Acute Respiratory failure/ pneumonia Essay Example

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13ACUTE RESPIRATORY FAILURE/ PNEUMONIA

Acute Respiratory Failure/ Pneumonia: Case Study Analysis

Acute Respiratory Failure/ Pneumonia: Case Study Analysis

Question 1

Charles Bukowski had various symptoms; however, the four key pieces of data that support a diagnosis of acute respiratory failure are that he exhibited hypertension that is related to pneumonia. In addition, his respiration rate is 28 breaths per minute and his breathing is deep and labored. Also, his saturation level was 89% on a Hudson mask of 6l/min. Finally, his ABG results were: a pH of 7.30, PaO2 58 mmHg, PaCO2 54mmHG and SaO2 of 89%.

When pathophysiology is taken into consideration, infection of the pulmonary may result in shunt or mismatch of the V/Q. A low mixture of venous oxygen exacerbates this condition (Gunning, 2003). In addition, the continuous destruction of the pulmonary microvasculature as the upper airway is obstructed resulting in the pulmonary vascular bed being destructed (Gunning, 2003). Diffuse occlusion and external compression also occur. As a result the pulmonary system does not have the ability meet its gas exchange purposes which are oxygenation and the elimination of carbon dioxide, leading to acute heart failure (Ferns & Chojnaka, 2006)

After suffering an injury to the lung, the alveolar may be damaged, microvascular permeability increased and there is edema in the non cardiogenic pulmonary. The lung injury is caused by inflammation that is systemic and, principally sepsis (Gunning, 2003). Fluid builds up in an individual’s lungs resulting in the lungs becoming stiff (Suh, G.Y et al, 2006). When this happens, breathing is impaired, Charles has a respiration rate of 28 breaths per minute and his breathing is labored. As a consequence of weakened breathing, the amount of oxygen that enters the capillaries in preparation to supply the lungs is less. Following this, the alveolar capillary membrane injury enables fluids to leak into the alveolar interstitial spaces; the capillary bed is then altered leading to an imbalance in the perfusion and ventilation (Suh, G.Y et al, 2006). When the Alveolar unit fails, there is a collapse of the system and some form of flooding resulting from edema, aspiration, pus or blood. The pulmonary vasculature will fail and exhibit the characteristic of pulmonary hypertension (Ahya, Flood & Paranjothi, 2001). When the alveolar does not get adequate ventilation, there is a decrease in the normal pH.

Lower levels of PaCO2, in the blood lead to the inhibition of stimulation of the centre of respiration. PaCO2 refers to the partial pressure of the carbon dioxide that is in blood from the arteries. Under normal circumstances, the levels of PaCO2 rise (Hall, Schmidt & Wood, 2005). The result of this is adequate stimulation if the respiratory center which then reacts by increasing the rate and the depth of breathing. Consequently, the excretion of carbon dioxide is also increased (Behrendt, 2000) leading to the patient exhibiting hypercapnia. In addition, the patient exhibits tachycardia. Mr. Bukowski has a heart rate of 108 beats per minute. However, when the levels are lower, there is also an increase in the rate of respiration initially. This then changes and turns out to be shallow and slower in an attempt to retain the carbon dioxide (Suh, G.Y et al, 2006).

Question 2

The intervention of antibiotics has been used by physicians over the years in cases where the patient has no other better choice. This is because there are worries that the patient may develop resistance to antibiotics (Gjelstad, Dalen & Lindbaek, 2009). Respiratory diseases and complications are the most common triggers of the use of broad spectrum antibiotics. Making the choice to give Mr. Bukowski two broad spectrum IV antibiotics to deal with acute respiratory failure is an effective action. Antibiotics are the most effective method of symptomatic treatment of acute respiratory failure. This is because ARF (Acute Respiratory Failure) does not present itself in a similar way to all who have it and the symptoms often differ. Broad spectrum antibiotics are a good choice because they will tackle any uncertainties or alterations that may occur (Gjelstad, Dalen & Lindbaek, 2009).

Some of the pathogens that cause acute respiratory failure may have developed resistance to certain antibiotics and this problem can be solved by prescribing having broad spectrum antibiotics. It has also been suggested that respiratory conditions are best treated with broad spectrum antibiotics especially if the patient needs to be monitored closely (Masip et al, 2005). The variations in the proportions of antibiotic prescriptions and administering of broad spectrum antibiotics for infections of the respiratory tract are very high (Michael et al, 2003). This holds the revelation that there are chances that the prescription behaviors of practitioners towards such infections are towards broad spectrum antibiotics. Since the patient is already staying at the hospital, monitoring of his condition has been made simpler.

Question 3

Patients with acute respiratory failure have obstructions on their airways which need to be managed to enable them breath better. Positioning a patient in an adequate way will enable them to have better breathing. In addition, coughing and breathing exercises will be assistive in clearing the airway. Also, since the patient has hypoxia, he will require oxygen which is administered as a drug would be.

The first nursing intervention I would apply is to manage a patent airway; positioning and help the patient perform regular coughing exercises as well as deep breathing exercises. In addition, by using triflow or spirometer I would administer oxygen using venture mask because it administers controlled oxygen and Continuous breathing of high concentrations of oxygen may cause oxygen toxicity.

This intervention would be appropriate to get the best result for the patient. When a patient with a respiratory problem is positioned well, like being upright and elevated in the correct way, their lungs will have an easier time expanding ensuring that their breathing is made easier (Bennett, 2003). The appropriate position to put the patient in this case is the semi-fowler’s position and lateral position. Semi-fowler’s describes when the patient lies in a supine position with the head of the bed being at approximately 30 degrees. It will help ensure that the patient’s airway is open and maintained that way since it will promote the expansion of lungs and mobilize secretions. The best practice in semi-fowler’s position is to have the patient’s bed elevated at 30 degrees. A pillow or folded towel may be used under the head to change the position slightly. Secretions are controlled through coughing and deep breathing exercises which also clear airways making breathing easier.

The patient needs oxygen because of his saturation level. Patients with hypoxia often almost always need to be given oxygen as a supplementation. The purpose of this kind of oxygen therapy is to provide the patient with required oxygen concentration without going over the limit (Higgins, 2005). The oxygen is administered through a venture mask to enable the caregiver to regulate the oxygen more appropriately. The method of delivery of the oxygen depends on the concentration of oxygen that is required and the mask is appropriate for this situation. In addition, the pathophysiology of the infection is also instrumental in regulating oxygen concentration. If a patient who has acute respiratory failure is provided with too much oxygen, it may be toxic to them (British Thoracic Society Standards of Care Committee, 2002). They will lose their hypoxic drive resulting in possible respiratory arrest. The best practice of oxygen administration is through a careful prescription. The flow rate should be considered, the concentration, the device used to deliver the oxygen, the duration and method of monitoring. Saturation of the oxygen being administered should be between 24 to 60 % (British Thoracic Society Standards of Care Committee, 2002).

Assessing Mr. Bukowski’s cough is an important intervention. This is because it will help him get rid of fluids that may be inside his lungs. Coughing is a type of reaction to get rid of things that are obstructing the airway. A spirometer or triflow will aid in recognizing that the airway has obstruction thus inducing a cough. Its function is to measure how the lung is functioning as it keeps the alveoli inflated while noting any obstruction to the airway. It is vital because it has an indicative quality of the patient’s breathing. It can show if the patient has problems with his lungs in terms of clearing them of any sputum. In addition to that, if there is any sputum, it will be a useful way to identify the pathology of the lungs (Brochard, Mancebo & Elliott, 2002). The patient has pneumonia so there will be sputum because of the fluid in his lungs which can be assessed. Studies done by Moore (2007) show that a patient with acute respiratory failure who are often engaged in coughing exercises have easier time breathing because they have gotten rid of some of the fluid in their lungs. It is important that a patient with pneumonia goes through this to achieve similar results.

Deep breath exercises are useful in identifying different sounds that may be symptomatic of certain conditions and situations. In addition, in order for the spirometer to give accurate results and function correctly, the patient needs to take deep breaths. Research shows that patients who have been lying in bed for a while, especially when recovering from an ailment or surgery, take shallow breaths and fail to cough as often as required (Lifenurses, 2009). The shallow breaths are mostly taken in order to ease pain and discomfort in the chest and deep breaths are assistive in making secretions mobile in collapsed lungs.

This is closely related to the assessment of the airways where they can be examined for bronchopasm, pleural friction and swelling and rubbing which may be responsible for obstructing the airway. The obstruction of the airway has been identified as a clinical emergency. For this reason, the airway should be assessed (NICE, 2007). If the cause of the failure is because of obstruction, the assessment can offer clues as to the right course of action to take. The clearing of the airway and maintaining it in a functional state is made a priority based on practical and updated information. The positioning of a patient is also linked to the adequacy of the airway. The type of position that a patient is in may aid in opening in the airways (Gattinoni & Carlesso, 2010).

The second intervention I would do is administering pain relief medication that is not opioid medication. Also, I would reeducate Mr. Bukowski regarding the use and action of PCA, and also reassure him that the PCA would not make him dependent on drugs.

Some conditions and infections share common pathways of pain receptors. This means that there are non opioid medications that can relieve more than one symptom that is manifested in a patient (Beaulieu, 2007). For instance, using paracetamol as medication for pain relief will also help in reducing the patient’s high temperature of 38.5°C. Medications that have been directed towards relieving pain that emanates from certain pathways can also provide relief from other symptomatic conditions in patients with acute respiratory failure (Beaulieu, 2007). Best practice for pain relief is administering NSAIDs, including COX-2 inhibitors, Gabapentin, pregabalin2 and paracetamol.

It has been concluded that patients with acute respiratory failure and other diseases that may be chronic often suffer from anxiety that may affect the decisions that they make about the medication they get. Personal preferences and fears may become a reality to them since they are ailing. Reeducating Mr. Bukowski on the functioning and use of PCA will give him an opportunity to learn of the benefits that the PCA can give him and encourage him to take the medication. It is vital that the worries of the patient are alleviated in order to assure them of their well being and adequate care.

In addition, talking to the patient and explain the mechanisms of the treatment that he is receiving may reduce symptoms that they have. The exclusion of opiods will ensure that the patient is in their right reasoning mind to understand and make decisions appropriately (Hall, Schmidt & Wood, 2005). In addition, the exclusion of this medication will be suitable for assessment and other interventions. For instance, when trying to find out if the pain is subsiding, the patient will have to feel his body without any interruptions and alterations from drugs (Kasper et al, 2004). Pain relief medication administered to the patient will give him a more ample time to relax and regulate his breathing.

Patients also often need to be in an environment that they feel are supportive to their problem. If they see that the nurse is making an effort to communicate to them the benefits of a drug that would make them better, they will feel that they are supported by the hospital and other people. The environment that is provided around the hospital ward will help in making the patient feel better about themselves and may help in alleviating some of the symptoms that they feel (Nursing Assessment, 2005). By administering pain medication, they are seeing to it that the pain in the leg and that of the surgery is addressed too.

Charle’s airway would have less obstruction because of the coughing and deep breathing exercises. In addition, the fluid in his lungs would reduce and the pain in his lungs will be alleviated. The oxygen being administered will help in lowering saturation levels. His temperature will lower and his pain will be alleviated by the medication.

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