Download Respiratory Physiology and Pathophysiology: ARF, ARDS, and Oxygenation and more Exams Nursing in PDF only on Docsity!
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Define blood pH: What is the normal values? What is considered alkaline and what is considered acidic?
pH is a measurement of the number of hydrogen ions found in the blood Normal value: 7.35-7. Acidic: <7. Alkalotic: 7.45 < Define PaO2: What is the normal values? What is considered alkaline and what is considered acidic? PaO2 is the amount of partial pressure needed to dissolve O2 in the blood in order to perfuse the cells of the body.
Normal value: 80- 100 Acidic: hypoxemia
mild: 60- 80 moderate: 40- 60 severe: 40> Alkalotic: hyperventilation Define PaCO2: What is the normal values? What is considered alkaline and what is considered acidic? PaCO2 measures the amount of CO2 dissolved in the blood or the pressure needed to dissolve the CO Normal values: 35- 45 Alkaline: 35> Acidic: 45<
What is hypoxemia? represents the partial pressure of O2 in the arterial blood < What is the primary cause if pH is going in the opposite direction of Co2? respiratory system is the primary cause If pH and bicarb are in the same direction what is the primary cause? metabolic is the primary cause How do you determine compensation from ABG values of pH? If pH is normal, then compensation has occurred. If pH is abnormal it is uncompensated What are the signs and symptoms of respiratory acidosis? What are the values' relationship? pH is decreased; Co2 is increased o hypoventilation
o rapid, shallow respirations o hyperkalemia o hypoxemia o headache o muscle weakness o increased cardiac output o disorientation What are the signs and symptoms of respiratory alkalosis? What are the values' relationship? pH is increased; CO2 is decreased o seizures o rapid, deep breathing o hyperventilation
o N/V What are the signs and symptoms of metabolic alkalosis? What are the relationships between the values? pH is increased and HCO3 is increased o headache o disorientation o hyperkalemia o muscle twitching o Kussmals respirations (fruity breath) o Changes in LOC What are causes of respiratory impairment? *look in book hypoxia fever
acidosis What are the functions of the respiratory system? o gas exchange of O2 and CO o filters air and humidifies in the mouth and nose o maintains homeostasis What is right-sided intubation? Where the tube is slightly deviated to the right lung, supplying the right lung with most if not all the O2. This is because the right lung is larger than the left. When should the nurse check placement of an intubated patient? How should it be checked? o after intubation o every time the patient moves
Should be checked using an X-ray, but usually checked using lung sounds What are early signs of hypoxia?
- restlessness
- tachycardia
- tachypnea
- anxiety
What are signs of circulatory compromise from respiratory failure? o heart rate o peripheral perfusion is compromised o blood pressure and urine output are decreased o acidosis and high lactate in blood gas What are the characteristics of respiratory distress/compensation different from failure?
- open airway without support needed
- tachypnea
- increased breath effort
- clear lung sounds
- tachycardia
- agitated but responds
- pale/ slow cap refill What are the characteristics of respiratory failure/decompensation different from distress? o possibly obstructed airway o slow breathing o no respiratory effort o abnormal lung sounds
o bradycardia o unresponsive o cyanotic What are crackles? What is the difference between coarse and fine? crackles are a high-pitch sound heard upon inspiration that cannot be cleared by cough
- fine is less fluid and quiet
- course is loud When is wheezing heard in lung sounds? heard upon inspiration AND expiration, but usually heard more on expiration What are rhonchi breath sounds? Loud, low course sound on inspiration or expiration that can be cleared by cough What is acute respiratory failure (ARF)? the new onset of the failure of the pulmonary system to provide sufficient oxygen to supply the body
What is oxygenation failure? What is it also known as? o When ventilation is normal, but perfusion/blood flow to the lungs is NOT, decreasing O2 in the body o Also known as HYPOXIC What is ventilatory failure? What is another name for it? o Perfusion of the lungs is normal, but ventilation is NOT, causing the lungs to retain/increase CO o Also known as HYPERCAPNIC What is the Arterial Oxygen Saturation (SaO2) that classifies as ARF? <90 in oxygenation AND ventilatory failure No matter what the underlying problem is, patients with ARF are ALWAYS... hypoxemic!!! When does ventilatory failure occur?
when the chest pressure does not change enough to permit air movement into and out of the lungs. What results from ventilation failure? too little O2 reaches the airway and CO2 is retained, leading to poor gas exchange and hypoxemia What are causes of ventilatory failure?
- physical problems of the chest wall or lungs
- defective respiratory control in the brain
- poor function of respiratory muscles (diaphragm) What are common causes of extra pulmonary ventilatory failure?
- neuromuscular disorders (Myasthenia Gravis, Guillian Barre, Poliomyelitis)
- CNS dysfunction (stroke, increased ICP, meningitis)
- chemical depression (drug intoxication)
- Kyphoscoliosis
- obesity
What are common causes of oxygenation failure? o High altitudes o Pneumonia o CHF with pulmonary edema o PE o ARDS o Hypovolemic shock o Hypoventilation o Interstitial pneumonitis-fibrosis What are the causes of ARF? extra-pulmonary, involving tissues outside of the lungs but affect the lungs. intrapulmonary, involving the disorders of the lungs What are the symptoms of hypoxic respiratory failure (oxygenation/pulmonary)?
- dyspnea
- dyspnea on exertion
- orthopnea
- restlessness
- tachycardia
- irritability
- confusion What are the symptoms of hypercapnic respiratory failure (ventilatory)?
- decreased LOC
- headache
- drowsiness
- lethargy
- seizures What is ARDS? the most deadly form of Acute Lung Injury What is ARDS characterized by? o Refractive hypoxemia o Decreased pulmonary compliance o Dyspnea o Non-cariogenic associated bilateral pulmonary edema o dense pulmonary infiltrates on xray What is the cardinal sign of ARDS? Refractory Hypoxemia: hypoxemia that persists no matter how much O2 is given
What is the nursing priority in the prevention of ARDS? early recognition in patients at high risk What happens in the exudative phase of ARDs and how long does it last? Lasts 4-7 days edema develops from the prolonged cytokine storm What happens in the proliferative phase of ARDS and how long does it last?
7-21 days inflammation occurs in the interstitial space What happens in the Fibrotic phase of ARDS and how long does it last? 21< days Fibrosis of the lungs set in, collapsing the alveoli and further developing hypoxemia What are the criteria for developing ARDS? (4)
- Occurrence of an acute lung injury or a history of symptomatic or pulmonary risk factors
- Sudden acute onset of respiratory distress
- Diffuse, bilateral infiltrate on chest xray
- No clinical evidence of cardiac issues or left sided HF How can cardiac issues be ruled out prior to diagnosis of ARDS?
- BNP must be normal
- EKG must be normal
- Chest xray without cardiomegaly What should the nurse be assessing/looking/monitoring for in ARDS patients? Breathing: s/s of grunting, cyanosis, pallor and retraction
- low PaO
- Refractory hypoxemia In early ARDS, what may be the only abnormal assessment finding? hypoxemia
