1
Exam 2
ARF: Acute Resp. Failure: is always s/t something else like asthma, anaphylactic shock,
COPD..
Assessment varies:
Hypoxemia: dyspnea, tachpnea, prolonged expiration, intercostals muscle retraction, use of
accessory muscles, SPO2 less than 80, paradoxic chest/ abdominal wall movement (late),
cyanosis (late)
Hypercapnia: dyspnea, decreased RR or increased with shallow resp., decreased TV, so
decreased minute vent.
Dx: ABG analysis. Bronchscopy, and/ or wash.
3 signs of ARF: hypoxia, hypercapnia, and acidosis. Severity is dx with abgs.
***** PaO2 less than 60,,,, PaCo2 greater than 45,, if pt has COPD (or other) must be with
acidosis !!
ARF happens when your body is no longer able to compensate.
Medical MGMT: O2 , and positive pressure (bipap, cpap, or other invasive)..
RX: bronchodilators to open those airways up, steroids to decrease inflame, sedation esp if on
vent to decrease demand, analgesics to decrease pain and demand, neuro muscular paralysis we
want to knock out all pt movements, since there is increased chest pressure we do not want them
to be able to cough (decrease chance of pneum. Thorax) ,,, Acidosis: increase co2 with resp acid,
and hypoxic with met. Acid…. Nutrition if they are healthy we want to start them on nutrition
before the 3rd day of mech. Vent.,,, if they are anemic for any reason we start nutrition within 24
hours !! (look for muscle wasting)
Goal is to treat UNDERLYING cause !! (correct acidosis)
Complications: Ischemic-anoxic encephalopathy: at some point they were not getting enough O2
to brain,, ,,,,, Dysrythmias: because of hypoxia, E/l imbalance, acidosis, or the beta 2 agonists we
gave…. Venous thromboembolism, GI Bleeding (protonix we give to decrease chance of getting
a stress ulcer aka curlings ulcer).
RN MGMT:
Positioning: if they are SOB , fluid overloaded the HOB up and feet down,,,,,, If they have
unilateral lung ds place GOOD lung down so more bld will flow thru…. If diffuse lung ds lay pt
on right side b/c right lung is larger !!
Exam 2
ARF: Acute Resp. Failure: is always s/t something else like asthma, anaphylactic shock,
COPD..
Assessment varies:
Hypoxemia: dyspnea, tachpnea, prolonged expiration, intercostals muscle retraction, use of
accessory muscles, SPO2 less than 80, paradoxic chest/ abdominal wall movement (late),
cyanosis (late)
Hypercapnia: dyspnea, decreased RR or increased with shallow resp., decreased TV, so
decreased minute vent.
Dx: ABG analysis. Bronchscopy, and/ or wash.
3 signs of ARF: hypoxia, hypercapnia, and acidosis. Severity is dx with abgs.
***** PaO2 less than 60,,,, PaCo2 greater than 45,, if pt has COPD (or other) must be with
acidosis !!
ARF happens when your body is no longer able to compensate.
Medical MGMT: O2 , and positive pressure (bipap, cpap, or other invasive)..
RX: bronchodilators to open those airways up, steroids to decrease inflame, sedation esp if on
vent to decrease demand, analgesics to decrease pain and demand, neuro muscular paralysis we
want to knock out all pt movements, since there is increased chest pressure we do not want them
to be able to cough (decrease chance of pneum. Thorax) ,,, Acidosis: increase co2 with resp acid,
and hypoxic with met. Acid…. Nutrition if they are healthy we want to start them on nutrition
before the 3rd day of mech. Vent.,,, if they are anemic for any reason we start nutrition within 24
hours !! (look for muscle wasting)
Goal is to treat UNDERLYING cause !! (correct acidosis)
Complications: Ischemic-anoxic encephalopathy: at some point they were not getting enough O2
to brain,, ,,,,, Dysrythmias: because of hypoxia, E/l imbalance, acidosis, or the beta 2 agonists we
gave…. Venous thromboembolism, GI Bleeding (protonix we give to decrease chance of getting
a stress ulcer aka curlings ulcer).
RN MGMT:
Positioning: if they are SOB , fluid overloaded the HOB up and feet down,,,,,, If they have
unilateral lung ds place GOOD lung down so more bld will flow thru…. If diffuse lung ds lay pt
on right side b/c right lung is larger !!
