Care of Patients with Respiratory Failure

Written by Peng Miao Yun
Internal Medicine
Updated on September 09, 2024
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In the nursing care of patients with respiratory failure, it is important to strictly monitor vital signs daily, as respiratory failure is considered an emergency and critical condition clinically. Observe the patient's blood pressure, consciousness state, and respiratory rate. At the same time, good skin care and oral care should be maintained to prevent aspiration pneumonia and bedsores. Most importantly, secretions should be cleared in a timely manner, including phlegm. Conscious patients should be encouraged to cough forcefully. For patients who are weak in coughing, assist them in turning and patting their backs regularly to facilitate the expulsion of phlegm. For comatose patients, mechanical suction can be used to maintain airway patency. It is advisable to avoid factors that may cause breathing difficulties, such as cold wind and poor air circulation. Pay attention to enhancing physical exercise appropriately, preventing colds, and maintaining a regular lifestyle.

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Written by Peng Miao Yun
Internal Medicine
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Principles of oxygen therapy for respiratory failure

Patients with respiratory failure undergoing oxygen therapy should be treated differently depending on the type of respiratory failure. If it is Type I respiratory failure, it is simply hypoxia without accompanying carbon dioxide retention. Our oxygenation principle can provide slightly higher oxygen flow, with an oxygen flow rate exceeding 5 liters per minute. However, if it is Type II respiratory failure, which comes with severe carbon dioxide retention, it requires continuous low-flow oxygenation. This type of respiratory failure is often caused by chronic pulmonary diseases. Because if high-flow oxygen is provided, the peripheral chemoreceptors' response to hypoxia will decrease in the short term, which will exacerbate respiratory suppression, leading to increased carbon dioxide retention and worsening the condition. Therefore, for Type II respiratory failure, low-flow continuous oxygen should be provided, with an oxygen flow rate controlled below 3 liters per minute.

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Written by Peng Miao Yun
Internal Medicine
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Respiratory failure classified by etiology

Respiratory failure can be classified according to its causes into four types. The first type involves diseases of the airway such as bronchial inflammation, bronchiectasis, and foreign body obstruction, leading to insufficient ventilation. The second type is due to lung tissue diseases, such as pneumonia, severe tuberculosis, emphysema, diffuse pulmonary fibrosis, adult respiratory distress syndrome, etc., causing a state of hypoxia and carbon dioxide retention due to ventilatory defects. The third type includes pulmonary vascular diseases, such as pulmonary vascular embolism and pulmonary infarction, which cause part of the venous blood to flow into the pulmonary veins, resulting in hypoxia. The fourth type involves diseases of the thoracic cage such as chest trauma, surgical trauma, pneumothorax, and pleural effusion, which affect daily activities and lung expansion, leading to insufficient lung ventilation and resulting in respiratory failure.

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Written by Peng Miao Yun
Internal Medicine
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Care for patients with respiratory failure

Patients with respiratory failure are always emergency and critically ill patients in clinical settings. For patients with respiratory failure, we need to pay close attention in nursing: first, strictly monitor the patient's vital signs, observe the frequency of respiration, blood pressure, and consciousness state; take good care of the skin and oral cavity to prevent dependent pneumonia and bedsores; and timely remove the patient’s sputum. Encourage conscious patients to cough more and expectorate sputum. For those with weak coughs, assist regularly with turning and patting the back to facilitate the removal of sputum. For comatose patients, mechanical suction or tracheostomy for mechanical ventilation can be performed. At the same time, avoid factors that can induce respiratory difficulty such as cold air and poor air circulation. Patients with respiratory failure consume a lot of energy, especially those on mechanical ventilation, who are in a stress state with increased catabolism. Therefore, daily protein intake should be increased, encourage the patient to eat more to enhance nutrition, and provide a diet high in protein, high in fat, and low in carbohydrates.

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Written by Han Shun Li
Pulmonology
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What are the symptoms of respiratory failure?

Respiratory failure is a common critical illness in clinical settings, characterized by serious impairments in the lung's ventilation and gas exchange functions. What are the symptoms after respiratory failure? First and foremost, the earliest and most obvious symptom is difficulty breathing. Many patients experience significant difficulty breathing; severe cases may even involve orthopnea, profuse sweating, and inability to speak. Another important symptom is cyanosis, which is a typical manifestation of hypoxia. Additionally, there can be neuropsychiatric symptoms such as mental confusion, agitation, convulsions, and even coma. Other systems may also exhibit symptoms, such as tachycardia, arrhythmias, and decreased gastrointestinal function.

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Written by Han Shun Li
Pulmonology
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Treatment of Respiratory Failure

Respiratory failure refers to the severe impairment of lung ventilation and gas exchange function caused by various reasons. The treatment of respiratory failure is comprehensive. Firstly, it is necessary to maintain the patency of the airway. Second, oxygen therapy is required. Oxygen therapy is mainly used to correct the patient's hypoxia. Third, a ventilator can be used to assist breathing. Fourth, the cause of the condition should be addressed. For example, if it is caused by a severe infection, aggressive anti-infection measures should be taken; if caused by a large amount of pleural effusion, aggressive drainage of the pleural fluid should be undertaken, etc. Additionally, general supportive therapy should be considered, such as maintaining electrolyte and acid-base balance. It is also important to protect the function of vital organs, such as maintaining the function of the heart and lungs, etc.