Page 77 - Critical Care Nursing Demystified

62 CRITICAL CARE NURSING DeMYSTIFIED

is a major cause of organ failure and death in the critical care areas. ARF can be
caused by pulmonary and nonpulmonary conditions.
Common pulmonary conditions include
Pneumonia, lung tumors, cardiac and noncardiac pulmonary edema, chronic
obstructive pulmonary disease, and airways obstructions
Nonpulmonary conditions that result in ARF include
Pneumothorax, pleural effusions, neuromuscular disorders (myasthenia
gravis, poliomyelitis), periperheral and spinal problems (tetanus, trauma),
and central nervous system problems (head trauma and drug overdose)

Prognosis
Mortality rates vary but most include an almost 50% mortality rate for those
admitted to the intensive care unit with this diagnosis. This medical problem
results in lengths of stay longer than a week in the ICU.
Hallmark Signs and Symptoms

Early
Neurologic changes: restlessness, agitation, confusion, anxiety.
Vital signs will elevate causing tachypnea, tachycardia, and hypertension.
Pulse oximetry will drop below the patient’s baseline. Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
Shortness of breath and dyspnea at rest (most common).
Accessory and intercostal muscle use.

Abnormal breath sounds: crackles, gurgles.
Changes in sputum amount, color, and need for suctioning.
Cardiac dsyrhythmias.
Overall skin pallor.
Late
Neurological changes: lethargy, severe somnolence, coma.

Vital signs drop causing bradypnea, bradycardia, and hypotension.
Cyanosis/mottling and poor respiratory effort.
Cardiac arrest.
Interpreting Test Results
ABGs are examined closely to determine ARF. In a patient with normal base-
line ABG values, ARF is diagnosed when the pO is less than 60 mm Hg and
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the pCO is greater than 45 mm Hg. In patients who are chronic pCO retainers,
2 2
the pH must also be included in the assessment, with values of less than 7.35
indicating ARF. End tidal CO will also be high.
2