Saint Marys University

School of Health and Natural Sciences

Bayombong, Nueva Vizcaya
SY 2016- 2017

Prepared By: Patricia Ann B. Aseron, BSN 4

Intensive Nursing Prcaticum

Basic Respiratory Functions:

Respiration
- Process of exchange of oxygen and carbon dioxide which involves ventilation, oxygenation, gas
transport, ventilation- perfusion (V/Q) relationship and control of breathing.

Pulmonary Ventilation
- Total volume of inspired and expired air per minute
- Factors: RR, Tidal volume (amount of inspired and expired air with each breath)

Alveolar ventilation
- Volume of air entering alveoli taking part in gas exchange

Effective ventilation is measured by the partial pressure of arterial carbon dioxide (PaCO2)

VENTILATION AND PERFUSION

V- alveolar ventilation
P- Pulmonary blood flow
Ventilation and perfusion matching is important to achieve ideal exchange of O2 and CO2
Normal V/Q ratio= 0.8

Abbreviations:
PaO2- arterial O2 tension
PaCO2- arterial CO2 tension
ACUTE RESPIRATORY FAILURE
Change of O2 for CO2 in lungs cannot keep up with rate of O2 consumption and CO2 production from
cells of the body.
Failure in:
a. Oxygenation
b. Carbon dioxide elimination

Classifications of ARF:

Type I- Hypoxemic cause

Type II- Hypercapic cause
Type III- Postoperative
Type IV- Shock

a. HYPOXEMIC ARF (Type 1)

Failure in oxygenation
PaO2 < 50 mmHg with low or normal PaCO2

Common causes of type I respiratory failure:

Alveolar unit failure
Collapse- Atelectasis
Flooding: edema, blood,
pus, aspiration
Fibrosis
Pneumonia
Pulmonary Embolism
Cardiogenic pulmonary edema
Non- cardiogenic pulmonary edema: ALI ( acute lung injury), ARDS (acute respiratory distress syndrome)

Clinical Manifestations: Hypoxic ARF

Paradoxical breathing
Retractions
Cyanosis
Prolonged expiration
Nasal flaring
 Tachypnea

b. HYPERCAPNIC ARF (Type 2)

Failure in carbon dioxide elimination
PaCO2 > 50 mmHg

Common causes of type II respiratory failure

Nervous system failure
Central hypoventilation
Neuropathies
Obesity hypoventilation syndrome
Neuromuscular transmission failure
/Neuromuscular and chest wall disorders: myasthenia gravis, kyphoscoliosis
Muscle (pump) failure
Muscular dystrophies
Myopathies
Airway failure
Obstruction: COPD
Dysfunction

Clinical Manifestations: Hypercapnic ARF

Pursed- lipbreathing
Morning headache
Rapid, shallow breathing
Tripod positioning (orthopneic)

Respiratory factors

Acute pulmonary vascular occlusion can result in ventilation-perfusion mismatch and respiratory failure
due to insufficient blood flow to functioning alveoli.
Pneumothorax can lead to respiratory failure if there is not enough lung reserve to compensate for the
collapsed lung or lung segment.
Fluid or blood accumulation in the pleural space (pulmonary effusion) may lead to compression of
pulmonary tissues and loss of pulmonary function, causing respiratory failure.
Destruction or infiltration of alveoli reduces the surface area available for gas exchange.
Acute upper airway obstruction (e.g., from foreign body aspiration, acute epiglottitis, anatomical
abnormalities, anaphylaxis) can inhibit air flow into the lungs and cause respiratory failure.
Pulmonary embolus can occur as a result of hypercoagulability from clotting cascade diseases or
abnormalities.
Exposure to toxic fumes can lead to damage of the upper airway, lower airway, or alveoli.

Non-respiratory factors

Poor perfusion of the brain, heart, and lungs

Ventilation with pulmonary gas exchange is dependent on diaphragm and chest wall muscle
functioning.
Opiate and sedative medicines decrease respiratory drive in the CNS, with resulting limited ventilatory
effort.
Injuries, disease, or insult of the CNS can result in loss of respiratory drive and secondary respiratory
failure.

Traumatic causes

Direct thoracic injury may result in a number of abnormalities that can lead to respiratory failure.
Direct brain injury can result in loss of respiratory drive.
Spinal injury can result in loss of peripheral nerve function and the lack of ability to ventilate due to
inadequate respiratory muscle function.

Few of the Possible Nursing Diagnoses for ARF:

Impaired gas exchange
Ineffective airway clearance
Ineffective breathing pattern
Fatigue related to oxygn deprivation
Anxiety related to oxygen deprivation
Fear related to air hunger and mechanical ventilation
Diagnostic Studies:
ABG
Pulse oximetry
CXR
CBC
Electrolyte values
Urinalysis
Culture and sensitivity
ECG
V/Q Scan
CT scan
Pulmonary function tests (PFT)

Nursing Interventions:

1. Provide a quiet, supportive environment.

2. Assess, record, and report all deviations from baseline evaluation and document complaints of increased
discomfort and difficulty breathing.
3. Encourage bed rest in semi to high Fowler position, allow frequent uninterrupted rest periods in between
therapeutic interventions.
4. Monitor vital signs, breath sounds, heart sounds, neurological status, and signs of hypoxia every 1 to 2
hours depending on status acuity.
5. Monitor need for suctioning secretions when client is unable to clear on his own.
6. Administer prescribed bronchodilators, be alert for potential side effects.
7. Prepare the client and family for intubation and mechanical ventilation.
8. Monitor arterial blood gases (ABGs).
9. Stabilize the endotracheal (ET) tube for comfort and assess skin integrity around mouth for irritation.
10. Suction via ET tube as needed, evaluate lung sounds and quality of mechanical ventilation.
11. Monitor renal status for fluid imbalance, assess intake and output with quality and quantity of urine.
12. Assure that the client maintains adequate nutritional status, whether by parenteral nutrition (TPN) or tube
feedings as prescribed by physician.
13. Turn every 2 hours to prevent skin breakdown, hemostasis, and pooling of pulmonary secretions.