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ATI Chapter 26 respiratory failure

Terms in this set (20)

Acute respiratory failure (ARF)
Caused by failure to adequately ventilate and or oxygenate
What can cause ARF?
Mechanical abnormality of the lungs or chest wall, impaired muscle function i.e. the diaphragm, malfunction in the respiratory control center of the brain, lack of perfusion to the pulmonary capillary bed such as from pulmonary embolism, or a condition that alters gas exchange like edema or pneumonia
How do you determine if a patient is an acute respiratory failure?
The ABGs
Acute respiratory distress syndrome (ARDS)
State of acute respiratory failure with the mortality rate of 25% to 40%. Systemic inflammatory response injures the alveolar capillary membrane. It becomes permeable and fills with fluid
Severe acute respiratory syndrome (SARS)
Result of a viral infection from a mutated strain of the coronavirus. Leads to an inflammatory response. Does not spread to the bloodstream
Risk Factors for ARF
Ventilatory failure, oxygenation failure, combined ventilatory and oxygenation failure
Risk factors for ARDS
Lung damage, aspiration, pneumonia, near drowning accident, trauma, damage to CNS, smoke, drug overdose
Risk factor for SARS
Exposure to an infected individual, immunosuppression
Objective findings
Rapid shallow breathing, cyanotic, tachycardia, hypotension, decreased oxygenation level, wheezing or rales, cardiac arrhythmias, confusion, lethargy, substernal or suprasternal retraction
Diagnostics for respiratory failure
Chest x-ray, ECG to rule out cardiac involvement, hemodynamic monitoring
Nursing care for respiratory failure
Maintain a patent airway, monitor respiratory status every hour or more as needed, mechanical ventilation, monitor for pneumothorax if a PEEP is used, obtain ABGs, continuous ECG monitoring, position, prevent infection, promote nutrition
Medications for respiratory failure
Benzodiazepines, general anesthesia, corticosteroids, opioid analgesic, neuromuscular blocking agents, antibiotics
Benzodiazepines
Lorazepam or midazolam. Reduces anxiety and resistance to ventilation
General Anesthetics
Propofol used to induce and maintain anesthesia
Corticosteroids
Methylprednisolone or dexamethasone. Decreases inflammation and help stabilize the alveolar capillary membrane during ARDS
Opioid analgesics
Morphine sulfate and fentanyl
Neuromuscular blocking agents
Vecuronium to facilitate ventilation and decreases oxygen consumption.
Antibiotics
Vancomycin to treat organism that causes SARS
Kinetic therapy
bed that rotates laterally to alter positioning for reduction of atelectasis and improve ventilation
Complications from respiratory failure
Trauma during intubation or a longterm intubation with endotracheal tube, aspiration pneumonia, infection, increased intrathoracic pressure, barotrauma, or immobilization (atrophy, pneumonia, pressure sores)
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