Respiratory failure

RESPIRATORY FAILURE

1. Respiratory failure Presentor Anjani Walia Msc N 1 st year

2. Objectives Related anatomy & physiology Define respiratory failure Types of respiratory failure Diagnosis of respiratory failure Clinical manifestation of respiratory failure Management of respiratory failure Complications r/t respiratory failure

3. Respiratory tract

4. Terms Respiration Diffusion Perfusion Ventilation

5. Control Resting respiration is the result of cyclical excitation of the respiratory muscles by the phrenic nerve. Apneustic center Pneumotaxic center Central chemoreceptors Peripheral chemoreceptors Baroreceptors

6. Respiratory failure Respiratory failure is a syndrome in which the respiratory system fails in one or both of its gas exchange functions Oxygenation Carbon dioxide elimination. May be classified as either hypoxemic or hyper capnic .

7. Types

8. Types

9. Acute & Chronic Acute respiratory failure develops over minutes to hours; therefore, pH is less than 7.3 Chronic respiratory failure develops over several days or longer, allowing time for renal compensation & an increase in bicarbonate concentration. Therefore, the pH usually is only slightly decreased.

10. Pathogenesis

11. Clinical manifestations Neurologic manifestations Tachycardia & arrhythmias Cyanosis Dyspnea Confusion & somnolence Cor pulmonale .

12. Diagnostic Evaluation Laboratory Studies ABG CBC RFT & LFT Electrolytes such as potassium, magnesium & phosphate S. creatine kinase , troponin I

13. Radiography Frequently reveals the cause Echocardiography Not be performed routinely, useful test when a cardiac cause of acute respiratory failure is suspected.

14. Management Cardiac monitoring, blood pressure, pulse oximetry & capnometry are recommended. Reverse/ prevent tissue hypoxia. Appropriate management of the underlying disease Treated with O2 supplementation & ventilatory assist devices

15. Diuretics First-line therapy generally includes a loop diuretic such as furosemide , which inhibits sodium chloride reabsorption in the ascending loop of Henle . Nitrates Nitrates reduce myocardial oxygen demand by lowering preload & afterload . Inotropic Agents The principal inotropic agents are dopamine, dobutamine & digoxin .

16. Opioid Analgesics Morphine IV is an excellent adjunct. Reduces preload Causes arterial dilatation, which reduces systemic vascular resistance and may increase cardiac output. Corticosteroids Effective in accelerating recovery from acute COPD exacerbations & are an important anti-inflammatory therapy in asthma.

17. Beta 2 Agonists These agents act to decrease muscle tone in both small and large airways in the lungs. Includes beta- adrenergics , methylxanthines & anticholinergics . Anticholinergics Antagonize the action of acetylcholine with muscarinic receptor on bronchial smooth muscle.

18. Complications Pulmonary: Pulmonary embolism, barotrauma , pulmonary fibrosis & complications secondary to the use of mechanical devices. Nosocomial pneumonia Cardiovascular: Acute MI GI: Gastric distention, ileus , diarrhea, pneumo peritoneum & stress ulceration Nosocomial infections ARF Nutritional: Malnutrition

19. Nursing diagnosis Impaired gas exchange Ineffective breathing pattern Impaired verbal communication Activity intolerance Self care deficit Impaired physical mobility Risk for impaired skin integrity Risk of imbalanced nutrition: less than body requirement

20. Summary

21. Conclusion Issues involved in timely recognition of & response to clinical deterioration remain complex, yet patient safety relies on nurses’ timely assessments and actions.

22. References Hinkle LJ, Cheever HK. Brunner & Sudharth's textbook of medical surgical nursing. 13th Edition. I volume .New Delhi: Wolters Kluwer Publications; 2014.Pp 545-47 Respiratory Failure: Background, Pathophysiology , Etiology [Internet]. [cited 2018 Mar 6]. Available from: https://emedicine.medscape.com/article/167981-overview#showall Pathophysiology of acute respiratory failure. - PubMed - NCBI [Internet]. [cited 2018 Mar 6]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/8200186 NCP Nursing Care Plan for Acute Respiratory Failure [Internet]. [cited 2018 Mar 6]. Available from: http://nurse-thought.blogspot.in/2011/03/ncp-nursing-care-plan-for-acute_18.html

23. Thank you