NURSING 2755: MDC4 Exam 2 Study Guide Modules 05-08_LATEST Update,100% CORRECT

NURSING 2755: MDC4 Exam 2 Study Guide Modules 05-08_LATEST
Update,100% CORRECT
Modules 05-08 – Lesson content.
1
*In preparation for exam II MDCIV*.


Module 05

Acute respiratory failure:



What is it? Critical Values Remember

 A mismatch of ventilation (V) or ABG
o - PaO2 o Ventilation = air movement (V)
perfusion (Q), or a combination Result:
- Less than 60 mm Hg
of both. o ABG - PaCO2 o Perfusion = blood flow
 When there is a VQ mismatch, Result: Greater than 45 mm Hg (gas exchange) (Q)
gas exchange is decreased, o ABG – pH
resulting in respiratory failure. Result: <7.35
 ABGs are ordered to evaluate the o ABG - SaO2
pts. gas exchange anticipating -Result: Less than 90%
that the client is hypoxemic.




Ventilatory Failure:

Causes: Example: Drug OD continues to rise in the US to epidemic levels as reported by the
CDC. Fentanyl is quickly rising as the drug of choice among abusers. Fentanyl is a
 Neuromuscular disorders. potent opioid either RX or manufactured illegally. Fentanyl can quickly depress the
 Central nervous respiratory system. In this example, there is nothing mechanically wrong with the
system dysfunction. lungs, no V/Q mismatch. Without the drug in the pts. body, the lungs would perform
 Chemical depression. both ventilation and perfusion normally. However, as the drug depresses the central
nervous system, it depresses the drive to breathe (V), which then slows perfusion (Q).
During an OD, breathing ceases completely as the client slips into unconsciousness. In
this example, the pt. has a V/Q mismatch and a resulting respiratory failure.

NURSING 2755: MDC4 Exam 2 Study Guide Modules 05-08_LATEST
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Recognizing Symptoms:

Evaluating compromised respiratory status: Dyspnea (S/S of respiratory failure)
 A way to evaluate compromised
respiratory status is to assess for SOB  Occurs when the pt. is no longer able to lay flat in a bed which is
(dyspnea) while the pt. is performing also known as orthopnea.
everyday tasks.  This pt. will find it easier to rest or sleep in an upright position.
 The common term used to describe the Clinically, the PCP will monitor for hypercapnia and hypoxia
work of breathing while performing a by monitoring Arterial Blood Gases (ABG).
task is dyspnea on exertion (DOE).

 S/S of hypoxic respiratory failure. *Be Hypercapnia
aware as nurse*
 Different S/S, but the same end result of respiratory failure can occur.
o Restlessness Understand the difference between hypoxia and hypercapnia.
o Irritability The S/S are as follows:
o Agitation
o Confusion o Decreased level of consciousness (LOC)
o Tachycardia o Headache
o Drowsiness
o Lethargy
o Seizures




NURSING 2755: MDC4 Exam 2 Study Guide Modules 05-08_LATEST
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Acidosis

The onset of acidosis is associated with respiratory
failure.

S/S of acidosis include:

o Decreased LOC
o Drowsiness
o Confusion
o Hypotension
o Bradycardia
o Weak peripheral pulses



Oxygenation as Early Intervention

 The goal is to maintain the PaO2 level above 60 mm Hg
and treat the underlying cause.
 Depending on the urgency and how quick the onset of
respiratory failure occurs determines the aggressiveness
of the treatment.
 If the situation allows, start with oxygen delivered by
nasal cannula or mask.
 The next, more aggressive, intervention would be the use
of BiLevel Positive Airway Pressure (BiPAP). This is a
non- invasive approach to forcing air into the lungs to
improve oxygenation (gas exchange).
 The invasive procedure of endotracheal intubation
with mechanical ventilation is utilized as a last resort.




Additional Interventions to open the airway: Other interventions to allow for maximum lung expansion:

 Nebulizer tx which is administered to dilate  Place the pt. semi-high Fowler’s position.
the bronchioles and promote gas exchange.  Stay calm: If you are anxious, the client will
 This can be administered while the pt. is using either become anxious and use more energy to breathe.
oxygen or BiPAP.  Consider holding off on any unnecessary procedures
that cause energy expenditures.




NURSING 2755: MDC4 Exam 2 Study Guide Modules 05-08_LATEST
Update,100% CORRECT