Diagnosis: Right-Sided Pneumonia Leading to Acute Respiratory Failure Date Diagnosis: Right-Sided Pneumonia Leading to Acute Respiratory Failure Question 1 Two days after Mr. Bukowski’s operation on the fractured right neck of femur, four key pieces of assessment data supporting the diagnosis of acute respiratory failure were observed…
The sympathetic nervous system is being stimulated by the increased carbon dioxide in the arterial blood, leading to increased heart rate and respiratory rate that helps the body to compensate for the hypercapnia and hypoxia (Smyth, 2005, 72). This is demonstrated by the elevated respiratory rate of Mr. Bukowski two days after the operation which is 28 breaths per minute and the observance of deep and labored breathing pattern. There is indication that he has been experiencing limited chest expansion as evidenced by intercostal muscle recession thus, indicating also his right lung has collapsed and will not received enough ventilation (Higgins & Guest, 2008, 24). The abnormal respiration pattern characterized by increased respiratory effort and collapsed of the right lung supports his diagnosis of Acute Respiratory Failure. In Mr. Bukowski’s case auscultation of breath sounds is the second key assessment data needed to support the diagnosis of acute respiratory failure. Kaynar & Shama (2010) indicate that the most common reason for respiratory failure is the mismatch in the ventilation/perfusion (V/Q) (n.p). Mr. Bukowski was diagnosed with pneumonia and includes physical findings such as crackles, rales, decreased intensity of breathing sounds and presence of rhonchi breathing sounds, and used of accessory muscles during respiration. The presence of course crackles will lead to V/Q mismatch because course crackles in pneumonia indicate that he has existing secretions in the airway (Shackell & Gillespie, 2009, 18). Therefore, the contributing cause of respiratory failure in Mr. his case is diminished ventilation secondary to the presence of crackles and diminished entry sounds as revealed during the assessment process. The third key assessment data and the most definite indicator of acute respiratory failure is the measurement of arterial blood gases (ABG). Acute respiratory failure is a state in which the respiratory system fails to perform the gas exchange function (Lightower, Vedzicha, Elliott & Ram, 2003, 185).The body fails to excrete carbon dioxide which leads to hypercapnea, a condition where the partial pressure of carbon dioxide (PaCO2) is more than 45mmHg (Delerme & Ray, 2008, 252; Mueller, 2008, 787). The retention of carbon dioxide in the body (hypercapnia) contributes to the respiratory acidosis of clients with respiratory failure thus, categorized as Type 2 respiratory failure (Smyth, 2005, 72). The ABGs measurement of Mr. Bukowski reveal a PaCO2 level of 54mmHg and a pH of 7.30. The increased of PaCO2 level above the normal range indicates that he is having hypercapnia and pH level below the normal range (7.35-7.45) indicate also respiratory acidosis. Meanwhile, it is not only retention of carbon dioxide gases that contributes to respiratory failure but the limitation of gas exchange such as oxygen as well (also called arterial hypoxemia) (Kaynar and Shama, 2010, n.p.). Progressive diffusion barrier and V/Q mismatch, also called alveolar hypoventilation, caused the arterial hypoxemia in patients with acute respiratory failure (Levy, 2005, 548). Arterial blood gases measurements of Mr. Bukowski revealed a low partial pressure of oxygen (PaO2) level of 58mmHg and low oxygen saturation (SaO2) level of 89%. The normal PaO2 level is between 80mmHg to 100mmHg while SaO2 level 95%-98%. Even with oxygen administration of 6L/min via Hudson mask, ABGs remain in respective ...
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