Overview of respiratory failure
Respiratory failure is a clinical syndrome in which pulmonary ventilation and/or gas exchange is severely impaired for various reasons, so that adequate gas exchange cannot be maintained even at rest, resulting in hypoxemia with (or without) hypercapnia, which causes a series of pathophysiological changes and metabolic disorders. The main clinical manifestations are hypoxia and/or carbon dioxide retention, such as dyspnea, shortness of breath, psycho-neurological symptoms, etc., and gastrointestinal hemorrhage when complicated by pulmonary encephalopathy. Maintaining respiratory function in patients with respiratory failure is an important goal in the treatment of this type of condition.
Main nursing problems
1. potential complications: hypoxic injury to vital organs.
2. ineffective airway clearance.
3. ineffective respiratory type.
Nursing Measures
1.Oxygen therapy nursing
Patients and their families should understand the basic knowledge of oxygen therapy, for COPD patients with respiratory failure, high-flow oxygen inhalation is not allowed, so as not to cause carbon dioxide retention and induce pulmonary encephalopathy. And closely observe the effect and adverse reaction of oxygen therapy.
2. Medication care
Take medication as prescribed by the doctor, and closely observe the efficacy and adverse reactions of medication. When using respiratory stimulants, keep the airway open, the drip speed should not be too fast, and pay attention to the changes of respiration, mental state and arterial blood gas after using the drugs.
3.Non-invasive ventilation care
Patients should synchronize breathing with the ventilator. Patients try to breathe through the nose, reduce swallowing movements, reduce talking in the mask, and close the mouth tightly when breathing to prevent gastrointestinal distension. The distilled water in the humidification tank should be added at any time, subject to the upper and lower lines of the standard water level, and the sterilized distilled water in the humidification tank should be thoroughly replaced once every 24 hours.
4. Invasive ventilation care
Keep the artificial airway open during transoral intubation, manage the dental cushion to prevent the catheter from being bitten and blocking the artificial airway, and fix the tracheal tube to prevent it from falling off and shifting. Remove the stagnant material on the air bag daily, add distilled water in the humidification tank at any time, and replace it thoroughly once in 24 hours.
Health promotion
1. Keep indoor air circulation, room temperature 18℃～22℃, humidity 55%～65% is appropriate, avoid smoke, dust and other stimuli.
2. When the patient’s sputum is thick and sticky and not easy to cough out, strengthen turning, patting the back to expel sputum, and drink an appropriate amount of water.
3. The patient actively performs respiratory exercise, the two upper limbs are stretched sideways, each hand lifts a heavy object, up and down for several times, in order to have no discomfort as appropriate. Patients to contract the lips breathing, increase the patient’s lung ventilation. Specific method: when inhaling, make the gas enter from the nostrils, when exhaling, shrink the lips as a whistle, let the gas slowly and evenly escape from between the lips, while contracting the abdomen, inhaling and exhaling time ratio of 1:2, instructing the patient to practice 3 to 4 times a day, each time for 10 minutes.
4. Patients should avoid cold, avoid inhaling irritating gases, go to public places less often to avoid respiratory tract infections, and advise patients who smoke to quit smoking.
5. Patients should have regular follow-ups, and consult the doctor in time if there is worsening of cough, fever, or excessive sputum.