Question Answer
ARF is defined as what? An inability to maintain adequate O2 uptake and CO2 clearance
A 13 yr old girl who previously had been diagnosed with mild persistent asthma has a PEFR of 100ml. This indicates what? Increased aw resistance
An unconscious pt is admitted to ED and results on room air are 7.23/81/43/33 SpO2 71%. With no other data available what form of therapy is indicated and why? Mechanical ventilation because the pt is unconscious, has a ventilation and oxygenation problem, and their SpO2 is really low, plus they cannot achieve an appropriate level of ventilation to maintain adequate gas exchange and acid-base balance
A patient is admitted to the ED with complaints of tingling in their fingers and toes. They have weak limbs and lack coordination. After 30 minutes their VC, MIP, Vt, SpO2, and RR have decreased. What would you recommend? Would recommend mechanical ventilation because the patient likely has Guillain-Barre. It may progress to the point they can no longer protect their airway.
What are absolute contraindications for NIV? Respiratory arrest, Cardiac arrest, Nonrespiratory organ failure, Upper airway obstruction, inability to protect the airway, inability to clear secretions, and facial/head surgery or trauma.
A patient is brought in after overdosing on sleeping pills. What would you expect this patient to look like? What would you do for them? And why? They would have a low pH, high CO2, and low O2. Slow RR, HR, and high pulse. Unconscious. We would mechanically ventilate because they are unable to protect their airway.
What are signs and symptoms of Respiratory Distress? sudden onset, appear alarmed, sleating, flushed, anxious or paniced, speaking in short sentences, increased HR, decreased BP, possible arrhythmias.
Describe how to differentiate from respiratory distress and failure. Failure: one word sentences, lethargic or difficult to arouse, no respiratory drive to breathe, possibly unable to protect airway
Pt in Ed with right leg weakness. HR 45bpm, RR 10bpm, BP 100/75, BS crackles in bases. no lung hx, but on Coumadin for “heart condition that got better, so no more meds” Mechanically ventilate? possible CVA so mechanically ventilation or place on bipap but be ready for intubation.
What is it called when someone is no longer breathing at all? Respiratory Arrest
A patient comes to the ED with SOB and is lethargic. They have a known history of COPD. Increased WOB, high HR, and low BP. ABG: 7.28/87/55/22 on 15L NRB. Would you mech vent this patient and why? Yes! Because low blood pressure, they are having a ventilation and oxygenation problem (by ABG), lethargic
Pt in ED with profuse bleeding after being hit on his motorcycle. HR 120 RR 12 BP 90/60 ABG: 7.26/68/68/25. What does this ABG tell you? What would you do for this patient and why? This patient has an oxygenation and ventilation problem. Mech vent because severe blood loss, could have head/neck injury, he could have unknown internal injuries.
What is a tx for someone in respiratory distress? BiPAP
21-year-old patient in ED brought from home. Was found unconscious lying in vomit. Vodka bottle in her hand. HR 124 BP 90/60 RR 12 and shallow ABG: 7.20/70/60/24 on RA. What would be a tx for this pt and why? BrS: crackles in bases Mech Vent, ABG reveals acute respiratory failure, crackles could be due to vomit aspiration, pt can’t protect her airway
35 yr old pt comes to ED w/ exacerbation of asthma. Has been given O2, corticosteroids & BD which has not been effective in reducing AW obstruction & WOB. RR 40 & labored bilateral wheezes ABG 7.48/30/70/18-would you intubate & why YES with sedation–if you don’t act now the patient could go into respiratory failure quickly (MK)
A 35 yr old patient¬†comes into the ER. Pt was at home sitting on the porch when he felt a sudden SOB that wouldn’t go away. He then panicked and it only became worse. This pt is displaying signs/symptoms of what? Respiratory Distress
Describe what you would see if a pt comes to the hospital in respiratory distress. Diaphoretic, flushed, speaking in short and broken up sentences, high HR.
In order to reach respiratory failure, what two other things need to fail? Ventilaion failure and oxygenation failure.
During respiratory failure, what is occurring in the tissues? Hypoxia
You are in the middle of administering a nebulizer treatment and the patient suddenly stops breathing. What do you do? Stop treatment and apply some typer of ventilation immediately.
You just drew an ABG on your patient and the results were 7.27/65/62/24. What do these results tell you and what should you do about it? They are not ventilating well. Apply mechanical ventilation.
What is the most common mode used for BIPAP?(RQ) Spontaneous/Time
With a Pt with the possibility of a stroke why might we need to use mechanical ventilation? Unsure if Pt will continue to have use of diaphragm
A Pt comes into the ER with slurred speech and a droopy eye her NIF test is less than -20 and is breathing very shallow would mechanical vent be necessary? Yes with a low NIF test she is showing decreasing ability to create a large enough inspiratory force so she will not be able to breathe in on her own.
Classification for 200: Sudden onset, appear alarmed, sweating flushed, anxious or panicked. What is Respiratory distress?
Classification for 500: Of the three classifications for respiratory (distress, failure, and arrest) these can be treated by mechanical ventilation What is all three (Distress, Failure, Arrest) (ApQ)
treatment for 750: an abg of 7.20/80/60/25 calls for this treatment. and this goal What is Mechanical ventilation, to improve ventilation and oxygenation status.
What are some of the last things to be effected before going into respiratory failure? Blood pressure and SpO2 also will see a low urine output
A patient comes to the ER with SOB and lethargic, she has HR of 38 and RR of 8, what should we do with this patient and what could be some causes of her signs and symptoms? This pt needs mechanically ventilated bc she has no drive to breath on her own and has an unprotected airway, this pt is probably a drug overdose due to the low HR and RR
If you have a patient come into the hospital with sudden onset of SOB and the pt seems sweaty, scared and has broken sentences what would you suggest? This pt is in respiratory distress, since this is just starting we can probably try BiPAP first and see if that will help with her SOB
What is one thing to look for if your patient is going into respiratory distress? Patient may appear alarmed, anxious, and sweating.
If you have a pt with hx of COPD and is SOB but is able to communicate with you. Would you vent this pt or Bipap? What settings would you like to see with COPD pt’s. Bipap, COPD will like short Itime.
What would be an abg that would point toward venting your pt? What would be an abg to point toward putting your pt on Bipap? Vent abg 7.29/90/51/22. Bipap 7.27/65/60/24.
If you have a patient who has a lot of bleeding and is in and out of consciousness, should they be mechanically ventilated or put on bipap and why? Mechanically ventilated due to the excessive bleeding and them not being able to protect their airway when unconscious.
What respiratory classification is a patient who has a sudden onset breathing problem? Respiratory Distress
Describe what is happening in respiratory failure and give an ABG that would reflect that situation. Tissue hypoxia is occurring due to inadequate gas exchange, the patient will be fatigued and possibly lethargic. ABG: -pH less than 7.28 -PaCO2 50mmHg or more -PaO2 decreasing progressively -HCO3 may be starting to compensate by increasing
When your ability to breathe is completely stopped…this is known as? Respiratory Arrest
A Pt is admitted to the ER with extreme SOB and is lethargic. She has a significant Hx of COPD. ABGs are: 7.30/78/60/26. What needs to be done. The pt cannot remove co2, and has a low o2 level. They are showing signs of RT arrest and need to be ventilated.
You have a pt that has come to the ER with increased SOB, and difficulty breathing. A CXR is done, and it shows an excessive amount of fluid around the heart. ABGs show 7.32/50/70/26. What actions need to be taken to help decrease this pts SOB. WE would try CPAP to remove some of the fluid, and this will also help improve oxygenation.
What are the last two things to drop in respiratory distress? Blood pressure and SpO2
Why does having high blood pressure decrease oxygenation to the tissues? The blood will pump by the capillary beds too fast and they will be unable to extract sufficient O2.
Which type of ventilator setting (pressure or volume) is best for a COPDer and why? Pressure setting..unlimited flows available to them and we can better protect their lungs.
Triggeriis also knownnow as what? Sensitivity
A patient is admitted into ED with a COPD exacerbation. His ABG was 7.26/82/52/29. The patient is conscious, says he is fine. Would the next step be mechanical ventilation, BiPAP, or CPAP? Why this therapy over another? BiPAP would be the best option because he is conscious and says he is fine regardless of his values. It’s better to start with BiPAP since it is hard to get a COPD’er off the vent since the drive to breathe is knocked out.
Respiratory failure will have (higher/lower) CO2 with a (higher/lower) pH. What would a patient look like when in respiratory arrest? higher, lower. They would have difficulty breathing, irregular RR, look fatigued, possibly lethargic, often too distressed to talk or cannot arouse.
If a patient is in beginning stage respiratory distress what is the best treatment? NIV would be most appropriate, in specific, it would be BiPAP therapy.
What would a pH be and a CO2 of a patient to be considered respiratory failure? pH 7.28 or less and CO2 50 mmhg or greater. MB
A patient is in the ER having SOB and unable to talk due too her level of distress and is also falling in and out of consciousness, what for a treatment would you be planning this patient needs? From the information given so far you would be expecting this patient will need to be mechanically ventilated.
What are three goals for mechanical ventilation? 1) Provide support to the pulmonary. system and to maintain adequate ventilation 2) Reduce work of breathing 3) Restore ABG to normal values
A 28 yr old female is taken to the ER after a MVA. She is unresponsive and unconscious. She is on 100% NRB and her ABG results are 7.12/68/95/26 What can you determine from the ABG and what type of treatment should the patient receive? ABG shows that the pt is in respiratory failure. She should be intubated and mechanically ventilated.
Your patient is unresponsive and in need of mechanical ventilation, the family wishes you to place the pt on the ventilation. When would this not be an appropriate action? If the pt has appointed someone to make that decision on their behalf or a living will is in place.
________ and ________ are the key indicators of the severity of acute hypoxemic respiratory failure. PaO2, SpO2
What bedside measurements are most often used to assess respiratory muscle strength? MIP and VC
What are signs/symptoms someone is in respiratory distress? (AH) CO2 of 50 or greater, pH 7.28 or less, lethargic, too distressed to talk, hypoxic.
Why do we provide mechanical ventilation? We provide it so that a person can achieve adequate ventilation to maintain gas exchange and acid base balance.
What distinguishes acute hypoxemic respiratory failure from acute hypercapnic respiratory failure? Acute hypercapnic respiratory failure also has a high PaCO2.
Why do we perform MIP and VC on a patient with a neuromuscular disorder and what are levels and what are the values that indicate there is an emergency? Those are used to assess respiratory muscle strength and whether a person can produce an adequate cough. The critical values are 0 to -20 for MIP and anything less than 10 to 15 mL/kg for VC. Respiratory fatigue is occurring, ARF likely imminent.
What are the two forms of acute respiratory failure? Acute hypoxemic respiratory failure and acute hypercapnic respiratory failure
Your patient has paradoxical breathing. What is this a sign of and what should not be done? This is a sign of increased work of breathing and the onset of respiratory muscle fatigue. You should not intubate or do IPPV with flail chest.
What is this patient’s ABG interpretation? 7.17/65/43/24 This is considered what if it progresses gets worse? What treatment? This is uncompensated respiratory acidosis with moderate hypoxemia. This patient may be in respiratory failure. The patient would likely be mechanically ventilated.
What are 2 respiratory findings that indicate Mild to moderate hypercapnia? Tachypnea & Dyspnea
You tested your pt using the following ventilator mechanics; MIP (NIF) & MEP. The following were your results; MIP(NIF)-15cmH2O MEP= 30cmH2O What is the purpose of this test? Are your test results in normal ranges? Purpose is to test diaphragm stregnth. No, both are in critical ranges.
Your pt labs returned with the following; Hb-9.8 SaO2-.90 PaO2-60 What is your pt’s Arterial Oxygen Content? What does the Arterial O2 Content tell you about your pt? CaO2-= [(9.8 x 1.34)x .90] + (60 x 0.003) answer= 11.99 vol% The amount of O2 reaching pt’s blood circulation.
Low ventilation/perfusion ration and Intrapulmonary shunt suggest what type of treatment as long as ALI is not involved? CPAP
You have an ABG of 7.28/60/50/27 and an FiO2 of 0.6, what can you determine about oxygenation? O2 is not being transported.
A patient has an RR of 40, shallow sometimes deep breaths, and assessment yields stridor. Three nebulizations of racemic epinephrine have yielded no improvements. Why is NIV not a good choice? The patient cannot maintain airway, has paradoxical breathing, and has a RR over 35.
Would NIV be your first step for a patient who has experienced severe trauma & blood loss? (Jenn B) NO, this person should be intubated and mechanically ventilated.
A patient has a Vt of 600ml and RR of 19. What is their VE? Is this VE normal? VE=11.4Lpm. A VE above 10LPM is cause for concern.
A patient has been on the vent for several days. What NIF do they need to achieve in order to be weaned from the vent? NIF > -20