Respiratory Failure and Nursing

Acute Respiratory Failure

–    The respiratory system can not adequately supply the blood with the O2 it needs or adequately remove the CO2.
–    Inadequate gas exchange due to pulmonary or non-pulmonary causes leading to hypoxemia, hypercarbia or both.
–    Respiratory failure is defined as:
–    PaO2   < 60 mmHg,
–    PaCO2 > 50 mmHg.
–    with pH  < 7.25

Types of Acute Respiratory Failure

–    Type I – Acute hypoxemic respiratory failure
–    Type II – Acute hypercapnic respiratory failure
–    Type III – Combined hypoxemic and hypercapnic failure
Respiratory system includes:
-CNS (medulla)
– Peripheral nervous system (phrenic nerve)
– Respiratory muscles
– Chest wall
– Lung
– Upper airways
– Bronchial tree
– Alveoli
– Pulmonary vasculature

Potential causes of Respiratory Failure
Respiratory Failure: Causes

1-  Airways obstruction:
–     Laryngotracheobronchitis
–    Tracheitis & Epiglottitis
–    Retropharyngeal / Peritonsillar abscess
–    Acute hypertrophic tonsillitis
–    Foreign body, trauma,
–    Bronchiolitis, Asthma, Foreign body

2.    Alveolar and pleural disease:
–    Pneumonia, pulmonary edema, embolism,
–    Empyma, pneumothorax, ARDS.

3.   CNS causes:
–     Infections, injury, trauma, seizures
–     Drugs induce rspiratory depression
–    CNS dysfunction (CVA)
–     Phrenic nerve injury
–     Myasthenia gravis
–     Muscle dystrophies, Polymyositis
–     Congenital myopathies, muscle fatigue
–     Tetanus, Polio

Clinical Manifestations  “Respiratory Failure”:

–    Difficult of breathing, shortness of breath, dyspnea, tachypnea, orthopnea, hyperventilation, use of accessory muscless  and nasal flaring.
–    Confusion, drowsiness, disorientation, and coma.
Tachycarida, cyanosis, diaphoresis, chest pain, peripheral vasodilatation with hypotension.

Diagnostic Test

–    ABGs levels show hypoxemia, acidosis, alkalosis, and hypercapnia.
–    Chest x-ray shows pulmonary infiltration and atelectasis.
–    Hematology reveals increased WBCs and ESR.
–    Sputum study identifies organism.

Management of Respiratory Failure Principles

–    Hypoxemia may cause death in RF
–    Primary objective is to reverse and prevent hypoxemia
–    Secondary objective is to control PaCO2 and respiratory acidosis
–    Treatment of underlying disease
–    Patient’s CNS and CVS must be monitored and treated

Intervention and rational

–    Maintain bed rest to reduce O2 requirement.
–    Keep the patient in semi-folwers position to promote chest expansion and ventilation.
–    Administer O2 to reduce hypoxemia and relieve respiratory distress.
–    Assess respiratory status to detect early signs of hypoxemia.
–    Monitor and record vital signs, tachycardia and tachypnea may indicate hypoxemia.
–    Monitor pulse oximetry to detect a drop in SaO2.
–    Provide suctioning, assist with turning, coughing, and deep breathing, and perform chest physiotherapy and postural drainage to facilitate removal of secretion.
–    Report deteriorating: ABGS (PaO2 and PaCo2)
–      CBC, and Chemistry to detect electrolyte imbalance result use of diuretics.
–    Maintain diet restrictions, fluid restrictions and a low Na diet may be necessary to avoid fluid overload.
–    M.V may indicated: monitor M.V. to prevent complication and optimize PaO2

Drug therapy:

–    Bronchodilators: “Aminolphyllin, Aerosol”
–    Analgesic: morphine sulfate.
–    Diuretics “Lasix” if overload is the cause.
–    Steroids: “hydrocortisone- Solu-medrol”
–    Histamine blockers “Zantac, famotidine”

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Posted in Critical Care Nursing, Respiratory

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