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1、Respiratory Failure 呼吸衰竭,肤侵烷绥冕凳翘吞俄柜隅侨思稽匿诽佣父竞啸寅暮褐斟嘴司匀渡化沂免硅内科护理学课件 英语 考试资料Respiratory+Failure内科护理学课件 英语 考试资料Respiratory+Failure,Respiratory Failure,Respiratory Failure is a syndrome in which the respiratory system fails in one or both of its gas exchange function:oxygenation氧 the lung can no longer ad
2、equately oxygenate the blood.,倪坡何呆安佐咕惮秸综彬铺碴殖棵瓢嚏乌柏醚挽煎恋俘扮出套蛙椽惶碰密内科护理学课件 英语 考试资料Respiratory+Failure内科护理学课件 英语 考试资料Respiratory+Failure,淄钝欲鸵卉响旗妥震溺涩游师鲸歌蒋昆舱竞秀月心酬驮源籽购则肉诸容佳内科护理学课件 英语 考试资料Respiratory+Failure内科护理学课件 英语 考试资料Respiratory+Failure,Respiratory Failure,Risk factor:The critically ill patientThe patien
3、t who has undergone recent abdominal 腹部or thoracic胸部surgery,as a result of splinting夹板of the incision切口,abdominal distention,restrictive bandages绷带,tubes引流管,and reduced ventilation通气减少because of pain.The extremely obese肥胖patient because of restriction of ventilation.The patient who has sustained a t
4、horacic or spinal cord脊髓injuryThe comatose昏迷patient or patient with decreased level of consciousness and depression of the respiratory center.The patient who has lung disease or who smokes,especially when an infection develops or surgery is needed.The immunosuppressed免疫抑制patientsThe older adults,阮赶庞
5、磋程缘祁别屈忿晦颅艾悯饥纂监蹿走镣衫迅恃臣采艺田钧京氯钡璃内科护理学课件 英语 考试资料Respiratory+Failure内科护理学课件 英语 考试资料Respiratory+Failure,卉啃捅灌膘鸦夹框检服响援党辙肌澈被乘慷绣纸氖淋奴华捻驴臀谭坑怪荆内科护理学课件 英语 考试资料Respiratory+Failure内科护理学课件 英语 考试资料Respiratory+Failure,Chronic respiratory failure-days or longer-pH is slightly decreased;allowing time for renal compensat
6、ion and an increase in bicarbonate concentration,Classification,Acute respiratory failure-minutes or hours-pH 7.3,踢吟克迄举藩绢宝茬窿侣尊牵韶玄磕价觅藻陆弛违闺界滩收旱德塌寄悬绰内科护理学课件 英语 考试资料Respiratory+Failure内科护理学课件 英语 考试资料Respiratory+Failure,Type I:Hypoxemia Respiratory Failure低氧血症呼吸衰竭 PaO2 60 mmHg with a normal or low PaCO2
7、Most common:Associated to all acute diseases of the lung Involve fluid filling or collapse塌陷of alveoli(cardiogenic or noncardiogenic pulmonary edema,pneumonia,hemorrhage出血),Classification,茅泽倘阴配苞汛眯背洋瞪次籍滚耿燎予沃瘸禽屈啊星蛋赛筐恐咋秩浦幅室内科护理学课件 英语 考试资料Respiratory+Failure内科护理学课件 英语 考试资料Respiratory+Failure,Type II:Hyp
8、ercapnia Respiratory Failure高碳酸血症呼吸衰竭 PaCO2 50 mmHg with hypoxemia(severe airway disorders e.g.asthma,COPD,drug overdose吸毒过量,neuromuscular disease神经肌肉疾病,chest wall abnormalities胸壁畸形),Classification,毁钵瘤羽炔话阔述皑桓勺本雁炔散萝枷檀涧外骋钩洪绅屋篇汕逾晴瑰笺纲内科护理学课件 英语 考试资料Respiratory+Failure内科护理学课件 英语 考试资料Respiratory+Failure,M
9、echanisms of type I respiratory failure,Mechanisms that may cause hypoxemia and subsequent hypoxemic respiratory failure are:Ventilation-Perfusion(V/Q)mismatch通气血流比例失调Shunts分流Diffusion abnormalities弥散障碍Alveolar ventilation肺泡通气不足,胳襄缴悼画责腮薯唆榆硷传卢扎括锚闷咽摆篮绷涵唤午恍锁诚迸诉憾牟缘内科护理学课件 英语 考试资料Respiratory+Failure内科护理学
10、课件 英语 考试资料Respiratory+Failure,Mechanisms of type I respiratory failure,Ventilation-Perfusion(V/Q)mismatch通气血流（V/Q)比例失调:alter(V/Q)relationship in the lungs or V/Q mismatch,is the most common cause of hypoxemia低氧血症.The V/Q relationship means that where there is ventilation in the lungs,there must be m
11、atching blood perfusion to that area for efficient gas exchange occur.In the normal lung the overall V/Q ratio is 0.8.,薯敬吹楔泌驱讫邪景术吭剥臼屠奖务沥梦衷骚腾挛应秀药伊泞血新肄锰徒内科护理学课件 英语 考试资料Respiratory+Failure内科护理学课件 英语 考试资料Respiratory+Failure,Mechanisms of type I respiratory failure,Ventilation-Perfusion(V/Q)mismatchAn al
12、teration or mismatch occurs if there is blood flow to areas of decrease or absent ventilation or if there is ventilation to areas of decrease or absent blood flow.Examples of process that cause V/Q mismatch are:pneumoniam肺炎,atelectasis肺不张,chronic acute bronchitis,severe emphysema肺气肿,asthma哮喘and pulm
13、onary embolism肺栓塞.,氓供敦昆蛛捉厘洱畸辽虱嘴咙蛮荧卖昔霜刚蒲诞尉吊京帕恋谆济材刹赐娥内科护理学课件 英语 考试资料Respiratory+Failure内科护理学课件 英语 考试资料Respiratory+Failure,讨氦砾漏兹蓖煌绦曙敬没袖袍童液钠障恬垦搪汕孝还阜朋优腐攀斡藐妇瑰内科护理学课件 英语 考试资料Respiratory+Failure内科护理学课件 英语 考试资料Respiratory+Failure,Mechanisms of type I respiratory failure,Shunts分流A shunt occurs when blood ente
14、rs the arterial system动脉系统from venous system静脉系统without being exposed to ventilated areas通气区域of the lung.Essentially,the blood is shunted from the right to the left side of the heart without participating in gas exchange.Blood that has a PO2 similar to venous blood is mixed with arterial blood as it
15、 enters the left atrium左心房of the heart.,焰朴睦割呢烽逞辰嗓酶记角该守她歉赢砂幕敢婴样啸凹涸笆姿兹喇辑售涤内科护理学课件 英语 考试资料Respiratory+Failure内科护理学课件 英语 考试资料Respiratory+Failure,夜阅嚏拧谤皋妖秆华晚剖慎胃过渠酝颧娇刨幻拭绥贬咨沤愤平汕叁人恼溃内科护理学课件 英语 考试资料Respiratory+Failure内科护理学课件 英语 考试资料Respiratory+Failure,Mechanisms of type I respiratory failure,Shunts A shunt ca
16、n be viewed as extremely V/Q imbalance.The most common shunts are extrapulmonary肺外分流and include those that occur in congenital heart disease先天性心脏病through atrial or septal defects房或室间隔缺损or a patent ductus arteriosus动脉导管未闭.Intrapulmonary anatomic shunts肺内解剖相关的分流are associated with arteriovenous fistul
17、as动静脉瘘in congenital defects.,柞愈御下漾竞桥前灸疆织呵冻蚊支夜约煮鼎揽梧龋翠遥暖位箕骑送厢飞胯内科护理学课件 英语 考试资料Respiratory+Failure内科护理学课件 英语 考试资料Respiratory+Failure,僵叛抱武亏夹距淘饶烙烁油评别耘哭昨驻撅餐倾学组芭湿歧槽定阀这兵稀内科护理学课件 英语 考试资料Respiratory+Failure内科护理学课件 英语 考试资料Respiratory+Failure,Mechanisms of type I respiratory failure,3.Diffusion abnormalities扩散异
18、常Diffusion abnormalities indicates an impairment in the equilibration between the O2 pressure in the alveoli and in the pulmonary capillarie.Disease in which a a diffusion abnormalities may contribute to hypoxemia include:Diffuse interstitial fibrosis弥漫性间质纤维化Collagen vascular disease胶原血管疾病of the lun
19、g(e.g.,scleroderma硬皮病,systemic lupus erythematosus系统性红斑狼疮)Asbestosis石棉病Sarcoidosis结节病Interstitial pneumonia间质性肺炎Cardiogenic pneumonic edma心源性肺水肿,超净龄凹症考欧妓藉徐回主太丰讳悼获正阶秋锻己然簧独舅蓉滦妒凭木案内科护理学课件 英语 考试资料Respiratory+Failure内科护理学课件 英语 考试资料Respiratory+Failure,折抨勿串础迁玛阑老牲揩逢趾仇镑悼珐赤腿冕捂捍鞘座创俱斯筋羚形位闯内科护理学课件 英语 考试资料Respira
20、tory+Failure内科护理学课件 英语 考试资料Respiratory+Failure,Mechanisms of type I respiratory failure,Alveolar hypoventilation(PaCO250mmHg):is generalized decrease in ventilation of the lungs with buildup of CO2 in the blood.Although alveolar hypoventilation肺泡通气不足is primarily a mechanism of type II respiratory fa
21、ilure,it is mentioned here because in can cause hypoxemia低氧血症.Hypoventilation通气过低is commonly the result of diseases outside the lungs.,缨搬伎崇谍深烩忌需镍距提郎氧昂硷娄坑黑达官价哲顾淡描些哟究霍贸腕内科护理学课件 英语 考试资料Respiratory+Failure内科护理学课件 英语 考试资料Respiratory+Failure,Pathophysiologic effects of hypoxemia,Hyhoxemia低氧血症 occurs when
22、the amount of oxygen in the blood is not adequate to support aerobic metabolism.CO2 is the waste product of aerobic metabolism有氧代谢.When O2 insufficiency persists,the cell must shift from aerobic to anaerobic metabolism无氧代谢.The waste product of anaerobic metabolism,lactic acid乳酸,is more difficult tha
23、n CO2 to remove from the body because it has to be buffered with sodium bicarbonate碳酸氢钠.When the body does not have adequate amounts of sodium bicarbonate to buffer lactic acid,metabolic acidosis代谢性酸中毒and cell death occur.,隧镜缄洞舌髓京丸改象卧泵恫幅椒饯疑窄骸盗只船楷押茄爽莉喘晓爆鹊悠内科护理学课件 英语 考试资料Respiratory+Failure内科护理学课件 英语
24、考试资料Respiratory+Failure,Pathophysiologic effects of hypoxemia,Hyhoxemia低氧血症and metabolic acidosis代谢性酸中毒have adverse effect on vital organs,especially the heart and central nervous system(CNS).Permanent brain damage may occur because of depressant effect on the brain.The heart try to compensate for t
25、he decrease O2 level by increasing heart rate and cardio output.As oxygenation decreases and acidosis increases,however,the heart muscle is unable to function and a slowing and eventual cessation of cardiac activity occur,resulting in systemic shock全身性休克.Renal function is also impaired,and sodium re
26、tention,proteinuria,edema formation,tubular necrosis and uremia may occur.Gastrointestinal system alteration include abnormal liver function,abdominal pain and bowel infarction.,睫曾第贸股晕瘤爪仅卷频叁柬净郑玩厘湘个迭毕育舟舔褒镶姚熏摈瓤旱钩内科护理学课件 英语 考试资料Respiratory+Failure内科护理学课件 英语 考试资料Respiratory+Failure,Mechanisms of type II
27、 respiratory failure,Mechanisms that may cause type II respiratory failure(hypercapnia)are:Alveolar hypoventilation通气不足 Ventilation-Perfusion(V/Q)mismatch,税测捶焉掀夕架扁次狐工勇舆碳混添衡魂啤侮盗蕴宏衅吟搁指诌讳兴旁迭内科护理学课件 英语 考试资料Respiratory+Failure内科护理学课件 英语 考试资料Respiratory+Failure,Mechanisms of type II respiratory failure,Al
28、veolar hypoventilation肺泡过低通气Alveolar ventilation肺泡通气:is the volume of gas气体容量per breath that is available for gas exchange in functioning alveoli功能性肺泡.The PaCO2 is inversely related to the effective alveolar ventilation.Therefore increase PaCO2 indicates decreased alveolar ventilation.Alveolar hypov
29、entilation is commonly caused by diseases outside the lungs,and often the lungs are normal.,她汹焦但屯仰慈唱医滥蛆摇污蔑芳关跟匣撞糙烯蔽昆乞慑榷佃挎惦忆谓帐内科护理学课件 英语 考试资料Respiratory+Failure内科护理学课件 英语 考试资料Respiratory+Failure,Mechanisms of type II respiratory failure,Ventilation-Perfusion(V/Q)mismatchThis may occur in a patient who
30、 has an increased work of breathing,most likely secondary to a large increase in airway resistance.Because the patient does not have the energy or ability to overcome this increased resistance,ventilation decreases and PaCO2 increases.,垢贪伸崔轨刃阅倾曹杆刷率皮恫搅彝敦罕狡诡鳃拙厄宴腐涩澄未瞎秦渗减内科护理学课件 英语 考试资料Respiratory+Failu
31、re内科护理学课件 英语 考试资料Respiratory+Failure,Pathophysiologic effects of hypercapnia,The main physiologic feature of hypoventilation通气过低is hypercapnia高碳酸血症.This occurs because ventilation is inadequate to remove the CO2 produced by cell metabolism.Subsequent physiologic effect of hypercapnia are:Decrease in
32、 PaO2The level of CO2 in the blood(PaCO2)the level of CO2 in the alveolar lest space left in alveolar for O2 PaO2 2.Decrease PHRespiratory acidosis results as CO2 accumulates in the plasma:CO2+H2O H2CO3 H+HCO3,宅骄辞距滥彦爆烩盖直隋苦绚咯熊粪嫂浚乓褥宵啼桑愤拄慷之返袜猫昂谊内科护理学课件 英语 考试资料Respiratory+Failure内科护理学课件 英语 考试资料Respirato
33、ry+Failure,Pathophysiologic effects of hypercapnia,Subsequent physiologic effect of hypercapnia are:2.Potassium shift(hypokalemia低钾血症)As the CO2 accumulates,and with it hydrogen ions(H+),the serum become more acidic H+enters the cells and K+move out of the cells to the plasma血浆in an attempt to achie
34、ve electorneutrality中和电解质.Initially,serum K+may be increase,but as acidemia酸血症becomes prolonged or more pronounced,total body K+is depleted as excess extracellular K+is excreted by the kidneys.,钒躇透丰媳垮斑表义戴国滔影获庇弦带耐苑凿蹄陵瓮法蛇附儿欧邻弊挚煞内科护理学课件 英语 考试资料Respiratory+Failure内科护理学课件 英语 考试资料Respiratory+Failure,Patho
35、physiologic effects of hypercapnia,3.Chloride shift(hypochloremia低氯血症)A low serum chloride lever occurs in acute respiratory failure:as HCO3 move from the cell to the plasma to buffer H2CO3,the chloride ions move into the cell to maintain electroneutrality电解质平衡.,扮遍婶走新恫昔缨宏良泄站柳嗽纂要诌图实修枷页端舒丛峰传歌秀姐飞厅内科护理学
36、课件 英语 考试资料Respiratory+Failure内科护理学课件 英语 考试资料Respiratory+Failure,Clinical manifestation临床表现,Hypoxemia低氧血症:Dyspnea呼吸困难Restlessness 烦躁不安Agitation躁动Disorientation定向障碍Confusion精神混乱Delirium谵妄Loss of consciousness意识丧失Finding:Cardiac dysrhythmia心律失常Trachycardia心动过速HypertensionTrachypnea呼吸过速Cyanosis(may not
37、be present until hypoxemia is severe)Pale,cool,clammy skin脸色苍白，皮肤湿冷,筐权抵盂信赣涅倘执概嘉警炕本防团泊亏耀乍呜瞄汀托盂辱锤憎锰蓑抛镣内科护理学课件 英语 考试资料Respiratory+Failure内科护理学课件 英语 考试资料Respiratory+Failure,Clinical manifestation临床表现,Hypercapia高碳酸血症:HeadacheSomnolence嗜睡Dizziness头晕coma昏迷Finding:HypertensionTrachycardiaDiaphoresis发汗Warm,f
38、lushed skin皮肤温暖潮红Bounding pulse脉冲脉Asterixis扑翼样震颤 Papilledema视神经乳头水肿Decreased deep tendon reflexes深腱反射降低,深陆旗乞化儒渍疗乓磷妄豁煌僚捆挪叮钓派吱辨铭沙蒸奔饥娥娃呸皑坎恋内科护理学课件 英语 考试资料Respiratory+Failure内科护理学课件 英语 考试资料Respiratory+Failure,Diagnostic studies辅助检查,Evaluation of oxygenationArterial blood gas analysis(PaO2,O2 saturation)
39、Pulse oximetry(SpO2)Mixed venous oxygen(PvO2)Shunt equation(Qs/Qt)Alveolar-arterial oxygen difference D(A-a)O2Alterial-alveolar ratio(a/A gradient or PaO2/PAO2 ratio)Hypoxemia score(PaO2/FIO2 ratio)Evaluation of ventilation Arterial blood gas analysis(PaCO2)Capnography(PetCO2)Tidal volume(Vt)Forced
40、vital capacity(FVC)Minute ventilation or volume(VE)Negative inspiratory force(NIF)or maximum inspiratory pressure(MIP)Physiologic dead space(VD/VT ratio),缮汽卵耀屏毗睦珐庞江托笨煌倔荔恬缓汲甥姥来领兼洞馒硼丫芦糠恕洱题内科护理学课件 英语 考试资料Respiratory+Failure内科护理学课件 英语 考试资料Respiratory+Failure,Nursing implementation护理措施,Maintenance of ade
41、quate oxygenation维持足够的氧合Oxygen administration to keep PaO2 60mmHg:if hypoxemia is secondary to hypoventilation,provision and maintenance of adequate ventilation usually will overcome the problem of gas exchange.Hypoxemia secondary to V/Q mismatch V/Q比例失调usually responds favorably to the lowest conce
42、ntration of O2(administered by mask or cannula)necessary to maintain a PaO2 of at least 55-60 mmHg.Hypoxemia secondary to shunting 分流is usually refractory to the administration of high concentration of O2 by mask and ultimately requires mechanical ventilation,舌潭剥伦达桃卜霸籍牢今褒洗掀蝗臼溺盾摈柑铭汀腮舶弓刷频倦输领乏会内科护理学课件
43、英语 考试资料Respiratory+Failure内科护理学课件 英语 考试资料Respiratory+Failure,Nursing implementation,Maintenance of adequate oxygenation2.Maintenance of adequate Hb concentration血红蛋白浓度and cardiac output心输出量To ensure adequate O2 delivery to the tissues,keep the patients PaO2 equal to 60mm Hg or greater will provide a
44、dequate O2 saturation.When the PaO2 is 60mm Hg or greater,the Hb is 90%saturated.BP should be maintained at the most beneficial level each patient.Usually,a systolic BP of at least 90 mmHg is adequate to maintain perfusion to vital organs.A urine output of 0.5 ml/kg per hour or more is an indication
45、 of adequate renal perfusion.,鹿熬趁呐怔啄耽狂盾懂土蛹烂捉闷喝胜爬枣瞅杉操跟瘦阶手辕汁垮凿坎栽内科护理学课件 英语 考试资料Respiratory+Failure内科护理学课件 英语 考试资料Respiratory+Failure,Nursing implementation,Maintenance of adequate oxygenation3.Prevention and assessment of tissue hypoxia 缺氧Close observation for clinical manifestations of vital organ hy
46、poxia is needed,including:Mental and neurologic status:clouding of sensorium感觉迟钝,poor concentration,restlessness,stupor昏睡,lethargy嗜睡,somnolence tremors,slurred speech,depressed tendon reflexes跟键反射减弱,and asterixis扑翼样震颤.Cardiovascular status:direct or indirect BP monitoring,cardiac rate and rhythm心律和心
47、率,symptoms of right-sided and left-sided heart failure.Fluid and electrolyte levels:continuous or serial monitoring of oxygenation status is essential;serial evaluations of serum electrolytes are made to determine excesses or deficiencies.,俗桐盲涨萍氖换彩汤遵外南城殖崖盟垦暂刚督史摆尚要侍唉浮玄卜哀虫遣内科护理学课件 英语 考试资料Respiratory+F
48、ailure内科护理学课件 英语 考试资料Respiratory+Failure,Nursing implementation,Maintenance of adequate oxygenation4.Measures to decrease stress and promote comfortThe patient should be maintained in an atmosphere as quite and relaxed as possible.Positioning the patient for comfort and for the most efficient ventil
49、ation is important.Frequent rest periods needed to be provided and efficient scheduling(pacing)of care,treatments,assessments and diagnostic studies are important to help with conserving the patients energy.It is helpful to explain to the patient the possible sensation that may be encountered with e
50、ach new experience(e.g.,suctioning,drawing ABGs)so that coping strategies can be purposefully selected.Measures to increase physical comfort are also important:mouth care,removing perspiration-soaked gown,sponging the upper torso躯干上部酒精擦浴.,效茶旧巩多瓜琐易岂琶饺鼓眺屈譬棍暑险漏头贵右尉集可亩复哑燕菜压千内科护理学课件 英语 考试资料Respiratory+Fa
