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    Respiratory Failure (KK 2a)

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    IlaJako Stefanatic
    This document discusses respiratory failure, which occurs when one or both of the gas exchange systems (air entering the lungs or oxygen entering the blood from the lungs) is inadequate. There are two main types - hypoxemic respiratory failure, where oxygenation is inadequate, and hypercapnic respiratory failure, where ventilation is inadequate and carbon dioxide levels rise. Causes can include issues with the airways, lungs, chest wall, nervous system or muscles. Diagnosis involves blood gas analysis and other tests. Treatment focuses on addressing the underlying cause, providing oxygen therapy, mobilizing secretions, mechanical ventilation if needed, medications, nutrition support, and careful nursing care of patients on ventilators to prevent complications.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Respiratory Failure (KK 2a)

    Uploaded by

    IlaJako Stefanatic
    338 views29 pages
    This document discusses respiratory failure, which occurs when one or both of the gas exchange systems (air entering the lungs or oxygen entering the blood from the lungs) is inadequate. There are two main types - hypoxemic respiratory failure, where oxygenation is inadequate, and hypercapnic respiratory failure, where ventilation is inadequate and carbon dioxide levels rise. Causes can include issues with the airways, lungs, chest wall, nervous system or muscles. Diagnosis involves blood gas analysis and other tests. Treatment focuses on addressing the underlying cause, providing oxygen therapy, mobilizing secretions, mechanical ventilation if needed, medications, nutrition support, and careful nursing care of patients on ventilators to prevent complications.

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    respiratory

    Original Title

    Respiratory Failure (Kk 2a)

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    This document discusses respiratory failure, which occurs when one or both of the gas exchange systems (air entering the lungs or oxygen entering the blood from the lungs) is inadequate. There are two main types - hypoxemic respiratory failure, where oxygenation is inadequate, and hypercapnic respiratory failure, where ventilation is inadequate and carbon dioxide levels rise. Causes can include issues with the airways, lungs, chest wall, nervous system or muscles. Diagnosis involves blood gas analysis and other tests. Treatment focuses on addressing the underlying cause, providing oxygen therapy, mobilizing secretions, mechanical ventilation if needed, medications, nutrition support, and careful nursing care of patients on ventilators to prevent complications.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    338 views29 pages

    Respiratory Failure (KK 2a)

    Uploaded by

    IlaJako Stefanatic
    This document discusses respiratory failure, which occurs when one or both of the gas exchange systems (air entering the lungs or oxygen entering the blood from the lungs) is inadequate. There are two main types - hypoxemic respiratory failure, where oxygenation is inadequate, and hypercapnic respiratory failure, where ventilation is inadequate and carbon dioxide levels rise. Causes can include issues with the airways, lungs, chest wall, nervous system or muscles. Diagnosis involves blood gas analysis and other tests. Treatment focuses on addressing the underlying cause, providing oxygen therapy, mobilizing secretions, mechanical ventilation if needed, medications, nutrition support, and careful nursing care of patients on ventilators to prevent complications.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 29

    Respiratory Failure

    Siswoyo & Wantiyah


    Resp Failure:one or both exchanging systems
    is inadequate (air to lung or lung to blood)
    Blood Supply to Lung
    Respiratory Failure
    Not a disease process, sign of severe dysfunction
    Predisposing Factors:
    Airways/alveoli
    CNS
    Chest wall
    Neuromuscular
    Commonly defined in terms of ABGs:
    PO2 of less than 60 mmHg
    PCO2 greater than 45 mmHg
    Arterial pH of less than 7.35
    Classification of Respiratory Failure
    Hypoxemic Respiratory Failure
    Oxygenation failure- inadequate O2 transfer
    between alveoli & pulmonary capillary bed
    PaO2 60 mm Hg or less on 60 % O2
    Inadequate O2 saturation of hemoglobin
    Causes tissue hypoxia > Metabolic acidosis; cell
    death; decreased CO; impaired renal function
    Common causes: disorders that interfere with O2
    transfer into the blood- respiratory or cardiac
    system
    Hypoxemic Respiratory Failure
    Mechanisms that may lead to Hypoxemia:
    1. Mismatch ventilation & perfusion (V/Q mismatch)
    V/Q: Volume blood perfusing lungs each minute
    Each ml of air for each ml of blood
    1:1= V/Q ratio of 1
    Causes of V/Q mismatch:
    Ventilation portion blocked (secretions in
    airway/alveoli, airway/alveolar collapse, decreased
    movement chest/ventilation)
    Perfusion portion blocked (pulmonary embolus)
    Hypoxemic Respiratory Failure
    Range of ventilation to perfusion (V/Q relationship)
    A. Absolute shunt, no
    ventilation fluid in alveoli
    B. Ventilation partially
    compromised- secretions
    C. Normal lung unit
    D. Perfusion partially
    compromised by emboli
    obstructing blood flow
    E. Dead space: no
    perfusion- obstruction of
    pulmonary capillary
    Hypoxemic Respiratory Failure
    Mechanisms that may lead to Hypoxemia:
    2. Shunt- Extreme V/Q mismatch
    Occurs when blood
    leaves heart without gas
    exchange
    Types:
    1. anatomic shunt: O2
    blood does not pass
    through lungs
    2. intrapulmonary shunt-
    alveoli fill with fluid
    Treatment: Mechanical
    ventilation to force O2
    into lungs; treat cause
    Hypoxemic Respiratory Failure
    Mechanisms may lead to Hypoxemia:
    3. Diffusion limitations
    Alveoli membrane
    thickened or destroyed
    Gas exchange across
    alveolar-capillary
    membrane cant occur
    Classic sign: hypoxemia
    present during exercise,
    not at rest
    Treat the cause such as
    pulmonary fibrosis;
    ARDS
    Hypoxemic Respiratory Failure
    Mechanisms may lead to Hypoxemia:
    Clinical manifestations of hypoxemia
    Specific: Respiratory:
    Nonspecific: Cerebral, cardiac, other
    Treatment: treat cause, O2 and mechanical
    ventilation
    Hypercapnic Respiratory Failure

    Ventatory failure: Inability of the respiratory system to


    ventilate out sufficient CO2 to maintain normal PaCO2
    PaCO2 greater than 45 mm Hg, Arterial pH less than 7.35
    PCO2 rises rapidly and respiratory acidosis develops,
    PO2 drops more slowly
    Common causes include disorders that compromise lung
    ventilation and CO2 removal (airways/alveoli, CNS, chest
    wall, neuromuscular)
    Clinical manifestations: specific respiratory, nonspecific
    of cerebral, cardiac, neuromuscular
    Treatment: adeq O2, airway, meds, treat underlying cause,
    nutrition
    Collaborative Care for Respiratory Failure:
    Diagnostic tests
    History/physical assessment
    Pulse oximetry
    ABG analysis
    Chest X-ray
    CBC, sputum/blood cultures, electrolytes
    EKG
    Urinalysis
    V/Q scan- if pulmonary embolism suspected
    Hemodynamic monitor/pulmonary function tests
    Collaborative care for Respiratory Failure
    Respiratory Therapy
    Main treatment- correct underlying cause & restore
    adequate gas exchange in lung
    Oxygen Therapy (Maintain PaO2 at least 60 mm Hg,
    SaO2 90%)
    Mobilization of secretions
    Effective coughing & positioning
    Hydration & humidification
    Chest physical therapy
    Airway suctioning
    Positive pressure ventilation
    Noninvasive positive pressure ventilation
    Intubation with mechanical ventilation
    Collaborative Care for
    Respiratory Failure cont
    Drug Therapy
    Relief bronchospasm; reduce airway inflam and
    pulmonary congestion; treat pulmonary infections;
    reduce anxiety, pain
    Medical supportive therapy
    Treat underlying cause
    Nutritional therapy
    Enteral; parenteral
    Protein and energy stores
    Collaborative Care: Artifical airways-
    tracheostomy and endotracheal tubes
    Endotracheal tube
    Taping and inline suctioning of an
    endotracheal tube
    Exhaled C02 (ETC02) normal 35-45

    Used when trying to wean


    patient from a ventilator
    Independent Lung Ventilation
    Collaborative Care:
    Mechanical Ventilation
    Provide adeq gas
    exchange
    Criteria to put on vent
    RR > 35-45
    pCO2 >45
    pO2 <50
    Types- Positive, Neg
    Types: Negative pressure ventilator
    Types: Positive pressure mechanical
    ventilation with endotracheal tube (PPV)
    Complications/Nursing Care of
    Positive Pressure Mechanical ventilation
    Cardiovascular: decreased CO; inc intrathoracic pressure
    Pulmonary: Barotrauma; Volutrauma; alveolar
    hypoventilation/hyperventilation; ventilator-associated
    pneumonia
    Sodium and water imbalance
    Neurological: impaired cerebral bl flow>IICP
    Gastrointestional: stress ulcer/GI bleed; gas; constipation
    Musculoskeletal: dec muscle tone; contractures; footdrop;
    pressure ulcers from BR
    Psychosocial: physical & emotional stress; fight vent
    Other problems
    when on mechanical ventilation
    Machine disconnection or malfunction
    Nutrition needs
    Nursing assessment specific to
    Respiratory Failure
    Assess both airway and
    lungs
    Refer to hypoxic and
    hypercapnic respiratory
    failure symptoms
    Data:
    Subjective data
    Objective data
    Nursing Diagnoses
    Impaired spontaneous ventilation
    Impaired gas exchange r.t mismatch
    perfusion-ventilation
    Relevant Nursing Problems related to
    Respiratory Failure
    Prevention of acute respiratory failure
    Nursing Care Plans
    Gerontology considerations
    Nursing Care Plans Mechanical ventilation
    Suctioning procedure and oral care
    29

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