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The Arterial Blood Gases of a patient with chronic obstructive pulmonary disease (COPD) deteriorate, & respiratory failure is impending. For which clinical indicator should the nurse assess FIRST?

The Arterial Blood Gases of a patient with chronic obstructive pulmonary disease (COPD) deteriorate, & respiratory failure is impending. For which clinical indicator should the nurse assess FIRST? Correct Answer Mental confusion

Concept:

  • Respiratory failure is a condition in which the respiratory system fails to maintain its main function and provide adequate oxygenated blood to the body. In respiratory failure, the PaO2 is lower than 60mmHg and the PCo2 is higher than 50mmHg.

Key Points

  • Symptoms of respiratory failure:
    • Bluish discolouration of fingers, lips and skin
    • Confusion or altered consciousness (Hence option 2 is correct)
    • Sleepiness or passing out
    • Anxiety
    • Rapid breathing or extremely slow breathing
    • Shortness of breath

Important Points

  • Causes:
    • Lungs diseases such as COPD; asthma; pulmonary embolism.
    • Conditions that affect the nerves and muscles such as spinal cord injuries and muscular dystrophy.
    • Damage to the tissues and ribs around the lungs.
    • Drug and alcohol overdose
    • Inhalation injuries such as harmful fumes.
  • Diagnosis of respiratory failure
    • Physical examination
    • Pulse ox symmetry to measure the oxygen level
    • Arterial blood gas test to measure the level of carbon dioxide in the blood.​

Additional Information

  • COPD:  is a chronic inflammatory lung disease that is resulted due to obstructed airflow from the lungs.
  • ABG analysis: is indicated for the measurement of acidity i.e. pH and the level of oxygen and carbon dioxide in the arterial blood. This is recommended in patients with pulmonary or cardiac pathologic conditions or patients admitted to the ICU.
  • A distended neck vein is a classic sign of right ventricular heart failure which is also characterized by Jugular vein distention, oedema and hepatomegaly.
  • Bradycardia: is described as abnormal heart rate and, or below normal heart rate i.e. less than 60 beats per minute. This is a result of cardiac diseases such as heart block, congenital heart disease or valvular heart disease.
  • Cyanosis: is described as bluish discolouration of the skin or mucous membrane which is usually a result of inadequate oxygen present in the blood.

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