answers

Which patient condition is contraindicated for the use of propofol?

<p>Hyperlipidemia (B)</p> Signup and view all the answers

What should be monitored closely in patients receiving benzodiazepines?

<p>Respirations and SaO2 (C)</p> Signup and view all the answers

What is a critical nursing action when administering sedation to a patient on mechanical ventilation?

<p>Continuously monitor ECG and blood pressure (B)</p> Signup and view all the answers

What is a key action to be taken when discontinuing corticosteroids in hospitalized clients?

<p>Discontinue the medication gradually to prevent withdrawal. (C)</p> Signup and view all the answers

Which of the following medications is recommended for pain management in hospitalized patients?

<p>Morphine sulfate (B)</p> Signup and view all the answers

Why is it important to monitor glucose and electrolytes in patients receiving corticosteroids?

<p>Corticosteroids can lead to adrenal suppression. (A)</p> Signup and view all the answers

What is the significance of having naloxone available for patients using opioid analgesics?

<p>To reverse the effects of respiratory depression. (C)</p> Signup and view all the answers

Which statement best describes client education regarding the use of corticosteroids?

<p>Always take oral doses with food to minimize stomach irritation. (B)</p> Signup and view all the answers

What is a crucial nursing action when administering neuromuscular blocking agents?

<p>Ensure clients are intubated and ventilated. (A)</p> Signup and view all the answers

What must be available to reverse the effects of neuromuscular blocking agents?

<p>Neostigmine and atropine. (A)</p> Signup and view all the answers

Which of the following correctly describes a side effect of neuromuscular blocking agents?

<p>They can leave clients awake and frightened. (B)</p> Signup and view all the answers

What should be done to ensure client safety when administering neuromuscular blocking agents?

<p>Explain all procedures to the client. (A)</p> Signup and view all the answers

Which statement about neuromuscular blocking agents is true?

<p>They help to decrease oxygen consumption. (C)</p> Signup and view all the answers

What nursing action should be performed prior to administering the first dose of an antibiotic?

<p>Culture the sputum prior to administration of the first dose. (D)</p> Signup and view all the answers

What is the recommended method for administering IV doses of vancomycin to avoid red man syndrome?

<p>Give IV doses slowly over at least 60 minutes. (C)</p> Signup and view all the answers

Which of the following statements regarding client education for oral antibiotic doses is accurate?

<p>Finish the prescribed dose even if symptoms improve. (B)</p> Signup and view all the answers

Which aspect is essential to monitor in patients receiving vancomycin therapy?

<p>Coagulopathy and renal function. (C)</p> Signup and view all the answers

What should a nurse avoid when administering antibiotics?

<p>Giving multiple medications simultaneously. (A)</p> Signup and view all the answers

What is the main action of Remdesivir in treating SARS-CoV-2 infection?

<p>Slows replication of the virus (C)</p> Signup and view all the answers

Which of the following nursing actions is NOT required before initiating Remdesivir therapy?

<p>Monitor for hyperkalemia (A)</p> Signup and view all the answers

What should a nurse monitor for as a potential adverse effect of Remdesivir?

<p>Hypersensitivity reaction (D)</p> Signup and view all the answers

While administering Remdesivir, which parameter is crucial for assessing renal function?

<p>Glomerular filtration rate (GFR) (A)</p> Signup and view all the answers

Which adverse gastrointestinal effects should a nurse monitor for during treatment with Remdesivir?

<p>Nausea and vomiting (B)</p> Signup and view all the answers

What is the primary action of antirheumatics like Baricitinib and Tocilizumab in the context of SARS-CoV-2 infection?

<p>Inhibit inflammatory processes associated with the infection (C)</p> Signup and view all the answers

Which nursing action is crucial when monitoring a patient receiving antirheumatics?

<p>Monitor for hypersensitivity reactions (B)</p> Signup and view all the answers

What laboratory test should be obtained before initiating therapy with antirheumatics like Baricitinib?

<p>CBC with differential (C)</p> Signup and view all the answers

Why is it important to monitor liver and kidney function in patients receiving antirheumatics for SARS-CoV-2?

<p>These medications can affect renal and hepatic metabolism (D)</p> Signup and view all the answers

What potential complication should a nurse specifically monitor for in patients receiving antirheumatics?

<p>Manifestations of arterial and deep vein thrombosis (B)</p> Signup and view all the answers

What is the primary action of anticoagulants like dalteparin and enoxaparin?

<p>Inhibit blood coagulation (A)</p> Signup and view all the answers

Which nursing action is crucial before initiating therapy with anticoagulants?

<p>Obtain CBC with differential and absolute neutrophil count (B)</p> Signup and view all the answers

What should a nurse monitor for in a patient receiving anticoagulants?

<p>Hypersensitivity reactions (A)</p> Signup and view all the answers

What is an appropriate nursing assessment related to the administration of anticoagulants?

<p>Check injection site for bruising and inflammation (C)</p> Signup and view all the answers

Which guidelines should be referred to for immunizations regarding SARS-CoV-2?

<p>Centers for Disease Control and Prevention (CDC) (B)</p> Signup and view all the answers

What is one of the primary roles of a respiratory therapist during mechanical ventilation?

<p>Manage the ventilator and adjust settings. (D)</p> Signup and view all the answers

Which of the following actions is NOT crucial when confirming the placement of an endotracheal tube post-intubation?

<p>Checking the client's nutritional intake. (A)</p> Signup and view all the answers

What is the purpose of PEEP during mechanical ventilation?

<p>To keep alveoli expanded during expiration. (C)</p> Signup and view all the answers

What should a nurse monitor when caring for a patient with an endotracheal tube concerning the tube's cuff?

<p>Cuff pressure to maintain between 20 to 30 cm.H2O. (D)</p> Signup and view all the answers

Which equipment should always be readily available during the intubation procedure?

<p>A manual resuscitation bag and face mask. (D)</p> Signup and view all the answers

What is the primary benefit of using a kinetic bed for patients?

<p>To reduce atelectasis and improve ventilation (D)</p> Signup and view all the answers

Which nursing action should be taken if a client experiences distress during rotation on a kinetic bed?

<p>Stop the rotation (C)</p> Signup and view all the answers

What is a critical monitoring parameter during kinetic therapy?

<p>Breath sounds (B)</p> Signup and view all the answers

How should rotational therapy be initiated for a patient?

<p>Start slowly and gradually increase rotation (A)</p> Signup and view all the answers

What should be provided alongside kinetic therapy to prevent skin breakdown?

<p>Routine skin care (D)</p> Signup and view all the answers

What complication can arise from long-term intubation?

<p>Damage to trachea and vocal cords (A)</p> Signup and view all the answers

How often should the positioning of an endotracheal tube be checked?

<p>Every 1 to 2 hours (A)</p> Signup and view all the answers

What is the recommended cuff pressure to maintain for an endotracheal tube?

<p>20 to 30 cm H2O (C)</p> Signup and view all the answers

Which nursing action should be performed when a client is moved or turned who has an endotracheal tube?

<p>Monitor lung sounds and chest movement (A)</p> Signup and view all the answers

What is a potential reason for needing a tracheostomy in ventilated patients?

<p>Long-term ventilation requirements (D)</p> Signup and view all the answers

What is a potential complication of long-term intubation?

<p>Damage to trachea and vocal cords (D)</p> Signup and view all the answers

When checking the cuff pressure of an endotracheal tube, what is the appropriate range to maintain?

<p>20 to 30 cm H2O (B)</p> Signup and view all the answers

What action can help prevent infection in patients with an endotracheal tube?

<p>Using sterile suctioning techniques (A)</p> Signup and view all the answers

What should a nurse assess every time a client with an endotracheal tube is moved?

<p>Lung sounds and oxygen saturation (A)</p> Signup and view all the answers

Which of the following actions is important to secure the position of an endotracheal tube?

<p>Documenting the level of the tube (D)</p> Signup and view all the answers

What is a primary cause of acute respiratory failure (ARF)?

<p>Inadequate ventilation due to lung disease (B)</p> Signup and view all the answers

Which condition is a likely consequence of a systemic inflammatory response in ARDS?

<p>Fluid accumulation in the alveoli (B)</p> Signup and view all the answers

What type of failure can occur with diseases affecting lung tissue, such as emphysema?

<p>Combined ventilatory and oxygenation failure (A)</p> Signup and view all the answers

Which of the following factors can lead to fluid accumulation in the alveoli during ARDS?

<p>Trauma to the lungs (D)</p> Signup and view all the answers

What is a significant risk associated with older adult clients regarding respiratory failure?

<p>Decreased lung elasticity and thickened alveoli (B)</p> Signup and view all the answers

Which mechanism explains the transmission of SARS?

<p>Airborne droplets from respiratory activities (D)</p> Signup and view all the answers

What can result from a lack of perfusion to the pulmonary capillary bed?

<p>Pulmonary embolism may occur (B)</p> Signup and view all the answers

What leads to a decrease in surfactant production in ARDS?

<p>Inflammatory response damaging alveoli (B)</p> Signup and view all the answers

What is the primary purpose of administering vecuronium to a client with acute respiratory distress syndrome (ARDS)?

<p>To facilitate ventilation (D)</p> Signup and view all the answers

Which of the following factors contributes to combined ventilatory and oxygenation failure?

<p>Poor respiratory movement (D)</p> Signup and view all the answers

Which action is essential when monitoring a patient administered remdesivir?

<p>Obtain liver enzymes and GFR (C)</p> Signup and view all the answers

Which of the following antibiotics is commonly sensitive to cultured organisms in respiratory infections?

<p>Vancomycin (A)</p> Signup and view all the answers

Which patient condition is most likely to develop dyspnea as a prominent symptom?

<p>Severe asthma attack (D)</p> Signup and view all the answers

What is a common diagnostic finding on a chest x-ray for patients with ARDS?

<p>Ground-glass opacities (D)</p> Signup and view all the answers

What is an important nursing action to take before administering the first dose of antibiotics for pneumonia?

<p>Culture the sputum (D)</p> Signup and view all the answers

In which scenario is a patient's risk for acute respiratory distress syndrome (ARDS) increased?

<p>Near-drowning incident (D)</p> Signup and view all the answers

When administering anticoagulants to a patient with COVID-19, which assessment is essential?

<p>Assess for bruising at the injection site (A)</p> Signup and view all the answers

What is the primary action of antivirals like remdesivir when treating SARS-CoV-2 infections?

<p>Slow replication of the virus (C)</p> Signup and view all the answers

Which laboratory value indicates severe hypoxemia in a patient with respiratory failure?

<p>PaO2 less than 60 mm Hg (A)</p> Signup and view all the answers

Which medication action is associated with antirheumatics used in SARS-CoV-2 infections?

<p>Inhibit inflammatory processes (B)</p> Signup and view all the answers

Which condition could cause elevated intracranial pressure that may lead to respiratory failure?

<p>Hemorrhagic stroke (D)</p> Signup and view all the answers

During which phase should the nurse assure that emergency resuscitation equipment is available?

<p>Preintubation phase (C)</p> Signup and view all the answers

What is identified as a common complication that can arise from ARDS?

<p>Sepsis (A)</p> Signup and view all the answers

Which specific laboratory tests should be obtained before initiating therapy for a patient on anticoagulants?

<p>Prothrombin time and INR (D)</p> Signup and view all the answers

Which of the following is a risk factor for developing oxygenation failure?

<p>Low hemoglobin levels (B)</p> Signup and view all the answers

What is a key nursing action when administering bronchodilators in a patient with ARDS?

<p>Monitor for wheezing and breath sounds (D)</p> Signup and view all the answers

What nursing intervention is most critical during the management of a patient with ARDS?

<p>Maintaining optimal patient positioning (A)</p> Signup and view all the answers

What should be included in client education for those receiving anticoagulant therapy?

<p>Risk of bleeding and bruising (C)</p> Signup and view all the answers

Which component is typically monitored during hemodynamic assessment in ARDS patients?

<p>Pulmonary capillary wedge pressure (A)</p> Signup and view all the answers

Which of the following describes a vital nursing intervention during mechanical ventilation?

<p>Frequent assessment of lung sounds and SaO2 (A)</p> Signup and view all the answers

Which statement best describes the primary function of the nucleic acid amplification test (NAAT) for SARS-CoV-2?

<p>It identifies viral ribonucleic acid (RNA). (D)</p> Signup and view all the answers

Which of the following describes the role of pulmonary capillary wedge pressure in ARDS?

<p>Reflects fluid status in the lungs (A)</p> Signup and view all the answers

What is the recommended action when providing care for a patient with a kinetic therapy bed?

<p>Monitor for client distress and adjust rotation gradually (C)</p> Signup and view all the answers

What is essential to monitor after administering enteral nutrition in a client with ARDS?

<p>Metabolic and caloric needs (C)</p> Signup and view all the answers

What is a recognized sign of severe acute respiratory syndrome (SARS-CoV-2) infection?

<p>Loss of taste and smell (C)</p> Signup and view all the answers

Which of the following interventions is crucial in safely managing patients with respiratory distress?

<p>Close monitoring of hemodynamic status (D)</p> Signup and view all the answers

What is the most critical action for a nurse to take when a patient exhibits absent breath sounds and dyspnea after a motor vehicle crash?

<p>Administer oxygen via a high-flow mask. (B)</p> Signup and view all the answers

In which position should a nurse place a client with ARDS to promote effective ventilation?

<p>Prone. (D)</p> Signup and view all the answers

What nursing action is essential when monitoring a client on mechanical ventilation?

<p>Ensure continuous ECG monitoring for changes. (C)</p> Signup and view all the answers

How should a nurse assess the need for suctioning a client on mechanical ventilation?

<p>Auscultate for coarse crackles over the trachea. (D)</p> Signup and view all the answers

What should a nurse do to prevent aspiration when administering enteral feedings?

<p>Elevate the head of the bed 30° to 45°. (D)</p> Signup and view all the answers

Which medication class is recommended for clients with SARS-CoV-2 infection who require supplemental oxygenation?

<p>Corticosteroids. (A)</p> Signup and view all the answers

What is a critical nursing action when administering benzodiazepines?

<p>Monitor respirations in clients not on mechanical ventilation. (C)</p> Signup and view all the answers

Which of the following actions should a nurse prioritize when suctioning a patient?

<p>Oxygenate the client before the procedure. (D)</p> Signup and view all the answers

When using propofol, what is a key monitoring action that nurses must perform?

<p>Titrate to desired sedation based on the patient's neurologic status. (A)</p> Signup and view all the answers

How should a nurse manage a client receiving corticosteroids to prevent side effects?

<p>Administer with an antiulcer medication. (D)</p> Signup and view all the answers

Which nursing action is essential when using neuromuscular blocking agents?

<p>Monitor muscle strength and provide sedation. (B)</p> Signup and view all the answers

What is a major consideration when using mechanical ventilation in patients with high PEEP?

<p>It can lead to pneumothorax due to lung collapse. (B)</p> Signup and view all the answers

What is a significant risk associated with the use of opioids in patients receiving mechanical ventilation?

<p>Severe respiratory depression. (B)</p> Signup and view all the answers

Which intervention can a nurse take to support a client's emotional needs during critical care?

<p>Encourage verbalization of feelings and provide alternative communication methods. (C)</p> Signup and view all the answers

Flashcards

Acute Respiratory Failure (ARF)

Inability of the lungs to adequately oxygenate or ventilate, resulting in a ventilation-perfusion mismatch.

Ventilatory Failure

Problem with the mechanical ability of the lungs or chest wall, respiratory muscles (like the diaphragm), or brain's breathing control center.

Oxygenation Failure

Caused by insufficient blood flow to lung blood vessels (like a pulmonary embolism) or problems with gas exchange in the lungs (like pulmonary edema or pneumonia).

ABG values

Blood gas measurements used to diagnose respiratory failure by determining oxygen and carbon dioxide levels in blood.

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Diseased Lungs

Respiratory problems like asthma, emphysema, or cystic fibrosis that can hinder both ventilation and oxygenation in the lungs.

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ARDS

Acute Respiratory Distress Syndrome (ARDS) is a serious lung condition that occurs due to fluid buildup in the alveoli, preventing proper gas exchange, which leads to respiratory failure.

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ARDS Triggers

Common causes of ARDS include trauma (burns, physical injuries, aspiration), infections (sepsis), and medical procedures like transfusions.

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ARDS Mechanism

An inflammatory response damages the lung's membranes, causing leakage of fluids and proteins into the alveoli. This impairs gas exchange, reducing oxygen supply to the body.

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SARS

Severe Acute Respiratory Syndrome (SARS) is a respiratory illness caused by a specific type of coronavirus, such as SARS-CoV-2, which can be highly contagious.

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SARS Transmission

SARS spreads easily through airborne droplets released during coughing, sneezing, or even talking, making it highly contagious.

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Acute Respiratory Distress Syndrome (ARDS)

A serious lung injury that causes fluid buildup in the alveoli, leading to impaired gas exchange and respiratory failure.

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Risk Factors for Respiratory Failure

Conditions or factors that increase the likelihood of developing respiratory failure.

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Severe Acute Respiratory Syndrome (SARS)

A respiratory illness caused by a specific type of coronavirus, such as SARS-CoV-2, characterized by severe lung inflammation and respiratory distress.

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Orthopnea

Difficulty breathing when lying down, requiring the person to sit up or stand to get relief.

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Dyspnea

Shortness of breath, a feeling of tightness in the chest, or difficulty breathing.

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Hypoxemia

Low levels of oxygen in the blood.

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Cyanosis

Bluish discoloration of the skin and mucous membranes due to low oxygen levels in the blood.

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What are signs of acute respiratory distress syndrome?

Acute respiratory distress syndrome (ARDS) is a serious lung condition that causes fluid buildup in the alveoli, preventing proper gas exchange, which leads to respiratory failure. Symptoms include dyspnea, bilateral noncardiogenic pulmonary edema, reduced lung compliance, dense patchy bilateral pulmonary infiltrates on x-ray, severe hypoxemia despite administration of 100% oxygen, cyanosis, pallor, and intercostal and substernal retractions.

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COVID-19 Symptoms (Mild)

Common symptoms include: cough, fatigue, sore throat, loss of taste or smell, headache, muscle aches, and shortness of breath.

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COVID-19 Symptoms (Severe)

Severe symptoms can include: chest pain or pressure, bluish skin, confusion, and rapid breathing.

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ARDS (Acute Respiratory Distress Syndrome)

A serious lung condition where fluid fills the air sacs, preventing oxygen from reaching the blood.

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What can happen to the body during severe COVID-19?

Severe COVID-19 can damage kidneys, the heart, and lead to sepsis (a life-threatening infection).

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COVID-19 Transmission

The virus spreads mainly through respiratory droplets released when a person coughs, sneezes, or talks.

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PaO2 in ARF

Partial pressure of oxygen in arterial blood (PaO2) is less than 60 mm Hg in acute respiratory failure (ARF), indicating low oxygen levels in the blood.

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PaCO2 in ARF

Partial pressure of carbon dioxide in arterial blood (PaCO2) is greater than 50 mm Hg in ARF, indicating poor carbon dioxide removal from the body.

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SaO2 in ARF

Oxygen saturation (SaO2) is less than 90% in ARF, indicating that the blood is not carrying enough oxygen.

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ARDS Blood Tests

In addition to ABGs, other blood tests are used to diagnose and monitor ARDS, including brain natriuretic peptide (BNP) to assess heart function and inflammation.

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SARS Blood Tests

Besides ABGs, blood tests for SARS include complete blood count (CBC) with differential, aminotransferase levels, D-dimer, C-reactive protein, ferritin, and lactate dehydrogenase.

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Rapid Antigen Test

A quick test that detects proteins specific to the SARS-CoV-2 virus in respiratory samples. A positive result suggests a high likelihood of infection, while a negative result indicates a lower likelihood.

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Nucleic Acid Amplification Test (NAAT)

The preferred test for diagnosing SARS-CoV-2 infection due to its high sensitivity. Detects the virus's RNA.

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Ground Glass Opacities

A pattern visible on chest X-rays and CT scans that suggests fluid buildup in the lungs, often associated with SARS-CoV-2 infection and ARDS.

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Nursing Action: Positioning

Before and after a chest X-ray, nurses must assist clients with positioning for optimal imaging and comfort.

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Nursing Action: Reporting Results

Nurses promptly communicate the results of diagnostic tests, such as chest X-rays, to the appropriate healthcare professionals.

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Pulmonary Capillary Wedge Pressure (PCWP) in ARDS

In ARDS, the PCWP is usually low or within the normal range (4-12 mmHg).

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Hemodynamic Monitoring in ARDS

Continuous hemodynamic monitoring is crucial for managing fluid levels in patients with ARDS.

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ECG Monitoring During Catheter Placement

Nurses must carefully monitor the ECG during the insertion of central venous pressure catheters and hemodynamic monitors.

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Resuscitation Equipment Availability

Nurses must ensure that resuscitation medications and equipment are readily available when working with patients who have ARDS or require hemodynamic monitoring.

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Confirming Catheter Placement

After placing a central venous pressure catheter or hemodynamic monitor, nurses must confirm its position using a chest x-ray.

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What is the primary focus of nursing care for a client with respiratory failure?

Maintaining a patent airway, preventing infection, promoting nutrition, and providing emotional support.

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How often should you assess respiratory status for a client with respiratory failure?

Every hour, and more frequently as needed.

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What is the purpose of positive-end expiratory pressure (PEEP)?

To prevent alveolar collapse during expiration, thus improving oxygen exchange.

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Why is oxygenation important before suctioning secretions?

To prevent further hypoxemia (low blood oxygen levels) during the procedure.

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What are the signs of a pneumothorax?

Lung collapse, usually caused by high PEEP pressures.

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What are airborne precautions?

Used for clients with procedures that generate aerosols, such as intubation.

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How can you prevent aspiration during enteral feedings?

Elevate the head of the bed 30° to 45° and confirm nasogastric tube placement.

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What are some ways to provide emotional support to clients with respiratory failure?

Encourage verbalization of feelings and provide alternative communication methods.

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Benzodiazepines: Actions

Benzodiazepines, like Lorazepam and Midazolam, are drugs that reduce anxiety, resistance to ventilation, and decrease oxygen consumption.

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General Anesthesia: Example

Propofol is a common medication used to induce and maintain anesthesia, and it also sedates clients for mechanical ventilation.

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General Anesthesia: Nursing Actions

When using general anesthesia, especially Propofol, nurses must carefully monitor ECG, blood pressure, and sedation levels. It's contraindicated in patients with hyperlipidemia and egg allergies.

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Benzodiazepine Nursing Actions

Nurses should monitor respirations, blood pressure, and oxygen saturation (SaO2) when administering benzodiazepines. Use caution when administering with opioids.

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General Anesthesia: Pain Management

Propofol does not have analgesic (pain-relieving) properties. You must monitor for pain and administer analgesics as ordered.

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Corticosteroids: Action

Corticosteroids reduce inflammation by decreasing WBC migration and suppressing the inflammatory response.

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Corticosteroids: Nursing Action

When administering corticosteroids, taper the dosage gradually, co-administer an antiulcer medication, and monitor weight, blood pressure, glucose, and electrolytes.

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Opioid Analgesics: Action

Opioids provide pain relief by acting on the central nervous system to reduce pain signals.

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Opioid Analgesics: Nursing Action

Monitor respirations closely, especially in clients not on mechanical ventilation. Assess pain level and response to medication. Have naloxone and resuscitation equipment readily available.

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What is the purpose of naloxone?

Naloxone is a medication used to reverse the effects of opioid overdose, restoring normal breathing and consciousness.

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Neuromuscular Blocking Agents

Medications that paralyze muscles, making them easier to ventilate. They DO NOT sedate or relieve pain.

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Vecuronium, Atracurium, Rocuronium

Common examples of neuromuscular blocking agents used to relax muscles during mechanical ventilation.

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Nursing Actions with Neuromuscular Blocking Agents

Administer only to intubated and ventilated patients. Monitor vital signs and muscle strength. Provide pain relief and sedation.

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Neostigmine and Atropine

Medications used to reverse the effects of neuromuscular blocking agents.

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Client Education for Neuromuscular Blocking Agents

Explain that paralysis is induced by medication and reassure the patient.

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Vancomycin

An antibiotic that treats identified organisms causing infections. It's often used for bacteria resistant to other antibiotics.

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Red Man Syndrome

A side effect of rapid IV vancomycin administration, causing flushing, itching, and a red rash on the upper body.

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Why give vancomycin slowly?

To prevent Red Man Syndrome, a serious side effect caused by rapid IV administration.

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Vancomycin and Coagulopathy

Vancomycin can affect blood clotting and renal function, requiring monitoring.

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Vancomycin and Other Medications

Vancomycin should not be administered concurrently with other medications.

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Remdesivir: What is it?

Remdesivir is an antiviral medication approved for treating SARS-CoV-2 infection (COVID-19).

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Remdesivir: How does it work?

Remdesivir slows down the replication (copying) of the SARS-CoV-2 virus within the body.

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Remdesivir: Nursing Actions

Before starting Remdesivir, nurses check kidney function (GFR), liver health (enzymes), and clotting factors (PT, INR). They also monitor for allergic reactions, IV site issues, and changes in kidney and clotting function.

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Antivirals: Purpose

Antiviral medications like Remdesivir target viruses to help the body fight off infections.

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Antivirals: Limitations

Antivirals are not always a cure and may only slow down the virus's spread. They don't necessarily prevent the illness.

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Antirheumatics for COVID-19

Medications like Baricitinib and Tocilizumab that suppress the immune system's overreaction to SARS-CoV-2 infection, reducing inflammation and preventing tissue damage.

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Monitor for Hypersensitivity Reaction

Pay close attention to patients receiving antirheumatic drugs for signs of an allergic reaction, such as rash, itching, swelling, difficulty breathing, or a rapid heartbeat.

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Monitor for Blood Clots

Antirheumatic drugs can increase the risk of blood clots in the arteries or veins. Look for signs of swelling, redness, pain, or shortness of breath.

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Liver and Kidney Function

Antirheumatic medications can sometimes affect the liver and kidneys. Regular monitoring of liver enzymes and kidney function tests is essential.

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Complete Blood Count (CBC)

Before starting and throughout treatment with antirheumatics, check a CBC with differential (different types of white blood cells) to assess the patient's blood cell count.

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Anticoagulants (SARS-CoV-2)

Medications that prevent the blood from clotting too quickly, used to treat patients infected with SARS-CoV-2.

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Dalteparin and Enoxaparin

Common types of anticoagulant medications used to treat SARS-CoV-2.

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What are nursing actions with anticoagulants?

Monitor for hypersensitivity reactions, assess injection sites for bruising and inflammation, monitor for bleeding, obtain CBC before and during therapy.

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Immunizations (SARS-CoV-2)

Vaccines for the SARS-CoV-2 virus, typically administered in a series of doses.

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CDC guidelines for immunizations

The Center for Disease Control and Prevention provides recommendations for different age groups regarding SARS-CoV-2 vaccination.

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Mechanical Ventilation: What's the Goal?

To support breathing and improve oxygen levels when the lungs can't work on their own. This helps prevent low blood oxygen (hypoxemia) and carbon dioxide buildup.

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Endotracheal Tube: Placement Confirmation

After inserting the tube, we need to make sure it's in the right spot in the windpipe. We check things like the end-tidal carbon dioxide levels, lung sounds on both sides, chest movement, and a chest X-ray.

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Positive End-Expiratory Pressure (PEEP): What does it do?

PEEP keeps the tiny air sacs in your lungs (alveoli) open even after you breathe out. This improves gas exchange and prevents those sacs from collapsing.

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Intubation: What Happens Before?

Before inserting the tube, we need to make sure your airway's clear and ready. We give you 100% oxygen, help with breathing using a mask, and have emergency gear nearby.

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Intubation: What Happens After?

Once the tube is in place, we secure it properly with a balloon cuff that we check regularly. We also assess lung sounds, chest movement, and the X-ray to ensure it's in the right place.

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Kinetic Bed Rotation

A bed that rotates laterally to help patients breathe better by preventing lung collapse (atelectasis) and improving air flow.

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Kinetic Bed: Nursing Actions

Start rotations slowly and increase gradually as tolerated. Monitor vital signs like heart rate, oxygen levels, breathing sounds, and blood pressure. Stop rotation if the patient becomes distressed.

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Kinetic Bed: Skin Care

Regularly check and care for the patient's skin to prevent sores or breakdowns due to constant movement on the bed.

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Kinetic Bed: Sedation

May need to sedate the patient to help them tolerate the rotation, especially if they are anxious or uncomfortable.

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Kinetic Bed: Purpose

This type of bed helps prevent the lungs from collapsing (atelectasis) and improves air flow into the lungs, leading to better breathing.

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Tracheal Trauma

Injury to the trachea (windpipe) or vocal cords caused by the endotracheal tube during intubation or long-term ventilation.

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Tracheostomy Need

A surgical procedure to create an opening in the trachea (windpipe), allowing for long-term ventilation when the endotracheal tube alone is insufficient.

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Endotracheal Tube Positioning

Regularly checking the location of the endotracheal tube to ensure it's properly in the trachea (windpipe) and not in the wrong place.

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Cuff Pressure Monitoring

Regularly checking the pressure within the cuff of the endotracheal tube to ensure it's within the recommended range (20 to 30 cm H2O) to prevent injury to the trachea (windpipe).

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Securing Endotracheal Tube

Using proper methods and guidelines to keep the endotracheal tube securely in place, preventing it from moving or being accidentally pulled out.

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What is ARF?

Acute Respiratory Failure (ARF) happens when your lungs can't get enough oxygen into your blood or remove enough carbon dioxide.

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What causes ARF?

ARF can be caused by problems with your lungs' mechanics (like muscles or chest wall), your breathing control center in your brain, or your blood flow to the lungs.

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What's the difference between ARF & ARDS?

ARF is a general term for lung failure. ARDS is a specific type of severe lung injury that causes fluid buildup.

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What causes ARDS?

ARDS can be triggered by trauma, infections, and medical procedures.

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What is SARS?

Severe Acute Respiratory Syndrome is a respiratory illness caused by a virus, like SARS-CoV-2 (COVID-19).

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How does SARS spread?

SARS spreads easily through airborne droplets released when someone coughs, sneezes, or even talks.

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What are some ways to prevent SARS?

Washing your hands, wearing masks, social distancing, and getting vaccinated all help prevent SARS.

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What are the signs of ARDS?

Symptoms like dyspnea, reduced lung compliance, dense patchy infiltrates on X-ray, severe hypoxemia, cyanosis, pallor, and intercostal retractions.

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SARS-CoV-2

A type of coronavirus responsible for the COVID-19 illness, which can cause severe respiratory distress.

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What are COVID-19 symptoms (mild)?

Common symptoms include cough, fatigue, sore throat, loss of taste or smell, headache, muscle aches, and shortness of breath.

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What are COVID-19 symptoms (severe)?

Severe symptoms can include chest pain or pressure, bluish skin, confusion, and rapid breathing.

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Vecuronium

A neuromuscular blocking agent that paralyzes muscles, making it easier to ventilate.

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Remdesivir

An antiviral medication approved for treating SARS-CoV-2 infection (COVID-19).

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Antirheumatic Drugs

Medications like Baricitinib and Tocilizumab that suppress the immune system's overreaction to SARS-CoV-2 infection.

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Positive End-Expiratory Pressure (PEEP)

PEEP keeps the tiny air sacs in your lungs (alveoli) open even after you breathe out.

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Kinetic Bed

A bed that rotates laterally to help patients breathe better by preventing lung collapse (atelectasis) and improving air flow.

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Tracheostomy

A surgical procedure to create an opening in the trachea (windpipe), allowing for long-term ventilation when the endotracheal tube alone is insufficient.

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Endotracheal Tube

A tube inserted into the trachea (windpipe) to help patients breathe.

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Prone Positioning

Placing a client in the prone position (face down) can help improve oxygenation in patients with ARDS by allowing for better lung expansion.

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Ventilation

The process of moving air in and out of the lungs, allowing for the exchange of oxygen and carbon dioxide.

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Respiratory Status

The overall health and functioning of the respiratory system, including breathing rate, depth, pattern, and lung sounds.

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Suctioning

A procedure used to remove mucus and secretions from the airway, often necessary for patients with respiratory distress.

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Intubation

The insertion of a breathing tube into the trachea (windpipe) to maintain an open airway and help with breathing.

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Mechanical Ventilation

A machine that assists or takes over breathing for patients who can't breathe on their own.

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Opioid Analgesics

Medications like morphine and fentanyl that provide pain relief by acting on the central nervous system.

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Benzodiazepines

Medications like lorazepam and midazolam that reduce anxiety, resistance to ventilation, and decrease oxygen consumption.

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Corticosteroids

Medications like cortisone acetate and methylprednisolone that reduce inflammation and suppress the immune response.

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Study Notes

Respiratory Failure Overview

  • Respiratory failure encompasses acute respiratory failure (ARF), acute respiratory distress syndrome (ARDS), and severe acute respiratory syndrome (SARS).
  • Older adults are more susceptible to respiratory decompensation due to age-related lung changes (decreased elasticity, thicker alveoli) that diminish pulmonary reserve.

Acute Respiratory Failure (ARF)

  • ARF arises from inadequate ventilation and/or oxygenation, causing a ventilation-perfusion mismatch.
  • Ventilatory failure results from:
    • Mechanical lung or chest wall abnormalities.
    • Impaired respiratory muscle function (especially the diaphragm).
    • Respiratory control center malfunction in the brain.
  • Oxygenation failure results from:
    • Inadequate perfusion to pulmonary capillaries (e.g., pulmonary embolism).
    • Conditions altering gas exchange medium (e.g., pulmonary edema, pneumonia).
  • Lung diseases (e.g., asthma, emphysema, cystic fibrosis) can lead to both oxygenation failure and increased breathing effort, eventually causing respiratory muscle fatigue and ventilatory failure.
  • Combined ventilation and oxygenation failure leads to more severe hypoxemia than either failure alone.
  • ARF diagnosis is based on arterial blood gas (ABG) values.

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Description

Test your understanding of respiratory failure, including acute respiratory failure, ARDS, and SARS. This quiz will cover causes, effects, and implications for older adults. Brush up on your knowledge and learn about the mechanisms behind ventilatory and oxygenation failures.

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