Impaired Gas Exchange Appropriate diagnosis if the patient is ventilating adequately but
diffusion across the alveolar-capillary membrane is impaired
Findings:
● dyspnea
● abnormal breathing patterns
● abnormal breath sounds
● abnormal ABG
Interventions:
● Thorough Hx and physical assessment to identify at risk pt
and initiate early interventions
● Deep breathing/ coughing, incentive spirometry, and early
ambulation
● Frequent assessment of high risk pt.
● Prevents: atelectasis (if surfactant damaged atelectasis
happens), pneumonia, complications of immobility, and
optimize hydration and nutrition
Dx: Inadequate Perfusion Dx:
● kidney injury
● cyanotic, cold, weak pulses
● risk for hemodynamic compromise
● monitor SaO2 and mixed venous oxygen saturation
Dx: Inadequate Ventilation/ Ineffective Assessment Findings:
Breathing Pattern ● rate of breathing
● abnormal chest wall movement
● irregular breathing pattern
● abnormal work of breathing
Dx: Ineffective Airway Clearance Dx. Occurs when an artificial airway is used because normal
mucociliary transport mechanisms are bypassed and
impaired
Inadequate Airway Clearance Findings:
● Adventitious breath sounds.
● Abnormal respiratory rate, rhythm, and depth.
● Declining oxygen saturation.
● Ineffective or absent cough reflex.
● Copious mucus production.
● Hypoxemia.
● Restlessness.
● Change in level of consciousness
Interventions:
● Position to decrease secretions
, ● Suction as needed
● Mobilize secretions
● Give respiratory medications
● Involve respiratory therapy
Respiratory Rapid Assessment Assessment:
● position
● work of breathing
● breathing patterns
● ability to speak
● pursed lip breathing
● retraction
● paradoxical breathing
Assessment Priorities:
● do frequently
● assessment of ability to breathe and provide assistive
measures
● breath sounds
● LOC changes?
Oxygenation
● Oxygen into each cell
● Two components:
○ Respiratory
■ Airway: open passage for air
■ Ventilation: breathing muscle must expand to ventilate
■ Diffusion: gas exchange in alveoli
○ Circulation
■ Perfusion: adequate blood pressure to deliver blood to each cell
Arterial Blood Gases
● pH → 7.35-7.45
● pO2 → 80-100
● pCO2 → 35-45
● HCO3 → 22-26
● pH less than 7.35 → acidic ;
● pH more than 7.45 → alkaline
, ● Compensation = pH within normal range but CO2/HCO3 values out of range
● Partial compensation = body changes values to correct pH but has not accomplished normal pH
ROME
pH & CO2 ↑↓ (opposite) → respiratory
pH & HCO3 ↑↑ (equal) → metabolic
1) Acidic or basic ??
2) Respiratory (CO2) or Kidney/metabolic (HCO3) ??
3) Compensated ?? → look at pH
Respiratory acidosis Tx: Metabolic Acidosis Tx:
● Look for sx hypoxia ● Can be caused by DKA
● Tx: O2 → 2L NC, paO2 <60 ● Tx: Dialysis, DKA intervention (insulin drip)
● IS, Raise HOB
● Bronchodilators
● Reverse airway obstruction
● Noninvasive and pressure ventilation
Respiratory Alkalosis Tx: Metabolic Alkalosis Tx:
● Slow Breathing: breathe into brown paper bag, ● Tx underlying cause: diuretics, steroids, NG
pursed lip breathing suction
● IS ● Hypokalemia
● IV fluids
Hypoxia Symptoms: Sx:
1) mental status changes: restless, agitation, confused
2) increased HR, RR, HTN
3) (LATE) cyanosis, coma, lethargy, somnolence, hypotension,
decreased CO
- Tx w/ hydration and IV bolus
Acute Respiratory Failure (ARF)
★ Occurs when oxygenation, ventilation, or both are inadequate
○ Not a disease but a symptom that reflects lung function
○ If bad, can progress to ARDS
➔ Hypoxemic respiratory failure (oxygenation failure)
◆ Hypoxemia
diffusion across the alveolar-capillary membrane is impaired
Findings:
● dyspnea
● abnormal breathing patterns
● abnormal breath sounds
● abnormal ABG
Interventions:
● Thorough Hx and physical assessment to identify at risk pt
and initiate early interventions
● Deep breathing/ coughing, incentive spirometry, and early
ambulation
● Frequent assessment of high risk pt.
● Prevents: atelectasis (if surfactant damaged atelectasis
happens), pneumonia, complications of immobility, and
optimize hydration and nutrition
Dx: Inadequate Perfusion Dx:
● kidney injury
● cyanotic, cold, weak pulses
● risk for hemodynamic compromise
● monitor SaO2 and mixed venous oxygen saturation
Dx: Inadequate Ventilation/ Ineffective Assessment Findings:
Breathing Pattern ● rate of breathing
● abnormal chest wall movement
● irregular breathing pattern
● abnormal work of breathing
Dx: Ineffective Airway Clearance Dx. Occurs when an artificial airway is used because normal
mucociliary transport mechanisms are bypassed and
impaired
Inadequate Airway Clearance Findings:
● Adventitious breath sounds.
● Abnormal respiratory rate, rhythm, and depth.
● Declining oxygen saturation.
● Ineffective or absent cough reflex.
● Copious mucus production.
● Hypoxemia.
● Restlessness.
● Change in level of consciousness
Interventions:
● Position to decrease secretions
, ● Suction as needed
● Mobilize secretions
● Give respiratory medications
● Involve respiratory therapy
Respiratory Rapid Assessment Assessment:
● position
● work of breathing
● breathing patterns
● ability to speak
● pursed lip breathing
● retraction
● paradoxical breathing
Assessment Priorities:
● do frequently
● assessment of ability to breathe and provide assistive
measures
● breath sounds
● LOC changes?
Oxygenation
● Oxygen into each cell
● Two components:
○ Respiratory
■ Airway: open passage for air
■ Ventilation: breathing muscle must expand to ventilate
■ Diffusion: gas exchange in alveoli
○ Circulation
■ Perfusion: adequate blood pressure to deliver blood to each cell
Arterial Blood Gases
● pH → 7.35-7.45
● pO2 → 80-100
● pCO2 → 35-45
● HCO3 → 22-26
● pH less than 7.35 → acidic ;
● pH more than 7.45 → alkaline
, ● Compensation = pH within normal range but CO2/HCO3 values out of range
● Partial compensation = body changes values to correct pH but has not accomplished normal pH
ROME
pH & CO2 ↑↓ (opposite) → respiratory
pH & HCO3 ↑↑ (equal) → metabolic
1) Acidic or basic ??
2) Respiratory (CO2) or Kidney/metabolic (HCO3) ??
3) Compensated ?? → look at pH
Respiratory acidosis Tx: Metabolic Acidosis Tx:
● Look for sx hypoxia ● Can be caused by DKA
● Tx: O2 → 2L NC, paO2 <60 ● Tx: Dialysis, DKA intervention (insulin drip)
● IS, Raise HOB
● Bronchodilators
● Reverse airway obstruction
● Noninvasive and pressure ventilation
Respiratory Alkalosis Tx: Metabolic Alkalosis Tx:
● Slow Breathing: breathe into brown paper bag, ● Tx underlying cause: diuretics, steroids, NG
pursed lip breathing suction
● IS ● Hypokalemia
● IV fluids
Hypoxia Symptoms: Sx:
1) mental status changes: restless, agitation, confused
2) increased HR, RR, HTN
3) (LATE) cyanosis, coma, lethargy, somnolence, hypotension,
decreased CO
- Tx w/ hydration and IV bolus
Acute Respiratory Failure (ARF)
★ Occurs when oxygenation, ventilation, or both are inadequate
○ Not a disease but a symptom that reflects lung function
○ If bad, can progress to ARDS
➔ Hypoxemic respiratory failure (oxygenation failure)
◆ Hypoxemia
