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and carbon dioxide elimination. Blood gases usually reveal: pH ≤ 7.35 || PaO2 ≤ 50 mmHg PaCO2 ≥ 50 mmHg || SaO2 < 90% Hypercapnea – increased CO2 in the arterial blood due to hypoventilation of the alveoli. This is primarily due to a decreased drive to breathe. Some of these causes are: § Depressed respiratory center § Diseases of the medulla § Spinal cord disruption § Diseases of neuromuscular junction § Thoracic cage abnormalities § Large airway obstruction Hypoxemia – decreased (PaO2) oxygen content in the arterial blood caused by respiratory alterations such as: § Decreased oxygen content of inspired gas § Hypoventilation § Diffusion abnormalities § Abnormal ventilation (V/Q mismatch) § Pulmonary right-‐to-‐left shunt Assessment Data [ Physical Manifestations ] § DYSPNEA o Dyspnea on Exertion o Orthopnea Increased respiratory rate Cyanosis Crackles Changes in LOC Tachycardia, increased cardiac output, and mild high blood pressure Possible arrythmias due to myocardial hypoxia
[ Laboratory Exams ] § ABG Analysis pH ≤ 7.35 || PaO2 ≤ 50 mmHg PaCO2 ≥ 50 mmHg || SaO2 < 90% § § § Pulse oximetry = ↓O2 saturation Chest X-‐ray (infiltrates, effusions, lesions) ECG if arrhythmia is suspected
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Medical Management 1. Oxygen therapy to keep PaO2 level above 60mmHg and reverse acidosis 2. mechanical ventilation if necessary 3. medications such as § bronchodilators § corticosteroids § antibiotics § diuretics § vasopressors 4. Incentive spirometry to increase lung volume [Nursing Management] 1. maintain patent airway 2. help client find a comfortable position to allow easy breathing 3. assist client in using relaxation, diversion, and guided imagery to reduce anxiety 4. start energy conservation measures 5. use postural drainage and chest physiotherapy to help clear secretions 6. monitor ABG levels and report changes immediately 7. prevent infections by using sterile technique while suctioning