Respiratory failure Is a broad, 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, compromise the matching of ventilation and perfusion, or disrupt blood flow in the lung

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 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 haemoglobin. > It is used in all settings where oxygen saturation monitoring is needed, such as the home, clinics, ambulatory surgical settings, and hospitals. >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.
Arterial Blood Gas (ABG) > Is a blood test that is performed using blood from an artery. It involves puncturing an artery with a thin needle and syringe and drawing a small volume of blood. > 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.

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. > Usually taken after full inspiration (deep breath). > Use to help diagnose or monitor treatment for conditions such as: Pneumonia, heart failure and other heart problems, emphysema, lung cancer, line and tube placement.

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. > It is useful as screening tests in potentially hazardous industries, such as coal mining and those that involve exposure to asbestos and other noxious fumes, dusts or gases.

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. > A device that detects and amplifies the tiny electrical changes on the skin that are caused when the heart muscle depolarizes during each heartbeat. 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, corticosteroids, and immunosuppressive medications. > Expectoration is the usual method for collecting a sputum specimen.

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

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, weight, and potassium levels Monitor vital signs Set an appropriate rate of fluid intake Place in semi- Fowlers position, as appropriate Administer diuretic as prescribed (furosemide)

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., pulmonary suctioning) Monitor/ assist with use of adjuncts(e.g., respiratory aids) Fill bubbling humidifiers/ nebulizers with sterile water Provide for isolation, as indicated Administer antimicrobials, 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, quiet environment, and calm activities Encourage relaxation techniques Encourage diversional activities Administer analgesics, as indicated

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

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

A. Hypoxemic respiratory failure - assessment upon admission - management of the clients anxiety and reduction of dyspnea - baseline weight and lung assessment is done B. Hypercapnic respiratory failure 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 importantant 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 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 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, 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, effortless and quiet

Due to reduced air entry in the airway Due to spasm of the airway

inspection