Page 78 - Critical Care Nursing Demystified

Chapter 2 CARE OF THE PATIENT WITH CRITICAL RESPIRATORY NEEDS 63

The chest x-ray will change from clear to white and cloudy (patchy infil-
trates) if ARF is due to aspiration, heart failure, or fluid in the chest cavity.
Low hemoglobin and hematocrit values can cause hypoxemia if there is no
iron on the hemoglobin molecule to combine with available oxygen.

NURSING ALERT

If a patient is anemic, he or she may never show signs of cyanosis due to the lack of
hemoglobin. Hemoglobin combining with carbon dioxide gives the purple tinge to a
patient with cyanosis.

Treatment
Early recognition and treatment of the underlying cause
Intubation before the patient is exhausted from breathing
Mechanical ventilation with PEEP and high FiO added if severely hypoxic
2
Insertion of a nasogastric tube with nutritional support

Insertion of pulmonary artery catheter if fluid and cardiac status uncertain
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Medications
Bicarbonate to correct acidosis according to the ABG values
Neuromuscular blockade to minimize oxygen demand and allow rest

Pain control medications if neuromuscular blockade to prevent pain from
immobility

Diuretics like furosemide to remove fluid if heart failure
Bronchodilators/steroids to dilate airways and decrease inflammation in
acute COPD
Stomach acid blockers to prevent ulcers from stress

Nursing Diagnoses for ARF Expected Outcomes
Impaired gas exchange The patient will have a pO that rises and a pCO
2
2
that drops to baseline
The patient will have clear chest x-rays
Ineffective breathing The patientʼs respirations will be between 16–20
pattern during unassisted breathing
Decreased cardiac output The patient will have a heart rate within baseline
The patient will have a stable cardiac rhythm