nur2755 section btp3 multidimensional care iv module 05 overview and activities readings activity time 2 hours medical surgical nursing patient centered collaborative care
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NUR2755 Section BTP3 Multidimensional Care IV
Module 05 Overview and Activities
Readings
Activity Time: 2 hours
Medical-Surgical Nursing: Patient-Centered Collaborative Care, Chapter 32
Recommended Reading -
ATI: RN Adult Medical Surgical Nursing – Chapters 17-19, 24-26
Assignments
Module 05 Remediation for ATI Content Mastery Series Proctored Assessment -
Community Health (Activity Time: 2 hours)
Module 05 Exam 01 (Activity Time: 1 hour, 45 minutes)
Module 05 Acute Respiratory Failure
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Acute Respiratory Failure
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Acute respiratory failure is a mismatch of ventilation (V) or perfusion (Q), or a
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combination of both. When there is a VQ mismatch, gas exchange is decreased, which
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can cause respiratory failure. ABGs are ordered to evaluate the client’s gas exchange
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anticipating that the client is hypoxemic.
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Critical Values
ABG - PaO2
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Result : Less than 60 mm Hg
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ABG - PaCO2
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Result : Greater than 45 mm Hg
ABG - pH
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Result : <7.35
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ABG - SaO2
Result : Less than 90%
Remember
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Ventilation = air movement (V)
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Perfusion = blood flow (gas exchange) (Q)
Ventilatory Failure
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There are many causes of ventilatory failure. The causes can range from neuromuscular
disorders, central nervous system dysfunction, and chemical depression.
Let’s look at one example. Drug overdose continues to rise in the US to epidemic levels
as reported by the CDC (Opioid Overdose, 2019). Fentanyl is quickly rising as the drug
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of choice among abusers. Fentanyl is a potent opioid either prescribed or manufactured
illegally. Unfortunately, fentanyl can quickly depress the respiratory system. In this
example, there is nothing mechanically wrong with the lungs, no V/Q mismatch. Without
the drug in the client’s body, the lungs would perform both ventilation and perfusion
normally. However, as the drug depresses the central nervous system, it depresses the
drive to breathe (V), which then slows perfusion (Q). During an overdose, breathing
ceases completely as the client slips into unconsciousness. In this example, the client
has a V/Q mismatch and a resulting respiratory failure.
Recognizing Symptoms
As a nurse, assessing and recognizing the symptoms of acute respiratory failure (ARF)
can save a client’s life. A way to evaluate compromised respiratory status is to assess for
shortness of breath (dyspnea) while the client is performing everyday tasks. The
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common term used to describe the work of breathing while performing a task is dyspnea
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on exertion (DOE).
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Dyspnea
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Another sign of respiratory failure is dyspnea that occurs when the client is no longer
able to lay flat in a bed which is also known as orthopnea. This client will find it easier to
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rest or sleep in an upright position. Clinically, the primary care physician will monitor for
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hypercapnia and hypoxia by monitoring Arterial Blood Gases (ABG). The nurse needs to
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be alert for signs and symptoms of hypoxic respiratory failure. The signs and symptoms
are as follows:
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Restlessness
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Irritability
Agitation
Confusion
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Tachycardia
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Hypercapnia
Hypercapnia has different signs and symptoms, but the same end result of respiratory
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failure can occur. The nurse should understand the difference between hypoxia and
hypercapnia. The signs and symptoms are as follows:
Decreased level of consciousness (LOC)
Headache
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