Acute Respiratory Failure Sudden and life-threathening deterioration of the gas exchange function of the lungs Increased

CO2 production, decreased O2 exchange Causes Chronic Respiratory Failure 1. COPD 2. Neuromuscular disease Pathophysiology: 1. Alveolar hypoventilation 2. Diffusion abnormalities 3. Ventilation-perfussion mismatching 4. Shunting Classification of Common Cause of ARF Decreased Respiratory Drive Causes: 1. brain injury 2. large lesion in the brainstem (multiple sclerosis) 3. use of sedative medications 4. metabolic disorders (hypothyroidism) Dysfunction of Chest wall 1. muscular dystrophy 2. polymyositis 3. myasthenia gravis 4. peripheral nerve disorders 5. amyotopic lateral sclerosis 6. Guillain-Barre syndrome 7. cervical spinal injury Dysfunction of the lung Parenchyma 1. Pleural effusion 2. hemothorax 3. pneumothorax 4. Upper airways obstruction 5. pneumonia, status asthmaticus, lobar atelectasis, pulmonary edema Other causes: Surgery, Pain, Clinical Manifestation: restlessness, fatigue, headache, dyspnea, air hunger, tachycardia, tachypnea, central cyanosis, diaphoresis and respiratory arrest Use of accessory muscles, decreased breath sounds, no adequate ventilation Management: Intubation and mechanical ventilation

and lupus erythematosus 4.g. lithium) 2. resulting in retention of nitrogenous (urea and creatinine) and non-nitrogenous waste products that are normally excreted by the kidney. it can be caused by injury (especially crush injury and extensive blunt trauma). . it may be caused by various conditions such as sickle-cell disease. systemic inflammation due to infection Renal (damage to the kidney itself): 1. also known as acute kidney failure or acute kidney injury. multiple myeloma. aminoglycoside antibiotics. infection usually sepsis. 3. is a rapid loss of renal function due to damage to the kidneys. stimulants and some other drugs 3. 5. some NSAIDs. 2. medication interfering with normal bladder emptying. Effects: Metabolic acidosis (acidification of the blood) hyperkalaemia (elevated potassium levels) changes in body fluid balance effects on many other organ systems Characterised by: oliguria or anuria (decrease or cessation of urine production) although nonoliguric ARF may occur CAUSES: 1. colorectal cancer). benign prostatic hypertrophy or prostate cancer. iodinated contrast. rhabdomyolysis (breakdown of muscle tissue) . such as anti glomerular basement membrane disease/Goodpasture's syndrome.ACUTE RENAL FAILURE Acute renal failure (ARF). Wegener's granulomatosis or acute lupus nephritis with systemic lupus erythematosus Post-renal (obstructive causes in the urinary tract) due to: 1. usually from shock or dehydration and fluid loss or excessive diuretics use 4. vascular problems. due to abdominal malignancy (e. hypovolemia (decreased blood volume) 3. acute glomerulonephritis which may be due to a variety of causes. either due to hypercalcemia or "cast nephropathy" (multiple myeloma can also cause chronic renal failure by a different mechanism) 5. Pre-renal (causes in the blood supply): 2. statins. such as atheroembolic disease and renal vein thrombosis (which can occur as a complication of the nephrotic syndrome) 6. 4. toxins or medication (e. obstructed urinary catheter. ovarian cancer. kidney stones.the hemoglobin damages the tubules. hemolysis (breakdown of red blood cells) .g.the resultant release of myoglobin in the blood affects the kidney. hepatorenal syndrome in which renal perfusion is compromised in liver failure 5.

adherence to the treatment plan b. serum osmolality and osmolarity. Promote optimal nutritional status a. give antipyretic/blanket as needed b. urine specific gravity 3. at an easily understandable way 7. Restrict protein intake 4. Assess for hypovolemia q 1 hour 1. and answer all the queries. Check urine. maintain adequate ventilation 2. Prevent complication from impaired mobility a. Monitor ECG g. assess the skin always 5. electrolytes 2. monitor for the effects e. CVP as needed b. skin breakdown c. Weigh client once a day e. Provide client teaching a. Monitor VS. explain all the procedures that will be done. maintain strict I & O c. Provide care for clients receiving dialysis 8.Nursing Interventions: 1. assess for signs of infection c. cardiac glycosides. Support client and significant others and reduce fear and anxiety a. decrease fluid intake as ordered 3. Measure I&O hourly c. administer TPN as ordered d. pulmonary embolism b. weigh daily b. strict aseptic technique on wound and catheter care 6. Monitor lab values. importance of planned rest periods d. PCWP. administer diuretics. Monitor I&O d. Monitor alteration in fluid balance a. including the ABG. take rectal temp. Monitor and Maintain Fluid and Electrolyte Balance a. Prevent fever and infection a. Enteral feeding: Check for residual and inform the physician e. PAP. signs and symptoms of the disease c. massage the body prominence. Administer IV fluid and electrolytes as prescribed d. used of prescribed drugs only . Obtain baseline data b. Weigh client c. atelectasis Frequent turning and repositioning. and anti-hypertensives as ordered. Replace fluid as ordered f. explain the disease process b.

Correct acidosis and replenish blood bicarbonates 4. report immediately DIALYSIS  Removal by artificial means of metabolic waste. Graft – piece of bovine artery or vein. Femoral/Subclavian cannulation – insertion of a catheter into one of these large veins for easy access to circulation: the procedure is similar to CVP insertion 4. take 4-6 weeks to be ready for use Nursing care: a. signs and symptoms of UTI or respiratory infection. remove the end product of CHON metabolism 2. no BP taking. Peritoneal dialysis HEMODIALYSIS Shunting of the blood from the client's vascular system through and artificial dializing machine. VS q 30minutes during the procedure . Fistula is accessed for hemodialysis by venipuncture.s circulation. and excess fluids from clients with renal failure  Principles: Diffusion and Osmosis Purposes: 1. Maintain safe levels of electrolytes 3. excess electrolytes. avoid restrictive clothing/dressing b. chart the client's weight 3. and return of the dialized blood into the client. External AV shunt – one cannula is inserted into an artery and the other into the vein both are brought out to the skin surface and connected by a Ushaped tube Nursing care: a. Dialysis coil – acts as a semipermeable membrane and the dialysate is a especially prepared solution Access Routes: 1. or saphenous veins Nursing care BEFORE and DURING hemodialysis 1. auscultate for bruit and palpate for thrill b. venipuncture IV administration of drugs on the shunt arm 2. remove excess fluids from the blood Types: 1. Gore Tex material. have the client void 2. change sterile dressing daily c.e. AV fistula – internal anastomosis of an artery to an adjacent vein in a sideways position. Hemodialysis 2. report bleeding and discoloration 3.

DWELL – 30 45 minutes 9. VS q 15minutes on the first cycle and q 1hour thereafter 3. Assemble the specially prepared dialysate solution with added medications 4. assess for complications: 1. protein loss Continuous Ambulatory Peritoneal Dialysis − for ambulatory client. peritonitis b. ensure bed rest and frequent position changes 5. clear. DIALYSIS DISEQUILIBRIUM SYNDROME – urea is removed from the blood more rapidly than from the brain PERITONEAL DIALYSIS Inroduction of a specially prepared dialysate solution into the abdominal cavity Nursing care: 1. Headache and nausea may occur 6. monitor for signs of bleeding since blood has been heparinized for procedure Nursing Care AFTER dialysis: 1. Assess for complications: a. HYPOVOLEMIC SHOCK 2. cloudy – INFECTION. assist physician for Trocar insertion 7.15mmHg Causes: rise in cerebrospinal fluid pressure increased pressure within the brain matter caused by lesions swelling within the brain matter Many conditions can increase intracranial pressure  Aneurysm rupture and subarachnoid hemorrhage  Brain tumor . PERITONITIS c. Monitor I&O and maintain records 12. done at home INCREASED INTRACRANIAL PRESSURE rise in normal brain pressure. respiratory difficulty c. normal pressure is 7. warm dialysate 6. INFLOW – 10 to 20 minutes 8. brownish – BOWEL PERFORATION d. observe the characteristics of the dialysate outflow a.4. bloody – common during the first exchanges but abnormal if it continues 11. DRAIN – unclamp and allow to flow by gravity 10. have the client void 5. get the client's weight 2. pale yellow – NORMAL b. weigh 2.

CAUSES:  excess alcohol intake. and often radiates to the back  signs of shock. toxins. cerebral edema. Diagnosis • elevated plasma and/or urinary ketones • metabolic acidosis (raised H+/low serum bicarbonate) Assessment: • intra and extra-vascular volume depletion with reduced skin turgor. trauma. thromboembolism Acute Hypoglycemia Acute Pancreatitis  a potentially life-threatening disorder characterized by inflammation of the pancreas that may also involve peripancreatic tissues or remote organ systems. ARDS. smell of ketones • ketonuria • vomiting/abdominal pain • drowsiness/reduced conscious level Management  insulin  intravenous insulin. namely tachycardia and hypotension. tolerable discomfort to severe incapacitating distress  pain is most intense in the epigastrium or periumbilical region. hyperlipidemia. Common precipitants include a new diagnosis of type 1 diabetes. or hypercalcemia Manifestation:  abdominal pain. . infection and deliberate omission of insulin. drugs. fluids and electrolytes is required to restore the metabolic equilibrium Acute Complications hypokalemia.         Encephalitis Hydrocephalus Hypertensive brain hemorrhage Intraventricular hemorrhage Meningitis Severe head injury Subdural hematoma Status epilepticus Stroke Metabolic Emergencies Diabetic Ketoacidosis (DKA) Diabetic Ketoacidosis occurs due to relative or absolute lack of insulin. ranging from mild. gallstones. or both. infection. tachycardia and hypotension (late features) • rapid and deep sighing respirations.

or TPN Infection and Antibiotic Therapy Massive bleeding . Diagnosis:  Elevated serum levels of amylase and lipase  X-ray.Ecchymoses in the periumbilical area (Cullen’s sign) or flanks (Turner’s sign) indicate hemorrhagic pancreatitis. NGT may be used. CT-Scan  Treatment Hydration Analgesia – Meperidine is given not morphine to prevent spasm of the sphincter of Oddi. ultrasound. w/o for toxicity esp in pt with renal failure Nutrition per orem unless there is nausea and vomiting.