N123 AQ- Chp 68 Acute Respiratory Failure – Flashcards

1, 3, 5- Correct The overall goals for the patient with acute respiratory failure are absence of dyspnea, maintenance of the airway, effective cough and ability to clear secretions, normal ABG values and normal breath sounds. Absence of dyspnea indicates normal breathing and adequate oxygenation. Maintenance of the airway is important for normal oxygenation and tissue perfusion. Effective coughing and the ability to clear secretions help to keep the airway patent. Normal bowel sounds are not a goal for respiratory failure, because they are related to the function of the gastrointestinal tract. Blood urea nitrogen and serum creatinine are markers of renal function, not respiratory function. Text Reference - p. 1661

1, 2, 3- Correct Hypoxemia refers to the decrease in arterial oxygen and may manifest as fatigue, confusion, and restlessness. In hypercapnic respiratory failure, the neuromuscular conditions are affected, resulting in muscle weakness or paralysis. The patient experiences deep tendon reflexes and tremors, as well as seizures at a later stage. Hypercapnia also causes cerebral vasodilation, increased cerebral blood flow, and a mild increase in intracranial pressure that produces a headache. Text Reference - p. 1658

3- Correct Hypoxemia, an inadequate amount of oxygen in the blood, frequently is quantified as a PaO2 of less than 50 mm Hg. If allowed to progress, hypoxemia can result in hypoxia, which is defined as an inadequate amount of oxygen available at the cellular level such that cells experience anaerobic metabolism. Dysoxia is a condition characterized by an inability of the cells to use oxygen properly despite adequate levels of oxygen delivery. There is not enough information to determine if the patient is hyperventilating. STUDY TIP: Remember that intelligence plays a vital role in your ability to learn. However, being smart involves more than just intelligence. Being practical and applying common sense are also part of the learning experience. Text Reference - p. 1658

4- Correct Pulmonary infections can exacerbate acute respiratory failure. An intravenous antibiotic such as azithromycin is administered to treat pulmonary infections. Albuterol is a short-acting bronchodilator that reverses the effects of bronchospasm. Lorazepam is used to decrease anxiety, agitation, and pain. Medications used in the treatment of pulmonary congestion infections include diuretics like nitroglycerin that are administered intravenously. Text Reference - p. 1663

2- Correct The nursing diagnosis for a patient includes subjective and objective data. Subjective data are inclusive of health information like health history, medications, surgery, or other treatments. Vital signs are objective rather than subjective data. Diagnostic tests are performed prior to a diagnosis. A neurologic examination assesses for any slurred speech, restlessness, or delirium. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation. Text Reference - p. 1660

1- Correct iltiazem is a calcium channel blocker and potent vasodilator. It increases the blood flow through the arteries and decreases the heart rate. Calcium channel blockers reduce blood pressure and increase cardiac output. Administration of nitroglycerine decreases pulmonary congestion caused by heart failure. Metaproterenol is a bronchodilator. It improves breathing by relaxing the muscles in the airways. Methylprednisolone is administered in conjunction with bronchodilators to treat bronchospasm and asthma. Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end of an exam may trigger your mind with the answer or provide an important clue to an earlier question. Text Reference - p. 1663

3- Correct Pulse oximetry is a noninvasive method to determine oxygen saturation levels. It may be used intermittently or continuously to assess SpO2. Pulse oximetry cannot be used to assess inspired oxygen concentration, expired oxygen concentration, or venous oxygen saturation. These can be measured through arterial blood gases measurements or pulmonary artery pressure monitoring. Text Reference - p. 1654

4- Correct A patient with a medical condition involving only one lung requires focused intervention. A lateral or side-lying position is used for patients whose condition involves only one lung, because it allows for improved ventilation to perfusion that matches with the affected lung. This position also optimizes pulmonary blood flow and ventilation to the dependent lung areas. When a patient is in the prone position, air-filled, non-atelectatic alveoli in the ventral (anterior) portion of the lung become dependent, and perfusion may be better matched to ventilation. However, not all patients respond well to prone positioning and there is no reliable way of predicting who will respond. Tripod positioning helps to increase chest and lung expansion and decrease the effort needed to breathe for patients with chronic obstructive pulmonary disease, not patients with conditions affecting only one lung. The supine position changes the pleural pressure and predisposes the patient to atelectasis. Text Reference - p. 1662

4- Correct The dietitian, along with the health care team, determines the best method of feeding for patients with acute respiratory failure. Enteral or parenteral feedings are started within 24 hours to meet the high energy requirements of malnourished patients. Patients with acute manifestations of respiratory failure are generally unable to tolerate oral feedings. Well-nourished patients can start enteral or parenteral feedings within three days. The patients can intake their food orally once the clinical manifestations subside. Test-Taking Tip: If the question asks for an immediate action or response, all of the answers may be correct, so base your selection on identified priorities for action. Text Reference - p. 1664

1- Correct Potassium levels of patients on corticosteroids should always be monitored, because corticosteroid administration can worsen hypokalemia caused by usage of diuretics. When consumed by inhalation, corticosteriods require at least four to five days for optimum therapeutic effects. However, when administered intravenously in cases of acute asthma, corticosteriods speed up the resolution of airway inflammation and edema. Anxiety and restlessness result from hypoxia. Fear caused by the inability to breathe and a sense of loss of control, not the medication in itself, may increase anxiety. Patients being treated for bronchospasm run the risk of high cardiac ischemia with prolonged use of a beta-adrenergic drug. Text Reference - p. 1663

4- Correct he nurse conducts a computerized scan or ventilation to perfusion V/Q lung scan to confirm pulmonary embolus. Tachycardia is an early sign of respiratory failure consequent to physiologic stress. In hypercapnic respiratory failure, muscle weakness or paralysis is caused by altered neuromuscular conditions. The patient experiences deep tendon reflexes, tremors, as well as seizures at a later stage. Hypercapnia also causes cerebral vasodilation, increased cerebral blood flow, and a mild increase in intracranial pressure that produces a headache. Text Reference - p. 1656

1- Correct The patient's condition has deteriorated as evidenced by lethargy and decreased respiratory rate. The elevated carbon dioxide levels have affected the central nervous system, causing lethargy, which may progress to coma. The patient has become exhausted and is unable to maintain the compensatory mechanisms needed to maintain acid-base balance. This patient is not improving, and is not more relaxed and resting. This patient's condition is not stabilizing. Test-Taking Tip: On a test day, eat a normal meal before going to school. If the test is late in the morning, take a high-powered snack with you to eat 20 minutes before the examination. The brain works best when it has the glucose necessary for cellular function. Text Reference - p. 1658

2- Correct A patient with acute respiratory illness has a high risk of bleeding from stress ulcers due to decreased mucus production. Therefore, administration of mucosal protective agents like carafate will be beneficial. Propofol is a sedative and analgesic that helps to alleviate pain. It does not help treat stress ulcers. Fentanyl is an opioid used to decrease anxiety but has no effect on the gastrointestinal tract. Vancomycin is an antibiotic used to treat bacterial infections. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Text Reference - p. 1669

4- Correct Respiratory failure interferes with ventilation and oxygenation. It is essential to reduce the body's need for oxygen at the cellular level. Bed rest is an essential and effective means of reducing the need for oxygen. Bed rest and limitation of activity do not prevent alveolar collapse, clear secretions, or decrease the basal metabolic rate. Text Reference - p. 1659

3- Correct Changes in mental status are often the earliest sign of impending respiratory failure, even before arterial blood gas results are obtained. The brain is very sensitive to even the slightest of variations in oxygen and carbon dioxide levels and acid-base balance. The early manifestations suggestive of inadequate oxygen delivery to the brain may include restlessness, confusion, agitation, and combative behavior. Cyanosis is an unreliable indicator of hypoxemia and is a late sign of respiratory failure, because it does not occur until hypoxemia is severe (arterial oxygen [PaO2] of 45 mm Hg or less). Difficulty in walking is unreliable and a late symptom of respiratory failure. A severe morning headache may suggest that hypercapnia occurred during the night and is usually seen in chronic respiratory insufficiency. Test-Taking Tip: Answer the question that is asked. Read the situation and the question carefully, looking for key words or phrases. Do not read anything into the question or apply what you did in a similar situation during one of your clinical experiences. Think of each question as being an ideal, yet realistic, situation. Text Reference - p. 1658

3- Correct Adequate hemoglobin concentration is maintained by transfusion of packed red blood cells. The hemoglobin increases the oxygen-carrying capacity of the blood and thus supports oxygenation. Pulmonary infections are reduced by administering IV antibiotics, such as azithromycin. Sedation and analgesia, along with drug therapy, help to decrease anxiety, agitation, and pain. Nutritional therapy focuses on the maintenance of caloric requirement of patients with acute respiratory failure. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation. Text Reference - p. 1664

3- Correct Staged coughing is performed while bending forward with a pillow pressed against the diaphragm. A lateral or side-lying positioning may be used for patients with conditions involving only one lung. While practicing breathing, the patient may sit down or lie on the back, with the hands at the side. Patients with moderate to severe chronic obstructive pulmonary disease (COPD) can sit with the arms propped on the over-bed table or on the knees to reduce the work of breathing. Text Reference - p. 1662

A match of ventilation and perfusion would result in a V/Q ratio of 1:1, which is expressed as V/Q = 1. When the match is not 1:1, a V/Q mismatch occurs. Text Reference - p. 1655

1- Correct Age affects normal arterial blood gas (ABG) values. Elderly people have a lower PaO2 level, with a decrease in approximately 10 mm Hg per decade. Normal ABG values are ranges for normal, healthy adults. It is important to establish a baseline for the individual, because abnormal values become "normal" for some individuals. Notifying either respiratory therapy or the primary health care provider is not necessary at this time. Administering oxygen is not necessary at this time. Test-Taking Tip: Do not read too much into the question or worry that it is a "trick." If you have nursing experience, ask yourself how a classmate who is inexperienced would answer this question from only the information provided in the textbooks or given in the lectures. Text Reference - p. 1665

NIPPV is most effective in treating patients with respiratory failure resulting from chest wall and neuromuscular disease. It is not recommended in patients who are experiencing hemodynamic instability, decreased level of consciousness , or excessive secretions. Text Reference - p. 1662

Providing adequate rest and recovery time between various procedures prevents desaturation and optimizes oxygenation. Suctioning is indicated when the patient's condition warrants it, not when it is scheduled regularly. Hyperventilation may be used before treatments, repositioning, interventions, and so forth to allow the patient to have a "reserve." Positioning for optimal oxygenation and ventilation is good lung down, not up. Test-Taking Tip: Read every word of each question and option before responding to the item. Glossing over the questions just to get through the examination quickly can cause you to misread or misinterpret the real intent of the question. Text Reference - p. 1663

4- Correct Capnography is the monitoring the partial pressure of carbon dioxide in the patient. It gives a breath-to-breath measurement for a patient on ventilation. Capnography is used to determine the placement of a nasogastric tube for feeding in a patient with respiratory failure. If the tube is placed in trachea instead of the esophagus, all feedings will go in to lungs. Pulse oximetry monitors oxygen status in the patient and provides information on lung ventilation. Monitoring hemodynamic parameters helps determine the accumulation of fluid in the lungs. Arterial blood gases provide information on oxygenation, ventilation and acid-base balance. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Text Reference - p. 1660

1, 2, 3- Correct The nurse has to monitor patients closely for cardiopulmonary depression when giving benzodiazepines such as lorazepam (Ativan) and opioids (morphine). Patients receiving these agents are best managed by following an evidence-based protocol that includes a regular "sedation holiday" for ongoing assessment. Sedative and analgesic agents may have a prolonged effect in critically ill patients, delay weaning from mechanical ventilation, and contribute to increased length of stay. If respirations become depressed, then the dose of morphine has to be reduced. Text Reference - p. 1663

3- Correct The patient's respiratory rate is decreased as a result of barbiturate overdose, which caused respiratory depression. The patient is at risk for hypercapnic respiratory failure resulting from the decreased respiratory rate, and thus decreased CO2 elimination. Barbiturate overdose does not lead to shunting of blood, diffusion limitations, or increased airway resistance. Text Reference - p. 1657

4- Correct In acute bronchospasm, short-acting bronchodilators are given at 15 to 30 minute intervals until a response occurs. To reverse the adverse effect of the drug, the bronchodilator should be administered with an oxygen-enriched gas mixture in a hand-held nebulizer or a metered-dose inhaler with a spacer. The patient is encouraged to cough to clear any secretions that are obstructing the airway. Spontaneous breathing is encouraged to improve ventilation and oxygenation. A mask is placed tightly over the patient's nose or nose and mouth and the patient breathes spontaneously while positive pressure ventilation (PPV) is delivered. Text Reference - p. 1663

It is appropriate to suction a patient with pneumonia using a mini-tracheostomy if blind suctioning is ineffective or difficult. An absent or compromised gag reflex, long-term mechanical ventilation, and a history of aspiration contraindicates the use of a mini-tracheostomy. Test-Taking Tip: Practicing a few relaxation techniques may prove helpful on the day of an examination. Relaxation techniques such as deep breathing, imagery, head rolling, shoulder shrugging, rotating and stretching of the neck, leg lifts, and heel lifts with feet flat on the floor can effectively reduce tension while causing little or no distraction to those around you. It is recommended that you practice one or two of these techniques intermittently to avoid becoming tense. The more anxious and tense you become, the longer it will take you to relax. Text Reference - p. 1662

1, 4, 5- Correct Pain interferes with chest and abdominal wall movement and compromises ventilation. It also activates the stress response. Pain results in generalized muscle rigidity. All these activities increase oxygen consumption and carbon dioxide production, increasing the ventilation demands. All these conditions result in limited airflow to the alveoli but have no effect on blood flow to the gas exchange units. The consequence of the imbalance is V/Q mismatch. Pain does not decrease muscle tension; it increases the muscle tension, causing muscle rigidity and an increase in oxygen demand. Pain also causes vasoconstriction rather than vasodilation. Test-Taking Tip: Never leave a question unanswered. Even if answering is no more than an educated guess on your part, go ahead and mark an answer. You might be right, but if you leave it blank, you will certainly be wrong and lose precious points. Text Reference - p. 1656

4- Correct Patients with ARDS having a shunt disorder are usually more hypoxemic than patients with ventilation-perfusion (V/Q) mismatch. They often require mechanical ventilation and a high FIO2 in combination to improve gas exchange. Bronchodilators and corticosteroids are not helpful for immediate relief, because the patient does not have bronchospasm and inflammation. Text Reference - p. 1656

4- Correct In ALI, the P/F ratio is between 200 and 300. This indicates compromised gas exchange through the alveoli. Under normal circumstances, when PaO2 is 85 to 100 mm Hg and FIO2 is 0.21, the P/F ratio would be greater than 400. The term acute respiratory distress syndrome (ARDS) is used when the P/F ratio is less than 200 (e.g., 80/0.8 = 100) and indicates refractory hypoxemia. Text Reference - p. 1665

2- Correct A patient with acute respiratory failure must be able to tolerate the type of oxygen delivery system chosen. A patient with chronic hypercapnia should be provided oxygen therapy using a low-flow device, such as a nasal cannula. A nasal cannula can maintain partial pressure of oxygen in the arterial blood (PaO2) and arterial oxygen saturation (SaO2). A low-flow device, rather than a high-flow device, is used. Aerosol therapy is used to thin and remove secretions but is not preferred for patients with chronic hypercapnia. A tight-fitting mask is used when the patient requires positive pressure ventilation (PPV), it is not used for patients with chronic hypercapnia. Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end of an exam may trigger your mind with the answer or provide an important clue to an earlier question. Text Reference - p. 1661

2- Correct Short-acting bronchodilators are prescribed to reverse bronchospasm caused by respiratory failure. The bronchodilators are beta-adrenergic agonist drugs with side effects that include tachycardia and hypertension. Prolonged use can increase the risk of dysrhythmias and cardiac ischemia. Agitation, anxiety, and restlessness primarily result from hypoxia. However, these can also be caused by evolution of brain injury and adverse drug reactions. Prolonged use of corticosteroids can cause adrenal insufficiency. The nurse should monitor the potassium levels of the patients post administration of corticosteroids, because they can worsen existing hypokalemia caused by diuretics. Text Reference - p. 1663

1- Correct During huff coughing, the patient performs a series of actions while saying the word "huff."This technique stops the glottis from closing during the cough. While performing augmented cough, one or both hands are placed on the anterolateral base of the lungs. The patient sits with the arms propped on the over-bed table or on the knees to assume the tripod position, which reduces the work of breathing for patients with chronic obstructive pulmonary disease (COPD). During a staged cough, the patient bends forward and presses a pillow into the diaphragm. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options. Text Reference - p. 1662

During huff coughing, the patient performs a series of actions while saying the word "huff."This technique stops the glottis from closing during the cough. While performing augmented cough, one or both hands are placed on the anterolateral base of the lungs. The patient sits with the arms propped on the over-bed table or on the knees to assume the tripod position, which reduces the work of breathing for patients with chronic obstructive pulmonary disease (COPD). During a staged cough, the patient bends forward and presses a pillow into the diaphragm. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options. Text Reference - p. 1662

2- Correct Hypoxemia refers to a decrease in arterial oxygen. Oxygen therapy is used to reverse hypoxemia caused by V/Q mismatch, because it increases the partial pressure of oxygen in the blood. A patient receives drug therapy for relief from bronchospasm to reduce pulmonary congestion. Nutritional therapy focuses on the maintenance of protein and energy stores in patients with acute respiratory failure. Medical supportive therapy focuses on treating the underlying cause of the respiratory failure by maintaining adequate cardiac output and adequate hemoglobin concentration. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Text Reference - p. 1661

4- Correct Hypoxemic respiratory failure occurs due to inadequate oxygen transfer between the alveoli and the pulmonary capillaries. The patient experiences hypercapnic respiratory failure because of the inability to remove sufficient carbon dioxide to maintain a normal partial pressure of carbon dioxide in arterial blood (PaCO2). Ventilatory demand is the amount of ventilation needed to keep the PaCO2 within normal limits. Normally, ventilatory supply far exceeds demand. When there is an imbalance in the lung function, patients with lung disease cannot effectively increase the lung ventilation as a response to exercise or metabolic demands. Text Reference - p. 1655

1, 5- Correct Short-acting bronchodilators, such as albuterol and metaproterenol, reverse bronchospasm. Lorazepam is used to decrease anxiety, agitation, and pain. Intravenous (IV) medications used in the treatment of pulmonary congestion infections include diuretics like nitroglycerin administered intravenously. Antibiotics, such as azithromycin or ceftriaxone, are often given to treat pulmonary infections. Text Reference - p. 1662

1,2- Correct Patients with chronic respiratory failure benefit the most from NIPPV. The mechanical ventilation provided by a mask placed tightly placed over the patient's nose reduces the patient's breathing effort. NIPPV is helpful for patients who require ventilatory support but refuse endotracheal intubation. NIPPV is considered inappropriate for patients with excessive secretions. NIPPV has not been found to be successful for patients with pulmonary edema. NIPPV is not appropriate for patients experiencing low levels of consciousness. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer Text Reference - p. 1662

2- Correct With opioid overdose, the central nervous system decreases the carbon dioxide (CO2) reactivity in the brainstem. Hypercapnic respiratory failure is a significant risk for patients with asthma, chronic obstructive pulmonary disease, and cystic fibrosis. A patient with chest wall abnormalities may experience limited lung expansion. High-level spinal cord injuries may limit nerve supply to the respiratory muscles of the chest wall and diaphragm. Text Reference - p. 1657

2- Correct Auscultation of breath sounds is performed to assess the patient's baseline breath sounds and any changes from the baseline. A crackling sound heard on inspiration may indicate pulmonary edema. Rhonchi sounds heard on expiration indicate additional lung secretions and may be symptomatic of pneumonia or chronic obstructive pulmonary disease (COPD). Bronchial breath sounds are heard over the lung periphery, which often indicates pneumonia. Absent or diminished breath sounds may indicate impaired breathing effort and hypoventilation. Text Reference - p. 1659

4- Correct Alveolar hypoventilation results in restrictive lung diseases. In this condition, there is an increase in the partial pressure of carbon dioxide and decrease in the partial pressure of oxygen. P/F ratio, the ratio of partial pressure of oxygen to that of the fraction of inspired oxygen, is used to assess the degree of impairment in gas exchange. A P/F ratio of 200 to 300 indicates an acute lung injury. When partial pressure of carbon dioxide is greater than 45 mm Hg and arterial pH is less than 7.35, the nurse suspects ventilatory failure. When the partial pressure of oxygen is less than 60 mm Hg while receiving 60% of inspired oxygen, the patient has oxygenation failure. Test-Taking Tip: Do not worry if you select the same numbered answer repeatedly, because there usually is no pattern to the answers. Text Reference - p. 1657

2, 4- Correct Opioids and benzodiazepines have a respiratory depressant action in a dose-dependent manner. Because the patient is alcoholic and has sustained a head injury, the chance of going into respiratory failure is higher with the use of opioids and benzodiazepines. Steroids, antibiotics, and nonsteroidal antiinflammatory drugs have no respiratory depressive action. Steroids and nonsteroidal antiinflammatory drugs may improve the patient's condition if respiratory failure is caused by brain stem edema. Text Reference - p. 1657