Respiratory failure Is a broad. compromise the matching of ventilation and perfusion. or disrupt blood flow in the lung . non specific clinical diagnosis indicating that the respiratory system is unable to supply the oxygen necessary to maintain metabolism or cannot eliminate sufficient carbon dioxide It is a result of a number of conditions that impair ventilation.

This condition is present when PO2 falls to.It is typically seen in chronic bronchitis and emphysema. in lung consolidation due to bacterial infection. .2 types: 1) Acute Respiratory Failure Is defined as a decrease in arterial oxygen tension (PaO2) to less than 50mmHg (hypoxemia) and an increase in arterial carbon dioxide tension (PaCO2) to greater than 50 mmHg (hypercapnia). or below.35 a) Hypoxemic Respiratory Failure . in lung collapse. or in pulmonary hypertension . with an arterial pH of less than 7. 60 mmHg.

S/S: Headache Nervous agitation Decreased PO2 which causes more widespread tissue damage & loss of consciousness Tachycardia Personality changes Restlessness Muscle incoordination Euphoria Impaired judgment Delirium Stupor Coma Cool skin Diaphoresis Hypotension Bradycardia .

b) Hypercapnic Respiratory Failure -this condition is present when arterial PaCO2 normally at 40 mmHg exceeds 45mmHg S/S: Muscular tremors Drowsiness Headache Conjuctival hyperemia Flushed skin Tachycardia Diaphoresis Mild to moderate increase in blood pressure .

2) Chronic respiratory failure > Is defined as a deterioration in the gas exchange function of the lung that has developed insidiously or has persisted for a long period after an episode of ARF Causes: COPD & Neuromuscular disorders .

such as the home. the partial pressure of carbon dioxide and oxygen . . or femoral artery or through an indwelling arterial catheter. The test is used to determine the pH of the blood. or in the case of an infant. > ABG levels are obtained through an arterial punctures at the radial. > It is used in all settings where oxygen saturation monitoring is needed. brachial. across a foot. usually a fingertip or earlobe. and hospitals. ambulatory surgical settings. clinics. and the carbonate level.Pulse Oximetry > Is a non-invasive method of continuously monitoring the oxygen saturation of haemoglobin. Arterial Blood Gas (ABG) > Is a blood test that is performed using blood from an artery. >A sensor is placed on a thin part of the patient's body. It involves puncturing an artery with a thin needle and syringe and drawing a small volume of blood.

and gas exchange. > Use to help diagnose or monitor treatment for conditions such as: Pneumonia. Pulmonary function test > Are used to assess respiratory function and to determine the extent of dysfunction. > It is useful as screening tests in potentially hazardous industries. heart failure and other heart problems.Chest X-ray > Is a non-invasive medical test that helps physicians diagnose and treat medical conditions. > A chest x ±ray may reveal an extensive pathologic process in the lungs in the absence of symptoms. emphysema. . dusts or gases. lung cancer. line and tube placement. diffusion. > It includes measurement of lung volumes. such as coal mining and those that involve exposure to asbestos and other noxious fumes. and the mechanisms of breathing. > Usually taken after full inspiration (deep breath). ventilatory function.

. > A device that detects and amplifies the tiny electrical changes on the skin that are caused when the heart muscle depolarizes during each heartbeat. corticosteroids. > Expectoration is the usual method for collecting a sputum specimen. and immunosuppressive medications. as detected by electrodes attached to the outer surface of the skin and recorded by a device external to the body.Electrocardiography (ECG/EKG) > Is a transthoracic (across the thorax or chest) interpretation of the electrical activity of the heart over a period of time. Sputum culture > Is a test to detect and identify bacteria or fungi that infect the lungs or breathing passages > May be necessary for patients receiving antibiotics.

Auscultate breath sounds. Encourage adequate rest and limit activities to within client tolerance. and report all deviations from baseline evaluation and document complaints of increased discomfort and difficulty breathing. as indicated (bronchodilators) . heart sounds. Monitor vital signs. Provide a quiet. Elevate head of bed/ position patient appropriately. neurological status. and signs of hypoxia. breath sounds. Maintain adequate I & O Provide supplemental oxygen Discuss implications of smoking related to the condition Administer medications. supportive environment. encourage deep breathing exercise and coughing exercises. record.Impaired gas exchange r/t inadequate ventilation Nursing interventions: Assess.

weight.Fatigue related to oxygen deprivation Nursing interventions: Assess vital signs Provide a quiet and supportive environment Encourage relaxation techniques Position the patient appropriately Provide diversional activitiesProvide supplemental oxygen Excess fluid volume r/t excess preload Nursing interventions: Auscultate breath sounds Monitor urine output. and potassium levels Monitor vital signs Set an appropriate rate of fluid intake Place in semi. as appropriate Administer diuretic as prescribed (furosemide) .Fowler¶s position.

. pulmonary suctioning) Monitor/ assist with use of adjuncts(e. prophylactic antibiotics Acute pain r/t damaged nerve endings secondary to abdominal surgery Nursing interventions: Assess for referred pain Monitor vital signs Provide comfort measures. as indicated Administer antimicrobials. as indicated .Risk of infection related to microbial invasion Nursing interventions: Monitor vital signs (especially temperature) Proper hand hygiene by all caregivers Maintain sterile technique in all invasive procedures(e.g. quiet environment.g. respiratory aids) Fill bubbling humidifiers/ nebulizers with sterile water Provide for isolation. and calm activities Encourage relaxation techniques Encourage diversional activities Administer analgesics..

Hypoxemic respiratory failure Concentrates on four areas: 1) Correction of hypoxemia .prescription of inotropic medications such as dobutamine to support the left ventricle .noninvasive positive pressure ventilation such as continuous positive airway pressure or mechanical ventilation 2) Reduction in preload .oxygen therapy at high FiO2 levels .morphine is given to reduce the SNS response and to reduce anxiety from dyspnea 4) Support of perfusion .nitrates are used for vasodilating properties 3) Reduction of afterload .diuretics are prescribed for to promote fluid excretion .A.antihypertensive agents are prescribed .client is placed on an upright position .

to deliver precise concentrations of FiO2 .used to maintain adequate ventilation .to deliver adequate tidal volumes to obtain an adequate minute ventilation & oxygenation . broad spectrum antibiotics are given 2) Oxygenation .used for artificial airway 5) Continuous mechanical ventilation .bronchodilators are used to treat obstructions to airflow in clients with COPD & asthma .use of NPPV with heliox to support the client and prevent the need for intubation 4) Endrotracheal intubation .to lessen the work of breathing in those clients who cannot sustain adequate ventilation on their own .use of oxygen masks . Hypercapnic respiratory failure 1) Reverse bronchospasm .B.for infection.using forms of NPPV such as CAP 3) Maintaining ventilation .

A.baseline weight and lung assessment is done B.management of the client¶s anxiety and reduction of dyspnea .assessment upon admission . Hypercapnic respiratory failure Neuromuscular blocking agents: .specific attention should be given to the eyes to prevent corneal abrasions and other eye injuries . eye care with lubricating ointment is importantant Suctioning Weaning from a ventilator .ensure safety . Hypoxemic respiratory failure .reorientation of the client and explanation of procedures .

effortless and quiet Due to reduced air entry in the airway Due to spasm of the airway inspection .3 kPa 35-45 mmHg/ 4.9 kPa 87% on 60% O2 ANALYSIS -due to decreased oxygen in the blood normal Physical Assessment AREA ASSESSED (SKIN) Color Texture Temperature (THORAX AND LUNGS) Posterior thorax Use of accessory muscle (breathing pattern) Breath sounds Pattern of respiration TECHNIQUE USED Inspection Palpation Palpation NORMAL FINDINGS Light to deep brown Smooth Warm to touch.Laboratory examination CRITERION (ABG) PaO2 PaCO2 Oxygen Saturation NORMAL FINDINGS 80-100 mmHg/ 9. uniform Scapula are symmetric and non-protruding (-) use of accessory muscle ACTUAL FINDINGS Pale smooth clammy Scapula are symmetric and non-protruding (+) use of accessory muscles to facilitate breathing (+) crackles and wheezes Regular but shallow REMARKS Due to hypercapnia Normal Due to hypoxia Inspection Normal inspection Due to dyspnea auscultation No adventitious sound Relapsed.7-6.0 kPa ACTUAL FINDINGS 6.4 kPa 4.3-13.

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