R. Part 3 - Acute Respiratory Failure (ARF)

Terms in this set (26)

What is acute respiratory failure?

failure of your lungs to have adequate oxygen exchange - results in hypoxia, then hypoxemia

what is the hallmark of acute respiratory failure?

hypoxemia as a result of impaired gas exchange

What is the etiology of ARF?

it can be divided into intrapulmonary and extrapulmonary

Etiology: Intrapulmonary

this is a lung problem - COPD, PE, pneumonia, asthma, all of the respiratory problems that lead to respiratory failure

Etiology: Extrapulmonary

this is not a lung problem - brain injury, stroke, spinal cord injury, overdose of mediaction - something has wiped out your drive to breathe - "when my patient had a stroke, they lost the ability to maintain their airway, and now needs a vent"

Type 1 and type 2

ARF defined: Type 1

hypoxemic and normocapnic

ARF defined: Type 2

hypoxemic and hypercapnic

ARF defined: PaO2 <

50 - anytime your O2 is less than your PCO2, you are not well off - normal is 80-100

ARF defined: +/- PCO2 >

50 - normal is 35-45

ARF - PaO2 and PCO2

your CO2 is going to be low no matter what, if you have acute respiratory failure. Checking to see if the O2 is less than your PCO2 - this is BAD

ARF defined: if chronically ______ pH < ____

hypercapnic; 7.5

Overall ARF defined =

type 1 or type 2, PaO2 < 50, +/- PCO2 > 50

Anytime a patient has a pH of < ____, they will be intubated/ ventilater

inadequate airway, inadequate ventilation, inadequate respiration - not getting good gas exchange in the blood

Causes of ARF results in

alveolar hypoventilation; hypoxemia is the result of V/Q mismatch

Complications of ARF

Hypoxemia, hypoxia, decreased tissue perfusion, and MODS

Complications of ARF: decreased tissue perfusion

lactic acid production

Complications of ARF: MODS

Multiple Organ Dysfunction Syndrome - because you don't have oxygen to perfuse the rest of the body, so the lungs are the beginning of a process that can take over your whole body

Clinical Manifestations of ARF

CNS, CV, Pulmonary, Renal, GI, and Integument

Clinical Manifestations of ARF: CNS

restlessness, antsy, confusion, agitation - these are also seen in patients who are not getting enough pain medications and in patients who are getting "ICU confusion", so just because they are restless does not mean that they have ARF

Clinical Manifestations of ARF: CV

chest pain, tachycardic, hypertensive, dysrhythmias - may throw PVCs

Clinical Manifestations of ARF: Pulmonary

tachypnea - to get more O2, accessory muscle use - intercostal retractions and tripoding

Clinical Manifestations of ARF: Renal

decreased urinary output - goal is for UO to be a minimum of 30 cc's per hour or 1 cc per kg per hour - if UO decreases with other signs listed here, think decreased O2

Clinical Manifestations of ARF: GI

decreased GI motility - patient on TF will have residuals, decreased O2 to the stomach, decreased bowel sounds, N&V, and abdominal distention

Clinical Manifestations of ARF: Integument

initially, won't see anything - cyanosis is a LATE sign, worry about peptic ulcers since the patient is not perfusing the skin well

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