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Respiratory Care Plans

Respiratory Care Plans. Respiratory Failure. 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. Basic mechanisms.

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Respiratory Care Plans

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  1. Respiratory Care Plans Respiratory Failure

  2. Respiratory failure (RF) is present when the lungs are unable to exchange O2 and CO2 adequately. RF - PaO2 is <60 mm Hg (patient in rest and breathing room air) Respiratory acidosis - PaCO2≥50mmHg 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: PaO2 is <60 mm Hg • PaCO2 >45 mm Hg • pH<7.35 • Chest x-ray examination

  6. Nursing diagnosis:Impaired Gas Exchange Related to inability of the lungs to exchange O2 and CO2 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 PaO2 >60 mm Hg, PaCO2 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 normovolemicas 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 H2O), 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<30 ml/hr for 2 consecutive hr and urinary specific gravity > 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

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