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), with an arterial pH of less than 7.35
Most common causes: decreased respiratory drive dysfunction of the chest wall drug overdose
a) Hypoxemic Respiratory Failure - This condition is present when PO2 falls to, or below, 60 mmHg. - It is typically seen in chronic bronchitis and emphysema, in lung consolidation due to bacterial infection, in lung collapse, or in pulmonary hypertension
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
Pulse Oximetry Is a non-invasive method of continuously monitoring the oxygen saturation of hemoglobin. A sensor is placed on a thin part of the patient's body, usually a fingertip or earlobe, or in the case of an infant, across a foot. Shows a decreased oxygen in the blood Arterial Blood Gas (ABG) > ABG levels are obtained through an arterial punctures at the radial, brachial, or femoral artery or through an indwelling arterial catheter. The test is used to determine the pH of the blood, the partial pressure of carbon dioxide and oxygen , and the carbonate level. > Shows an increase in PaCO2 and decrease in PaO2
Chest X-ray > A chest x ray may reveal an extensive pathologic process in the lungs in the absence of symptoms. Usually taken after full inspiration (deep breath). Determines underlying cause of respiratory failure
Pulmonary function test > Are used to assess respiratory function and to determine the extent of dysfunction. > It includes measurement of lung volumes, ventilatory function, and the mechanisms of breathing, diffusion, and gas exchange. Electrocardiography (ECG/EKG) Is a transthoracic (across the thorax or chest) interpretation of the electrical activity of the heart over a period of time, as detected by electrodes attached to the outer surface of the skin and recorded by a device external to the body.
of
> Monitor patients level of response Neuromuscular blocking agents: - reorientation of the client and explanation of procedures - ensure safety - specific attention should be given to the eyes to prevent corneal abrasions and other eye injuries ; eye care with lubricating ointment is important Suctioning Weaning from a ventilator
Laboratory examination
CRITERION (ABG) PaO2 PaCO2 Oxygen Saturation NORMAL FINDINGS 80-100 mmHg/ 9.3-13.3 kPa 35-45 mmHg/ 4.7-6.0 kPa 95-100% ACTUAL FINDINGS 6.4 kPa 4.9 kPa 87% on 60% O2 ANALYSIS due to decreased oxygen in the blood normal
Physical Assessment
AREA ASSESSED (SKIN) Color TECHNIQUE USED Inspection NORMAL FINDINGS Light to deep brown ACTUAL FINDINGS Pale REMARKS Due to increased blood flow
Texture
Temperature (THORAX AND LUNGS) Posterior thorax Use of accessory muscle (breathing pattern) Breath sounds Pattern of respiration
Palpation
Palpation Inspection
Smooth
Warm to touch, uniform Scapula are symmetric and non-protruding (-) use of accessory muscle No adventitious sound Relapsed, effortless and quiet
smooth
clammy Scapula are symmetric and non-protruding (+) use of accessory muscles to facilitate breathing (+) crackles and wheezes Regular but shallow
Normal
Due to hypoxia Normal
inspection
Due to dyspnea
auscultation
Due to reduced air entry in the airway Due to spasm of the airway
inspection
A. Hypoxemic respiratory failure Concentrates on four areas: 1) Correction of hypoxemia - oxygen therapy at high FiO2 levels - noninvasive positive pressure ventilation such as continuous positive airway pressure or mechanical ventilation 2) Reduction in preload - client is placed on an upright position - diuretics are prescribed for to promote fluid excretion - nitrates are used for vasodilating properties 3) Reduction of afterload - antihypertensive agents are prescribed - morphine is given to reduce the SNS response and to reduce anxiety from dyspnea 4) Support of perfusion - prescription of inotropic medications such as dobutamine to support the left ventricle