Assessment of Respiratory Distress Syndrome

The assignment requires a thorough assessment of a patient's respiratory status, including checking for signs of respiratory distress such as abnormal breath sounds, wheezing, and crackles. It also involves evaluating the airway patency by checking for airway patency and assessing the peripheral area by checking hemoglobin levels and skin texture.

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Respiratory depression
Student’s name
Institutional

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Respiratory depression
Importance of respiratory depression
Respiratory depression also known as known as hypoventilation is a condition which results to
breathing problems. That is there is a problem in the oxygen and carbon dioxide elimination. The
process of respiration involves the following processes, oxygen transfer to the alveolus, oxygen
transfer to the tissues and lastly the removal carbon dioxide through the process called exhalation
(Khan, Palepu, & Norena, 2012). Respiratory failure may occur if there is an abnormality in any
of these three areas. Respiration takes place in the alveolar found in the lungs where oxygen
diffuses into the lungs binding to the hemoglobin. It can be grouped as either hypercapnic or
hypoxemic. During hypoxemic condition the oxygen concentration is lesser than 60mm Hg
while the carbon dioxide concentration is lower or normal. The type two of respiratory failure
also known as hypercapnic is due to PaC02 is higher than 50mm Hg. Hypoxemia is mostly seen
on patients with respiratory hypercapnic failure. The degree in pH depends on bicarbonate level
which is dependent on time of hypercapnia.
Pain is the main reason why individual seek treatment mostly in the emergency department. The
medication that are widely used to reduce pain include opioids such as morphine. The main
reason why opiates cause respiratory depression is because this drugs affect the central nervous
system which is uncountable for regulation of our breathing and controlling our heart beat. This
drugs initiate opioid receptors activation, this leads to the prevention of neurotransmission in the
peripheral nervous system and central nervous system. Effects of opioids are more powerful in
the kappa and mu receptors. This binding results to reduction of the central nervous system
which in turn slows the breathing process. The more one overdoses opiates the more breathing is
reduced. The first symptom of opiate overdose in an individual is the reduction to 12 breaths per
minute or lesser. Symptoms of an opioid overdose include confusion, nausea and vomiting and

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lastly pinpoint pupils. An opioid antagonist naloxone is given to a client who has had opioid
overdose.
Risk factors
Darren was diagnosed with mild-severe cholecystitis and was supposed to undergo an elective
laparoscopic and open cholecystectomy in four hours. Regarding his present condition, he was
diagnosed with respiratory depression (Brainerd, 2012). He had a respiratory rate of <10Rpm,
Sp02<95% on RA and shallow breathing. If the patient was to go to surgery with this problem
left untreated it may result to severe acidosis which may result to death of the patient (Moss &
Mannino, 2013). This is because the patient must be sedated before the surgery begins so as to
prevent pain. This will result to overtoxcation of the drug. This may result to the increase in
pulse, blood pressure, increased respiratory rate, fullness of the head and mental cloudiness.
Increased CO2 level may cause dilation of the cerebrovascular vessels causing an increased blood
flow to the cerebrum. If the respiratory acidosis is extreme, it increases intracranial pressure
which leads to papilledema and dilation of the blood vessels found in the conjunctiva (Canet,
Osman, & Lambert, 2015). It may also result to an increased potassium in the blood also known
as hyperkalemia.
Patient centered smart goal
Maintaining the respiratory stability within the 24 hours timeline.

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Nursing intervention
Impaired gaseous exchange
Impaired gaseous exchange is defined as a decreased oxygenation or carbon dioxide removal in
the alveolar capillary membrane. The impaired gaseous exchange was related to suppressed
cough, lack of movement and the inability to clear secretion secondary to depression of the
central nervous system by the opioids (Phua, Badia, & Adhikar, 2012). The signs and symptoms
of impaired gaseous exchange include visual malfunction, headache, restlessness, hypoxia,
abnormality in the breathing rate and irritability (Rudd, Seth, David, & Scholl, 2012). The
following are impaired gas exchange goals and expected outcomes. The client asserts an
optimum gaseous exchange as evidenced by a respiratory rate of 14-20 per minute, the client
shows a clear lung evidenced by lack of secretion, and the client expresses oxygen treatment
intervention (Rudd, Seth, David, & Scholl, 2015).
Evaluate the rate in respiration rate, and depth. Access how the client uses accessory muscles
during breathing. If the inhalation and exhalation are shallow it may lead to hypoventilation.
Advice the patient to use accessory muscle during breathing and forced coughing. This skills
used help in opening the airways by clearing the secretion blocking the air ways hence
improving ventilation. Bronchodilators are administered through inhalation this therapy help in
dilation of the airways hence improving gaseous exchange (Noreanu, Breidthardt, Reichlin, &
Gagat, 2014). Administration of oxygen, oxygen helps in the improvement of hypoxemia.
Ineffective air clearance
This is the lack of power for the body to remove secretion in the respiratory tract. When there is
a blockage in the respiratory tract coughing occurs. Sometimes coughing may be not be the

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perfect solution due to respiratory fatigue or pain (Robert & Lester, 2102). The signs and
symptoms include cyanosis, lack of cough, dyspnea. This symptoms are caused by cognitive
impairment. The client is hydrated, hydration assist in moistening the secretions so as to make it
easy to expectorate. Advice the client to use diaphragmatic breathing through coughing
techniques this technique helps in facilitating ventilation and remove secretion without causing
fatigue. Administration of nebulizer this ensures the medication is properly delivered in the
airways. Execute a postural drainage during the night and the morning hours, gravity is used
during this process, this helps raise the secretion to make it easy for expectoration. Patient is
advised on avoiding irritants such as aerosols this irritants facilitate constriction of airways and
increase mucus secretion which blocks the air ways. The client is administered medication
example the bronchodilators, this drugs act by reducing airway resistance due to
bronchoconstriction. The client is advised on daily activity and ambulation. If the client is unable
to walk or if he is bed ridden turn the patient after every three hours. Daily activity facilitates the
mobility of secretion, immobility and supine position have been known to accelerate mucus
retention in the respiratory tract.
Ineffective tissue perfusion
Advice the patient on average walking, during muscular contractions are activated this enhances
blood flow to the tissue (Tanya, Sapha, & Patel, 2014). Advice the patient not to sit or stand for a
very long time. Too much sitting or standing enhances venous stasis. Conserve warm
temperatures, warmth enhances blood flow in the artery, this prevents vasoconstriction due to
cold (Raymond & Swenson, 2014). Advice the patient to avoid things that will cause him to be
under stress, stress causes vasoconstriction in the peripheral areas due to the sympathetic nervous
system. Encourage the patient to avoid on wearing tight clothes. Tight clothes block circulation

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and cause venous stasis. Council the patient on avoiding leg crossing during rest, log crossing
causes venous stasis by pressing the blood vessels. Administer adrenergic blocking agents and
vasodilators. The therapy regime helps in vasodilation of smooth muscles and the blockage
impulses originating from sympathetic nervous system. Discourage the use of nicotine, nicotine
has some side effects on the respiratory system, nicotine leads to the formation of vasospasms. In
case of an extreme level of ineffective tissue perfusion, advice the patient to get down the
extremities in a level below the heart, this mechanism of action enables prevents resistance and
enables easy blood flow in the arterial vessels (Ting, 2015).
Assessment
Impaired gaseous exchanged is assessed by checking for the respiration depth and rate so as to
check for hypoventilation in the alveolar. Breath sounds are auscultated so as to identify the
specific area with a decreased ventilation. The heart rate and rhythm is monitored go check for
any abnormalities on heart activities. The skin is assessed by checking for moisture and color,
skin pallor is a sign that there is hypoxemia. Assess for the clients performance during coughing,
check if he is able to cough out secretions since held secretions block gaseous exchange. Check
the client’s hydration condition. Too much hydration may impair gas exchange while decreased
hydration may increase the immobility of secretions.
Impaired tissue perfusion is accessed by checking the sites with tissue integrity impairment by
checking for itching, redness or swelling. Check for signs of reduced tissue perfusion. Evaluate
the leading factors that cause the abnormality in blood flow, Assess for breathing rate and
respiration activities, cardiac pump abnormality may result to respiratory distress. Assess for the
higher functions, check if the patient is alert and there is appropriate utterance of words, cerebral
imperfusion may result to impairment of speech. Check for the vital signs these include the blood

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pressure, respiration rate and temperature. In order for the tissues to have an adequate tissue
perfusion the blood pressure, respiration rate and temperature should be normal. Assess the
peripheral area by checking for the hemoglobin levels, decreased levels indicate a decreased
intake of oxygen. Assess the skin of the patient, check for skin texture for existence of ulcers or
hair. Dry skin with absence of hair or brittle nails indicate arterial insufficiency.
Ineffective airway clearance is accessed by checking for airway patency. Lungs are auscultated
for any abnormal sounds, example sound will be abnormal if there is accumulation of mucus in
the airways. Listen to breath sounds, absence of breath sounds may indicate presence of mucus.
Wheezing sounds signifies airway resistance, crackles signifies secretion in airways. Moisture
for any difference in mental status, an increase in restlessness or confusion may indicate the
presence of cerebral hypoxia.

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Reference
Brainerd, E. (2012). New perspectives on the evolution of lung ventilation mechanisms in
invertebrates. ". Experimental Biology Online. 4(2), 1-28.
Canet, E., Osman, D., & Lambert, J. (2015). Acute respiratory failure in kidney transplant
recipients: a multicenter study. crit car, 15(2), 91.
Khan, N., Palepu, A., & Norena, M. (2012). Differences in-hospital mortality among
critically ill patients of Asian, native Indian, and European descent. Chest, 134(6),
1217-1222.
Moss, M., & Mannino, D. (2013). Race and gender differences in acute respiratory distress
syndrome deaths in the United States: an analysis of multiple-cause mortality data.
Crit Care Med, 30(8), 1679-1685.
Noreanu, M., Breidthardt, T., Reichlin, T., & Gagat, E. (2014). Effect of oral beta-blocker on
short and long-term mortality in patients with acute respiratory failure: results from
the BASEL-II-ICU study. Crit care, 14(16), 198.
Phua, J., Badia, J., & Adhikar, N. (2012). Acute Respiratory Distress Syndrome Network.
Ventilation with lower tidal volumes as compared with traditional tidal volumes for
acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory
Distress Syndrome Network. N Engl J Med, 342(18), 1301-1308.
Raymond, H., & Swenson, E. (2014). The distribution and physiological significance of
carbonic anhydrase in vertebrate gas exchange organs. Respiratory dysfunction, 121,
45.
Robert, M., & Lester, T. (2102). Airway management. Pediatric Clinics of North America,
55(4), 873-876.

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Rudd, R., Seth, P., David, F., & Scholl, L. (2012). Increases in drug and opioid overdose
deaths--United States. MMWR Morb Mortal Wkly Rep, 78(4), 78.
Rudd, R., Seth, P., David, F., & Scholl, L. (2015). Increases in drug and opioid-Involved
overdose deaths. N Engl J Med, 25(3), 26.
Tanya, K., Sapha, A., & Patel, L. (2014). Surgical airway. International Journal of Critical
Illness and Injury Science, 23(2), 45-67.
Ting, I. (2015). Crassulacean acid metabolism. Annual review plant physiology, 36(1), 595-
602.