Podcast
Questions and Answers
What characterizes chronic respiratory failure?
What characterizes chronic respiratory failure?
- Rapid development of hypoxemia and hypercapnia
- Absence of acute symptoms (correct)
- Severe confusion and lethargy during evaluation
- Immediate resolution after acute episodes
Which of the following is NOT a cause of failure to ventilate?
Which of the following is NOT a cause of failure to ventilate?
- Obstruction
- Neurological impairment
- Shunting (correct)
- Abdominal compression
What does a pH level below 7.35 indicate?
What does a pH level below 7.35 indicate?
- Normal acid-base balance
- Respiratory alkalosis
- Metabolic alkalosis
- Metabolic acidosis (correct)
In assessing acute respiratory failure, which early symptoms are commonly observed?
In assessing acute respiratory failure, which early symptoms are commonly observed?
Which arterial blood gas measurement indicates a normal range for PAO2?
Which arterial blood gas measurement indicates a normal range for PAO2?
What is the appropriate treatment for restoring gas exchange in acute respiratory failure?
What is the appropriate treatment for restoring gas exchange in acute respiratory failure?
What does metabolic alkalosis indicate regarding bicarbonate levels?
What does metabolic alkalosis indicate regarding bicarbonate levels?
What is a common result of chronic respiratory failure due to conditions like COPD?
What is a common result of chronic respiratory failure due to conditions like COPD?
What is the primary purpose of ventilation in the respiratory system?
What is the primary purpose of ventilation in the respiratory system?
Which type of trauma involves injuries like sternal fractures or flail chest?
Which type of trauma involves injuries like sternal fractures or flail chest?
What critical value of PaO2 indicates hypoxemia?
What critical value of PaO2 indicates hypoxemia?
What is the characteristic pH level and PCO2 measurement for respiratory alkalosis?
What is the characteristic pH level and PCO2 measurement for respiratory alkalosis?
What is the primary function of the upper respiratory tract?
What is the primary function of the upper respiratory tract?
What is a common clinical manifestation of pulmonary embolism?
What is a common clinical manifestation of pulmonary embolism?
Which of the following represents a commonly recognized cause of respiratory acidosis?
Which of the following represents a commonly recognized cause of respiratory acidosis?
What is the mortality rate commonly associated with ARDS?
What is the mortality rate commonly associated with ARDS?
In the case of pulmonary embolism, what does an increase in pulmonary vascular resistance typically lead to?
In the case of pulmonary embolism, what does an increase in pulmonary vascular resistance typically lead to?
Which medication is preferred by providers due to its faster reversal and decreased chance of delirium?
Which medication is preferred by providers due to its faster reversal and decreased chance of delirium?
Which step is NOT part of the six steps for blood gas interpretation?
Which step is NOT part of the six steps for blood gas interpretation?
Which of the following assessments is considered the best test for pulmonary embolism if time and condition allow?
Which of the following assessments is considered the best test for pulmonary embolism if time and condition allow?
What is a potential side effect of Propofol (Diprivan)?
What is a potential side effect of Propofol (Diprivan)?
In the acute exudative phase of ARDS, what significant change occurs?
In the acute exudative phase of ARDS, what significant change occurs?
Which of the following IV medications is commonly used for seizure control?
Which of the following IV medications is commonly used for seizure control?
Which of the following is NOT a management strategy for acute respiratory failure?
Which of the following is NOT a management strategy for acute respiratory failure?
Which of the following treatments is NOT typically utilized in ARDS management?
Which of the following treatments is NOT typically utilized in ARDS management?
What two conditions may coexist in a patient with acidotic status?
What two conditions may coexist in a patient with acidotic status?
What is the primary goal of medical management for pulmonary embolism?
What is the primary goal of medical management for pulmonary embolism?
What is a common complication of intubating the right lung mistakenly?
What is a common complication of intubating the right lung mistakenly?
What is monitored using the Train of Four during paralysis?
What is monitored using the Train of Four during paralysis?
What must be assessed alongside ABGs and vital signs in respiratory assessments?
What must be assessed alongside ABGs and vital signs in respiratory assessments?
What is an essential preventive measure against Deep Vein Thrombosis (DVT)?
What is an essential preventive measure against Deep Vein Thrombosis (DVT)?
What must be documented every hour for patients receiving paralytics?
What must be documented every hour for patients receiving paralytics?
What characterizes the pulmonary condition known as ARDS?
What characterizes the pulmonary condition known as ARDS?
Which factor is NOT commonly associated with the development of ARDS?
Which factor is NOT commonly associated with the development of ARDS?
What is a primary pathophysiological change occurring in ARDS?
What is a primary pathophysiological change occurring in ARDS?
Which clinical manifestation is characteristic of ARDS?
Which clinical manifestation is characteristic of ARDS?
When using paralytics, what is essential for patient safety?
When using paralytics, what is essential for patient safety?
What is a potential outcome of the proliferative phase of ARDS?
What is a potential outcome of the proliferative phase of ARDS?
What condition is strongly associated with pulmonary embolism, particularly following surgery?
What condition is strongly associated with pulmonary embolism, particularly following surgery?
Which nursing management action is critical for a patient in acute respiratory failure (ARF)?
Which nursing management action is critical for a patient in acute respiratory failure (ARF)?
Which management strategy is recommended for improving oxygenation in ARDS patients?
Which management strategy is recommended for improving oxygenation in ARDS patients?
What is a common sign seen on a chest x-ray for patients with ARDS?
What is a common sign seen on a chest x-ray for patients with ARDS?
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Study Notes
Management of Respiratory Disorders
- Understand anatomy and physiology of respiratory system for effective management of disorders.
- Assess respiratory function using diagnostic tools: PFT, pulse oximetry, chest X-ray, CT scan, ABGs, biopsy, bloodwork, EKG.
- Auscultate lung fields both anteriorly and posteriorly; evaluate work of breathing through visual inspection.
Sedation and Pain Management in ICU
- Propofol (Diprivan): Fast-acting sedative, potential for hypotension and bradycardia; undergo hourly monitoring during usage.
- Precedex (Dexmedetomidine): Preferred for quicker reversal and lower delirium risk, also can cause bradycardia and hypotension.
- Benzodiazepines:
- Valium (Diazepam): Used in alcohol detoxification, may cause oversedation.
- Ativan (Lorazepam): Controls seizures, can lead to respiratory depression.
- Midazolam (Versed): Short-acting with similar risks.
Use of Paralytics
- Commonly includes Norcuron, Pavulon, Nimbex.
- Essential for patients on ventilators, requires continuous IV sedation.
Lung Anatomy
- Upper respiratory tract filters and warms incoming air.
- Lower respiratory tract comprises three lobes on the right, two on the left.
- Visceral pleura covers lungs, parietal pleura lines the pleural cavity.
Gas Exchange and Oxygen Transport
- Respiration: Involves gas exchange between atmosphere and blood; includes cellular exchange of O2 and CO2.
- Ventilation: Movement of air in/out of lungs; consists of active inspiration and passive expiration.
Chest Trauma
- Types: Blunt trauma (rib fractures, pulmonary contusion) and penetrating trauma (gunshot/stab wounds).
- Management focuses on airway, oxygen needs, fluid volume restoration, and drainage of pleural fluid/blood.
Pulmonary Embolism (PE)
- Obstruction in pulmonary artery from thrombus, primarily originating from DVT.
- Risk factors: trauma, surgery, pregnancy, heart failure, age >50, immobility, atrial fibrillation.
- Clinical manifestations include dyspnea, tachypnea, chest pain, and hemoptysis.
Assessment and Diagnosis of PE
- Utilize CXR, ECG, pulse oximetry, ABGs, V/Q scan, pulmonary angiogram, and CT scan.
- Treatment involves managing existing PE with thrombolytics (TPA) and preventing future occurrences through anticoagulation.
Acute Respiratory Failure (ARF)
- Defined as a rapid decline in gas exchange; characterized by pH < 7.35, PaO2 < 60 mmHg, PaCO2 > 50 mmHg.
- Differentiate between acute and chronic respiratory failure based on symptom onset and history.
Causes of Respiratory Failure
- Failures include inability to oxygenate (diffusion abnormalities), maintain airways (obstruction), or ventilate effectively (shunting, chest injury).
Clinical Signs of ARF
- Early signs: restlessness, tachycardia, hypertension; progression to lethargy, cyanosis, respiratory arrest.
- Management includes correcting underlying causes, intubation, mechanical ventilation, and ICU care.
Blood Gas Interpretation
- Normal ranges: pH (7.35-7.45), PCO2 (35-45), PAO2 (80-100), bicarbonate (22-26).
- Metabolic and respiratory acid-base abnormalities can occur; assessing for compensation is crucial.
Acute Respiratory Distress Syndrome (ARDS)
- Sudden onset lung injury resulting in severe pulmonary edema, hypoxemia, and bilateral infiltrates on CXR.
- Stages: acute exudative phase with protein flooding and decreased gas exchange, followed by a proliferative phase.
Management of ARDS
- Focus on intubation, mechanical ventilation with PEEP, vasopressor support, and nutritional care.
- Clinical research supports prone positioning for improved oxygenation.
Prevention of Venous Thromboembolism
- Key measures include early mobilization, leg exercises, anti-embolic stockings, and anticoagulation therapy to avoid DVT/VTE.
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