Page 1579 - Saunders Comprehensive Review For NCLEX-RN

of arterial carbon dioxide (PaCo ) greater than 50 mm
2
Hg occurring with acidemia.
4. Respiratory failure can be hypoxemic, hypercapnic, or
both. Inadequate gas exchange is the mechanism
behind failure. Arterial oxygen, carbon dioxide, or
both are not kept at normal levels, resulting in failure.
5. Many clients experience both hypoxemic and
hypercapnic respiratory failure and retained carbon
dioxide in the alveoli displaces oxygen, contributing
to the hypoxemia.
6. Manifestations of respiratory failure are related to the
extent and rapidity of change in PaO and PaCo .
2
2
B. Assessment
1. Dyspnea
2. Restlessness
3. Confusion
4. Tachycardia
5. Hypertension
6. Dysrhythmias
7. Decreased level of consciousness
8. Alterations in respirations and breath sounds
9. Headache (less common)
C. Interventions

1. Identify and treat the cause of the respiratory failure.
2. Administer oxygen to maintain the PaO level higher
2
than 60 to 70 mm Hg.
3. Place the client in a Fowler’s position.
4. Encourage deep breathing.
5. Administer bronchodilators as prescribed.
6. Prepare the client for mechanical ventilation if
supplemental oxygen cannot maintain acceptable
PaO and PaCo levels.
2
2
VI. Acute Respiratory Distress Syndrome
A. Description
1. A form of acute respiratory failure that occurs as a
complication caused by a diffuse lung injury or
critical illness and leads to extravascular lung fluid.
2. The major site of injury is the alveolar capillary
membrane.
3. The interstitial edema causes compression and
obliteration of the terminal airways and leads to
reduced lung volume and compliance.

4. The ABG levels identify respiratory acidosis

and hypoxemia that do not respond to an increased
percentage of oxygen.

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