1. Respiratory Care Plans Respiratory Failure

2. Respiratory failure (RF) is present when the lungs are unable to exchange O 2 and CO 2 adequately. RF - PaO 2 is <60 mm Hg (patient in rest and breathing room air) Respiratory acidosis - PaCO 2 ≥50 mm Hg or pH<7,35

3. Basic mechanisms  Alveolar hypoventilation  Ventilation-perfusion mismatch normal alveolar ventilation – 4 L/min normal pulmonary blood flow – 5 L/min ventilation/perfusion ratio – 0.8-1  Diffusion disturabances  Right-to-left shunt

4. Assessment  Early indicators Restlessness, anxiety, headache, fatique, cool and dry skin, increased BP, tachycardia, cardiac dysrhytmias.  Intermediate indicators Lethargy, tahypnea, hypotension caused by vasodilatation, cardiac dysrhytmias  Late indicators Cyanosi, diaphoresis, coma, respiratory arrest

5. Diagnostic tests  Arterial blood gas (ABG) analysis Typical results: PaO 2 is <60 mm Hg PaCO 2 >45 mm Hg pH<7.35  Chest x-ray examination

6. Nursing diagnosis: Impaired Gas Exchange Related to inability of the lungs to exchange O 2 and CO 2 adequately Desired outcomes: Within 1-2 hr following intervention/treatment, patient has adequate gas exchange as evidenced by RR of 12-20 breath/min with normal depth and pattern and absence of signs and symptoms of respiratory distress Within 24 hr after treatment, ABG reveal PaO 2 >60 mm Hg, PaCO 2 35-45 mm Hg, pH<7.35-7/45

7. Nursing interventions  Monitor for early signs and symptoms of RF  Monitor and document VS at frequent intervals  Monitor ABG results  Position patient in semi-Fowler’s position  Deliver oxygen as prescribed  Ensure that patient receives chest physiotherapy and coughing/deep-breathing exercises  Administer pharmacotherapy as prescribed and document effectiveness

8. Nursing diagnosis: Deficient Fluid Volume Related to increased loss secondary to tachypnea, fever, or diaphoresis Desired Outcome: Before hospital discharge (or within 24 hr after treatment, if patient is not hospitalized), patient become normovolemic as evidenced by urine output≥30 ml/hr with specific gravity 1.010-1.030, stable weight, HR and BP within patient’s normal limits, central venous pressure >2 mm Hg (5 cm H 2 O), fluid intake approximating fluid output, moist mucous membranes, and normal skin turgor

9. Interventions  Monitor I&O. Consider insensible losses if patient is diaphoretic and tachypneic  Be alert to and report indicators of deficient fluid volume (urine output 1.030)  Weight patient daily at the same time of day, with the same clothing, and the same scale; record weight  Report weight changes of 1-1.5 kg/day  Encourage fluid intake (at least 2.5 L/day in the unrestricred patient)  Maintain IV fluid therapy as prescribed  Promote oral hygiene, including lip and tongue care  Provide humidity for oxygene therapy

10. Patient-family teaching and discharge planning  Discharge planning and teaching should be directed at educating the patient and significant others about the underlying pathophysiology and treatment specific for that process