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    Respiratory Failure (Aan) PDF

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    Yudiono
    This document discusses respiratory failure, describing it as the lung's impaired ability to maintain adequate oxygen and carbon dioxide homeostasis. It classifies respiratory failure as acute, chronic, or acute-on-chronic and hypoxemic or hypoxemic hypercapnic. Causes include conditions affecting the lungs themselves or external factors. Pathophysiology involves inadequate ventilation leading to hypoxia, acidosis, and other issues. Clinical manifestations, assessment, medical management, and nursing care of respiratory failure are outlined.

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    Respiratory Failure (Aan) PDF

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    Yudiono
    247 views19 pages
    This document discusses respiratory failure, describing it as the lung's impaired ability to maintain adequate oxygen and carbon dioxide homeostasis. It classifies respiratory failure as acute, chronic, or acute-on-chronic and hypoxemic or hypoxemic hypercapnic. Causes include conditions affecting the lungs themselves or external factors. Pathophysiology involves inadequate ventilation leading to hypoxia, acidosis, and other issues. Clinical manifestations, assessment, medical management, and nursing care of respiratory failure are outlined.

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    This document discusses respiratory failure, describing it as the lung's impaired ability to maintain adequate oxygen and carbon dioxide homeostasis. It classifies respiratory failure as acute, chronic, or acute-on-chronic and hypoxemic or hypoxemic hypercapnic. Causes include conditions affecting the lungs themselves or external factors. Pathophysiology involves inadequate ventilation leading to hypoxia, acidosis, and other issues. Clinical manifestations, assessment, medical management, and nursing care of respiratory failure are outlined.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    247 views19 pages

    Respiratory Failure (Aan) PDF

    Uploaded by

    Yudiono
    This document discusses respiratory failure, describing it as the lung's impaired ability to maintain adequate oxygen and carbon dioxide homeostasis. It classifies respiratory failure as acute, chronic, or acute-on-chronic and hypoxemic or hypoxemic hypercapnic. Causes include conditions affecting the lungs themselves or external factors. Pathophysiology involves inadequate ventilation leading to hypoxia, acidosis, and other issues. Clinical manifestations, assessment, medical management, and nursing care of respiratory failure are outlined.

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    RESPIRATORY FAILURE

    BY :
    AAN NURAENI
    CRITICAL CARE NURSING
    FACULTY OF NURSING
    UNPAD
    2013
    Description

    Respiratory failure is impairement of the lungs


    ability to maintain adequate oxygen and
    carbondioxide homeostatis.
    It usually occurs secondary to another disorder, in
    such a way as to decrease the ventilatory drive,
    decrease muscle strength, dec chest wall elasticity,
    dec lung capacity for gas exchange, increase airway
    resistance, or increase metabolic O2 requirements
    Classification

    Acute respiratory failure (ARF) :


    It occurs over hours to days

    Urgency

    Chronic Respiratory failure (CRF) :


    It develops over months to years

    Allowing compensatory mechanism (improve oxygen transport


    and buffer respiratory acidemia)
    Acute on chronic repiratory failure (AOCF) :
    AOCF is ARF superimposed on CRF
    Classification

    Hypoxemic respiratory failure :


    Low PaO2 (< 50 mmHg)
    Normal or low PaCO2
    V/Q mismatch ARDS

    Hypoxemic hipercapnic respiratory failure :


    Low PaO2 (< 50 mmHg)

    Elevation of PaCO2 (> 50 mmHg).


    Etiology

    Extrapulmonary Intrapulmonary

    Brain : Drug overdose, central Upper airways : sleep


    alveolar hypoventilation
    sindrome, Brain trauma, post-
    apnea, tracheal
    op anesthesia deppression obstruction
    Spinal cord : GBS, Poliomyelitis Lower airways alveoli :
    etc
    COPD
    Neuromuscular : Myasthenia
    gravis, MS, Organophosphate Pulmonary emboli
    poisoning
    Inhalation of toxic gases
    Thorax : Massive obesity, chest
    trauma etc
    Pleura : Pleural effusion,
    Pneumothorax
    Pathophysiologi

    Respiratory system is made up of two basic parts :


    Gas exchange organ (Lung) Alteration
    The pump (the respiratory
    control mechanism)
    Respiratory insufficiency &/
    Respiratory failure

    Inadekuat ventilasi hipoxic dec pH resp acidosis


    Pathophysiology

    RF Hipoxemia, the main causes of hypoxemia


    are :
    Alveolar hypoventilation
    The O2 being brought into the alveoli is insufficient to meet
    metabolic needs of body
    Metabolic needs
    Ventilation
    Ventilation / Perfusion mismatching
    Ventilation and blood flow mismatched
    Alveoli partially collapsed or partially filled with fluid
    Intrapulmonary shunting
    Blood reaches the arterial system without participating in gas
    exchange
    Acute Respiratory Failure

    Defined by predetermined criteria :


    PaO2 of 50 mmHg or less (measured on room air)

    PaCO2 of 50 mmHg or more

    pH of 7,35 or less

    Hypercapnia and hypoxemia are present in CRF with pH ussually stay within
    range of 7,35 7,45
    AOCF : Secondary insult to the respiratory functin of CRF patients the
    individual can no longer compensate for the altered lung function.
    Because CO2 retention preexist in patients with CRF , PaCO2 is less relevant than
    pH and PaO2 in determining respiratory status
    Clinical Manifestation

    Secondary to Hypercapnia, Hipoxemia, and


    Respiratory Acidosis
    Headache
    Irritability
    Confusion
    Increasing somnolence, coma
    Asterixis (flapping tremor)
    Cardiac dysrhytmia
    Tachycardia
    Hipotension
    Cyanosis
    Clinical Manifestation

    Secondary to increased work of breathing :


    Dyspnea

    Exhaustion

    Secondary to pressure on right side of heart


    Peripheral edema

    Neck vein distension

    Hepatomegaly
    Assesment and Diagnosis

    Hypoxemia : ABG analysis


    PaCO2 > 50 mmHg
    PaO2 < 50 mmHg

    Hipercapnia
    Acidosis
    pH < 7.35

    Additional tests : Bronchoscopy, chest radiography,


    thoracic ultrasound, CT scan
    Spirometry
    Sputum for culture and sensitivity
    Medical management

    Oxygenation :
    To correct hypoxemia keeping the arterial Hb oxygen saturation > 90
    %
    Supplemental oxygen administration and positive airway pressure

    Ventilation : non invasive and invassive ventilation


    Pharmacology :
    To facilitate dilation of airways, such as Bronchodilators (beta 2 agonist
    and anticholinergic agents). Aminophiline have negative side effects.
    Steroids to decrease airway inflamation and enhance the beta2agonists
    effect. Sedation (assist maintaining adequate ventilation), analgesics
    Acidosis :
    Correction of hypoxemia and sodium bicarbonate
    Nutrition support
    Prevention of complications
    Nursing Management

    Health history :
    History of past or present associated disorder, recent change in
    respiratory status, change in sputum (color, viscosity, odor),
    increase dyspnea, change in mental status, complaints of chest
    tightness or pain.
    Current medications and any recent changes in medication
    regimen
    Self care modalities used

    A family memberor friend who maybe able to provide objective


    information about changes in the patients.
    Nursing Management

    Physical Examination :
    Abnormalities of general appearance, breathing dificulty,
    postural change
    Variation in mental status, which may range from agitation to
    somnolence
    Changes in vital signs to identify tachycardia, tachypnea,
    bradypnea, or apnea, hypotension, and other abnormalities.
    Respiratory status abnormalities

    Relevant laboratory studies, including ABGs, sputum culture


    and sensitivity, and bedside spirometry
    Nursing Diagnoses, Outcomes, and Intervention

    Nursing Diagnosis : Impaired Gas Exchange


    Outcomes :
    Demonstrate improve ventilation and oxygenation

    Have PaO2, PCO2 and pH within acceptable baseline limits.

    Demonstrate mental status at prerespiratory failure level

    Exhibit respiratory rate within or near normal levels, with


    moderate tidal volume
    Have no dyspnea or preacute illness level of dyspnea
    Nursing Intervention :
    Oxygen therapy rapidly evaluated with ABG, pulse oximetry

    Frequent assesment of respiratory status, vital signs, level of


    conciousness, tolerance of ventilatory support, ventilator
    setting
    Facillitation of use of controlled breathing tecniques

    Review of lab data, especially electrolytes, hematocrite

    Pain evaluation (collaboration analgesia especially opiates)


    Nursing diagnosis

    Ineffective airway clearance


    Decrease cardiac output
    Imbalanced nutrition : less than body requirements
    Nursing Management

    Nursing care is directed by the specific etiology of ARF. Common


    interventions :
    Positioning
    Preventing desaturation :
    Performing procedures only as needed
    Hyperoxygenating the patient before suctioning
    Providing adequate rest and recovery time between various procedures
    Minimizing oxygen consumption
    Deep breathing after extubation
    Promoting secretion clearance :
    Adequate systemic hydration
    Hummidifying supplemental oxygen
    Coughing and suctioning
    Chest physiotherapy
    Patient Education
    Adequate nutrition

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