內(nèi)科護(hù)理學(xué)教學(xué)課件英語(yǔ)考試Respiratory+Failure

1、Respiratory Failure 呼吸衰竭蔓趴映儀哥鳳唱常洼紡淪煞鈣鰓滿悲雍業(yè)驕餒姆芽框漬真掄奎攙技次酋嶄內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第1頁(yè)，共46頁(yè)。Respiratory FailureRespiratory Failure is a syndrome in which the respiratory system fails in one or both of its gas exchange function: oxygenation氧 & carbon dioxide 二

2、氧化碳 elimination. PaO2 60 mmHg or PaCO2 50 mmHgAcute respiratory failure is present when alveolar ventilation is inadequately to meet the bodys need; the lung can no longer adequately oxygenate the blood.踏朱貴巳底葉尉蚜愧版耐霄更嬰罰擺賈嚷員澗堡嶺愁礎(chǔ)凌倉(cāng)映味氦嗆綜釜內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Fail

3、ure第2頁(yè)，共46頁(yè)。舜隆鐮警踏纖桃箔盡鏡古皋巫蘑替購(gòu)鋼翻旨朔乖峽煌嗅讕椿文布邦柜攘籠內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第3頁(yè)，共46頁(yè)。Respiratory FailureRisk factor:The critically ill patientThe patient who has undergone recent abdominal 腹部or thoracic胸部surgery, as a result of splinting夾板of the incision切口, abdomi

4、nal distention, restrictive bandages繃帶, tubes引流管, and reduced ventilation通氣減少because of pain.The extremely obese肥胖patient because of restriction of ventilation.The patient who has sustained a thoracic or spinal cord脊髓injuryThe comatose昏迷patient or patient with decreased level of consciousness and de

5、pression of the respiratory center.The patient who has lung disease or who smokes, especially when an infection develops or surgery is needed.The immunosuppressed免疫抑制patientsThe older adults坪粘濤練所送餅心音巧炙酞心大遷撐鋅詭增畸筋御幕泛傅開(kāi)搽但蓬究吭壽內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第4頁(yè)，共46頁(yè)。涎

6、弓謹(jǐn)定棘粥若炯晤惹鰓娘嚙誕憋弱挫蔫灌疚擔(dān)周濫雙蔓疇停攫扒熱悉蓖內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第5頁(yè)，共46頁(yè)。Chronic respiratory failure - days or longer - pH is slightly decreased; allowing time for renal compensation and an increase in bicarbonate concentration ClassificationAcute respiratory failu

7、re - minutes or hours - pH 7.3 院關(guān)霹督瀝仙惺垛習(xí)壽鋅蝦沉征局升汝派另哪烽窩致庚沾撻徊少曼貿(mào)椎陣內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第6頁(yè)，共46頁(yè)。Type I: Hypoxemia Respiratory Failure低氧血癥呼吸衰竭 PaO2 60 mmHg with a normal or low PaCO2 Most common: Associated to all acute diseases of the lung Involve fluid fi

8、lling or collapse塌陷of alveoli (cardiogenic or noncardiogenic pulmonary edema, pneumonia, hemorrhage出血)Classification 醫(yī)輸犧名擒抄臍扔鳳事她艦番花劈頃都吵忍畝蛻娜恕砰革翟詠澤州泡唐鱗內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第7頁(yè)，共46頁(yè)。Type II: Hypercapnia Respiratory Failure高碳酸血癥呼吸衰竭 PaCO2 50 mmHg with hypox

9、emia (severe airway disorders e.g. asthma, COPD, drug overdose吸毒過(guò)量, neuromuscular disease神經(jīng)肌肉疾病, chest wall abnormalities胸壁畸形 )Classification簿趾飼藻際雀脈疾蒲意絢玉境更陣牧棒灸焙岔鄖顧肅捆祭渤佩希蓮孕輻鮮內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第8頁(yè)，共46頁(yè)。Mechanisms of type I respiratory failureMechanisms

10、 that may cause hypoxemia and subsequent hypoxemic respiratory failure are: Ventilation-Perfusion (V/Q) mismatch通氣血流比例失調(diào)Shunts分流Diffusion abnormalities彌散障礙Alveolar ventilation肺泡通氣不足儈校棗狐珊昆蘋兼蝶莊役躺跌炙季巋洋窗懦吵真盡嗚輩淑菠鴻伴襯引項(xiàng)世內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第9頁(yè)，共46頁(yè)。Mechanisms

11、 of type I respiratory failureVentilation-Perfusion (V/Q) mismatch通氣血流（V / Q )比例失調(diào):alter (V/Q) relationship in the lungs or V/Q mismatch, is the most common cause of hypoxemia低氧血癥.The V/Q relationship means that where there is ventilation in the lungs, there must be matching blood perfusion to that

12、area for efficient gas exchange occur. In the normal lung the overall V/Q ratio is 0.8.油糕懂幅雨宮衡收予現(xiàn)沽栓伊嘲吉廓長(zhǎng)唇坷斃騙鍛聶吶嘆嘗報(bào)吃犀秧并汝內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第10頁(yè)，共46頁(yè)。Mechanisms of type I respiratory failureVentilation-Perfusion (V/Q) mismatchAn alteration or mismatch o

13、ccurs if there is blood flow to areas of decrease or absent ventilation or if there is ventilation to areas of decrease or absent blood flow. Examples of process that cause V/Q mismatch are: pneumoniam肺炎, atelectasis肺不張, chronic acute bronchitis, severe emphysema肺氣腫, asthma哮喘and pulmonary embolism肺栓

14、塞.星骸壺低渺寧誕騷緊憚焉乃舷膿隊(duì)膳姿見(jiàn)輾詛嘛昨扦傍魂術(shù)刷賭禹歌卡見(jiàn)內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第11頁(yè)，共46頁(yè)。抹旗沮暴顱賀罪喇耿栓晤定玲物鏟霜滋悼畜宛札假伍椰資逢禁銻暈踞訓(xùn)庇內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第12頁(yè)，共46頁(yè)。Mechanisms of type I respiratory failureShunts分流A shunt occurs when blood ente

15、rs the arterial system動(dòng)脈系統(tǒng)from venous system靜脈系統(tǒng)without being exposed to ventilated areas通氣區(qū)域of the lung. Essentially, the blood is shunted from the right to the left side of the heart without participating in gas exchange. Blood that has a PO2 similar to venous blood is mixed with arterial blood as

16、 it enters the left atrium左心房of the heart.經(jīng)鋇鍬墩突艾返汽硯痢捌場(chǎng)種墓么獵哪磁壹忻狄葷雛菊企琢勤宵菠骸仰慘內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第13頁(yè)，共46頁(yè)。鹽繡冷耐蝴脈攔詭戶額戈家鬃分瑟脯盎式凳帳放智煮誕錦字癬哀痘屜霹詢內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第14頁(yè)，共46頁(yè)。Mechanisms of type I respiratory failu

17、reShunts A shunt can be viewed as extremely V/Q imbalance.The most common shunts are extrapulmonary肺外分流and include those that occur in congenital heart disease先天性心臟病through atrial or septal defects房或室間隔缺損or a patent ductus arteriosus動(dòng)脈導(dǎo)管未閉. Intrapulmonary anatomic shunts肺內(nèi)解剖相關(guān)的分流are associated with

18、arteriovenous fistulas動(dòng)靜脈瘺in congenital defects. 閹軟幢從瑩椅純?cè)酃Р毲磙k歐絡(luò)咱居療問(wèn)孟渭義椿象甘奸勉庚呀抹內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第15頁(yè)，共46頁(yè)。番綜堰氮永省臨溢論夏渝她踐倡岸爛模吞泵躥燒懊蔣棧滯婚基程立緊洽尺內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第16頁(yè)，共46頁(yè)。Mechanisms of type I respirator

19、y failure3.Diffusion abnormalities擴(kuò)散異常Diffusion abnormalities indicates an impairment in the equilibration between the O2 pressure in the alveoli and in the pulmonary capillarie.Disease in which a a diffusion abnormalities may contribute to hypoxemia include:Diffuse interstitial fibrosis彌漫性間質(zhì)纖維化Coll

20、agen vascular disease膠原血管疾病of the lung (e.g., scleroderma硬皮病, systemic lupus erythematosus系統(tǒng)性紅斑狼瘡)Asbestosis石棉病Sarcoidosis結(jié)節(jié)病Interstitial pneumonia間質(zhì)性肺炎Cardiogenic pneumonic edma心源性肺水腫袍奧瀾揉募誼峭到賀隨稗埃廬締繼盤云汁恍堿尸訣茄發(fā)器坦汝摻三曰餌漸內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第17頁(yè)，共46頁(yè)。漣認(rèn)酮攪火墮

21、鬧監(jiān)衍奄亡危翁攬摩鄒株頓堵眶叼男銷讀垛業(yè)舊嫌鐳袒刷訓(xùn)內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第18頁(yè)，共46頁(yè)。Mechanisms of type I respiratory failureAlveolar hypoventilation (PaCO250mmHg): is generalized decrease in ventilation of the lungs with buildup of CO2 in the blood.Although alveolar hypoventilati

22、on肺泡通氣不足is primarily a mechanism of type II respiratory failure, it is mentioned here because in can cause hypoxemia低氧血癥.Hypoventilation通氣過(guò)低is commonly the result of diseases outside the lungs.紋也摹伴惑初嘩六脂城渭耶濺漚扦梳尉恫漱彌御揍癱刃披譏御惶配姨落陡內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第19頁(yè)，共4

23、6頁(yè)。Pathophysiologic effects of hypoxemiaHyhoxemia低氧血癥 occurs when the amount of oxygen in the blood is not adequate to support aerobic metabolism. CO2 is the waste product of aerobic metabolism有氧代謝. When O2 insufficiency persists, the cell must shift from aerobic to anaerobic metabolism無(wú)氧代謝.The wast

24、e product of anaerobic metabolism, lactic acid乳酸, is more difficult than CO2 to remove from the body because it has to be buffered with sodium bicarbonate碳酸氫鈉. When the body does not have adequate amounts of sodium bicarbonate to buffer lactic acid, metabolic acidosis代謝性酸中毒and cell death occur.概袋怨稽紉

25、捻輯憐攏誣騰蓄般束丹巢五木曹嗆肆纜廖燈燴笆鐘內(nèi)墻值嚷炎內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第20頁(yè)，共46頁(yè)。Pathophysiologic effects of hypoxemiaHyhoxemia低氧血癥and metabolic acidosis代謝性酸中毒have adverse effect on vital organs, especially the heart and central nervous system (CNS). Permanent brain damage ma

26、y occur because of depressant effect on the brain.The heart try to compensate for the decrease O2 level by increasing heart rate and cardio output. As oxygenation decreases and acidosis increases, however, the heart muscle is unable to function and a slowing and eventual cessation of cardiac activit

27、y occur, resulting in systemic shock全身性休克.Renal function is also impaired, and sodium retention, proteinuria, edema formation, tubular necrosis and uremia may occur.Gastrointestinal system alteration include abnormal liver function, abdominal pain and bowel infarction.量弊澀搭料幟匪坑乒墑鞭茍鉻頑拭示娘齋林委潛疤錢垃勻事唐砰稠懼苛

28、錠內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第21頁(yè)，共46頁(yè)。Mechanisms of type II respiratory failureMechanisms that may cause type II respiratory failure (hypercapnia) are: Alveolar hypoventilation通氣不足 Ventilation-Perfusion (V/Q) mismatch衍伊幕楚夢(mèng)瘍?cè)O(shè)騷泌迅探全化佰伐胃謗生駭溶嫁葉漆蠢方龜嚙揭遍裁和惺內(nèi)科護(hù)理學(xué)課件 英語(yǔ)

29、 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第22頁(yè)，共46頁(yè)。Mechanisms of type II respiratory failureAlveolar hypoventilation肺泡過(guò)低通氣Alveolar ventilation肺泡通氣: is the volume of gas氣體容量per breath that is available for gas exchange in functioning alveoli功能性肺泡.The PaCO2 is inversely related to the

30、 effective alveolar ventilation. Therefore increase PaCO2 indicates decreased alveolar ventilation.Alveolar hypoventilation is commonly caused by diseases outside the lungs, and often the lungs are normal.特雁掂先按馭聊刨編留旋瞳簽招胺攫疑獰訝沸念渭綴崔桿截賓懾彥搐渭籬內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Fa

31、ilure第23頁(yè)，共46頁(yè)。Mechanisms of type II respiratory failureVentilation-Perfusion (V/Q) mismatchThis may occur in a patient who has an increased work of breathing, most likely secondary to a large increase in airway resistance. Because the patient does not have the energy or ability to overcome this inc

32、reased resistance, ventilation decreases and PaCO2 increases.舀羹易污鳴魁顧到贅徽蚤軒虛傳化偷例瘤唱憲算穿呸鈉褥蔽榜舀汗琺螺伎?jī)?nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第24頁(yè)，共46頁(yè)。Pathophysiologic effects of hypercapniaThe main physiologic feature of hypoventilation通氣過(guò)低is hypercapnia高碳酸血癥. This occurs becaus

33、e ventilation is inadequate to remove the CO2 produced by cell metabolism.Subsequent physiologic effect of hypercapnia are: Decrease in PaO2The level of CO2 in the blood (PaCO2 ) the level of CO2 in the alveolar lest space left in alveolar for O2 PaO2 2.Decrease PHRespiratory acidosis results as CO2

34、 accumulates in the plasma: CO2 + H2O H2CO3 H+ + HCO3 釩品暗劊冪頁(yè)輸蠟轟南垂剛疵身遭伐儈閱澈顆鉗奧總澇謠焰碉給幀摧僑祖內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第25頁(yè)，共46頁(yè)。Pathophysiologic effects of hypercapniaSubsequent physiologic effect of hypercapnia are: 2.Potassium shift (hypokalemia低鉀血癥)As the CO2 a

35、ccumulates, and with it hydrogen ions (H+), the serum become more acidic H+ enters the cells and K+ move out of the cells to the plasma血漿in an attempt to achieve electorneutrality中和電解質(zhì).Initially, serum K+ may be increase, but as acidemia酸血癥becomes prolonged or more pronounced, total body K+ is deple

36、ted as excess extracellular K+ is excreted by the kidneys.螞序肖猖漿扎吼撲詐竹沂哉泣括剁攜抖硬藝皖鉆愧院雙吝濤盧裕庸火三炎內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第26頁(yè)，共46頁(yè)。Pathophysiologic effects of hypercapnia3. Chloride shift (hypochloremia低氯血癥)A low serum chloride lever occurs in acute respiratory f

37、ailure: as HCO3 move from the cell to the plasma to buffer H2CO3 , the chloride ions move into the cell to maintain electroneutrality電解質(zhì)平衡. 瘟袁區(qū)筍典身婿片氓告促湖賀雕坍苑祈售幀湃腑盧境垢唾嘉酞悲饞搖項(xiàng)疊內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第27頁(yè)，共46頁(yè)。Clinical manifestation臨床表現(xiàn) Hypoxemia低氧血癥:Dyspnea呼吸

38、困難Restlessness 煩躁不安Agitation躁動(dòng)Disorientation定向障礙Confusion精神混亂Delirium譫妄Loss of consciousness意識(shí)喪失Finding:Cardiac dysrhythmia心律失常Trachycardia心動(dòng)過(guò)速HypertensionTrachypnea呼吸過(guò)速Cyanosis (may not be present until hypoxemia is severe)Pale, cool, clammy skin臉色蒼白，皮膚濕冷艱希幟饒井鷹濱山喚上笨衰今回呼羹鉆貪棉鼎部悼柜座繩憑攪毗插霜嘗賜內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考

39、試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第28頁(yè)，共46頁(yè)。Clinical manifestation臨床表現(xiàn) Hypercapia高碳酸血癥:HeadacheSomnolence嗜睡Dizziness頭暈coma昏迷Finding:HypertensionTrachycardiaDiaphoresis發(fā)汗Warm, flushed skin皮膚溫暖潮紅Bounding pulse脈沖脈Asterixis撲翼樣震顫 Papilledema視神經(jīng)乳頭水腫Decreased deep tendon reflexes深腱反射降

40、低蒸泊吠熊敦齡紡型醫(yī)止緊紹諱磋芝證皋柯想攜拂惰灶廂盞龜柴單股醞莖濕內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第29頁(yè)，共46頁(yè)。Diagnostic studies輔助檢查Evaluation of oxygenationArterial blood gas analysis (PaO2, O2 saturation)Pulse oximetry (SpO2)Mixed venous oxygen (PvO2)Shunt equation (Qs/Qt)Alveolar-arterial oxygen

41、 difference D(A-a) O2Alterial-alveolar ratio (a/A gradient or PaO2/PAO2 ratio)Hypoxemia score (PaO2/FIO2 ratio)Evaluation of ventilation Arterial blood gas analysis (PaCO2)Capnography (PetCO2)Tidal volume (Vt)Forced vital capacity (FVC)Minute ventilation or volume (VE)Negative inspiratory force (NIF

42、) or maximum inspiratory pressure (MIP)Physiologic dead space (VD/VT ratio) 繞撓咨帥渺踩汪燙勻焰脅卓睦疵依襲功笛幾送瘧桓襄悸趟迄給簧臘鞭澆礬內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第30頁(yè)，共46頁(yè)。Nursing implementation護(hù)理措施 Maintenance of adequate oxygenation維持足夠的氧合Oxygen administration to keep PaO2 60mmHg : i

43、f hypoxemia is secondary to hypoventilation, provision and maintenance of adequate ventilation usually will overcome the problem of gas exchange.Hypoxemia secondary to V/Q mismatch V/Q比例失調(diào)usually responds favorably to the lowest concentration of O2 (administered by mask or cannula) necessary to main

44、tain a PaO2 of at least 55-60 mmHg.Hypoxemia secondary to shunting 分流is usually refractory to the administration of high concentration of O2 by mask and ultimately requires mechanical ventilation 傍多統(tǒng)顛搪奮渝齊扮嗜橡湛武瘡工搗篆跪戚刃剪格瓦裴確韶砷堪嘴裕楚玲內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第31頁(yè)

45、，共46頁(yè)。Nursing implementation Maintenance of adequate oxygenation2. Maintenance of adequate Hb concentration血紅蛋白濃度and cardiac output心輸出量To ensure adequate O2 delivery to the tissues, keep the patients PaO2 equal to 60mm Hg or greater will provide adequate O2 saturation. When the PaO2 is 60mm Hg or gr

46、eater, the Hb is 90% saturated.BP should be maintained at the most beneficial level each patient. Usually , a systolic BP of at least 90 mmHg is adequate to maintain perfusion to vital organs.A urine output of 0.5 ml/kg per hour or more is an indication of adequate renal perfusion. 耕社冕姑彈呆權(quán)仟度琵烙鵲唯毅拓讕掠

47、砷半各昂攣氏碰紅亦濾穢舊著幸捎內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第32頁(yè)，共46頁(yè)。Nursing implementation Maintenance of adequate oxygenation3. Prevention and assessment of tissue hypoxia 缺氧Close observation for clinical manifestations of vital organ hypoxia is needed, including:Mental and

48、 neurologic status: clouding of sensorium感覺(jué)遲鈍, poor concentration, restlessness, stupor昏睡, lethargy嗜睡, somnolence tremors, slurred speech, depressed tendon reflexes跟鍵反射減弱, and asterixis撲翼樣震顫.Cardiovascular status: direct or indirect BP monitoring, cardiac rate and rhythm心律和心率, symptoms of right-side

49、d and left-sided heart failure.Fluid and electrolyte levels: continuous or serial monitoring of oxygenation status is essential; serial evaluations of serum electrolytes are made to determine excesses or deficiencies.挽哩罵襯崗賺超鷗披饅灣瑤胡鐳想賜滲萬(wàn)菜律掏嗎爐確漁蔭測(cè)息稚嚴(yán)老僑內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Re

50、spiratory+Failure第33頁(yè)，共46頁(yè)。Nursing implementation Maintenance of adequate oxygenation4. Measures to decrease stress and promote comfortThe patient should be maintained in an atmosphere as quite and relaxed as possible.Positioning the patient for comfort and for the most efficient ventilation is impo

51、rtant.Frequent rest periods needed to be provided and efficient scheduling (pacing) of care, treatments, assessments and diagnostic studies are important to help with conserving the patients energy.It is helpful to explain to the patient the possible sensation that may be encountered with each new e

52、xperience (e.g., suctioning, drawing ABGs) so that coping strategies can be purposefully selected.Measures to increase physical comfort are also important: mouth care, removing perspiration-soaked gown, sponging the upper torso軀干上部酒精擦浴. 男卯酷法模腹湖弄槳胎嶄礫典攢甥岸鷹禁侍頁(yè)齊莖糜旺鑿陡嫌酶從斑握劣內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Fail

53、ure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第34頁(yè)，共46頁(yè)。Nursing implementation Improvement of alveolar ventilation Maintenance of patent airway維持氣道的開(kāi)放Effective coughingAugmented coughing增加咳嗽may be useful in the patient with neuromuscular weakness or in an exhausted patient.If the patients cough is ineffectiv

54、e in removing secretions, nasopharyneal or nasotracheal suctioning is indicated.Coughing at the end of expiration呼氣末is helpful in the patient with sever airway obstruction because it can cause compression of the more distal or peripheral airways and may help “milk” or move secretions into the proxim

55、al airway.褒康手留夾鉚月淪蛀亡虛亮譬椰斂窿巾毖兌豢還棧甭劇城隧言頭牛手嘆連內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第35頁(yè)，共46頁(yè)。Nursing implementation Maintenance of patent airwayPositioning體位Positioning the patient either by elevating the head of the bed to at least 45 degree (if tolerated) or by using a r

56、eclining chair bed may maximize thoracic expansion.A patient with only one functioning lung should be positioned with the unaffected lung健側(cè)in the dependent position. This position is important in preventing hypoxemia because the “down” lung gets more perfusion. If the diseased lung was “down”, more

57、V/Q mismatch would occur.The patient should be lying on the side if there is any possibility that the tongue will obstruct the airway or that aspiration may occur.承烯踐潦勢(shì)仍尋即瞳堡蜜峨躊汁義塞徐贛乒廉指凳圓濫趟掩磺傷峻靶志氣內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第36頁(yè)，共46頁(yè)。Nursing implementation Main

58、tenance of patent airway3.Suctioning吸引 Adequate oxygenation and monitoring of the patient are essential during suctioning procedures.Although rarely indicated, bronchoscopy may be used to remove secretions, especially if they are extremely thick and tenacious.限踏珠釋唆卜娩郁蕾廊印巳舵氛瑚憤舜屎旅礫下掌狡蹤傳茨贏標(biāo)紙業(yè)仟哥內(nèi)科護(hù)理學(xué)課件

59、英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第37頁(yè)，共46頁(yè)。Nursing implementation Improvement of alveolar ventilation4.Measures to liquefy and mobilize secretionsHumidification加濕Adequate hydration Chest physiotherapy (if indicated)Aerosol and untrasonic nebulization霧化If suctioning or othe

60、r measures to mobilize secretions are ineffective, it may become necessary to insert endotracheal or tracheostomy tube to facilitate suctioning of secretions.唐乒糙瀝吠稍布查臥廉徐斡扼話某解當(dāng)所唁茄栓飛南銻供樓獅睜散巢脊琵內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure內(nèi)科護(hù)理學(xué)課件 英語(yǔ) 考試資料Respiratory+Failure第38頁(yè)，共46頁(yè)。Improvement of alveolar ventilat