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XI. PATHOPHYSIOLOGY
Medical Diagnosis

Acute Respiratory Failure secondary to COPD in Acute Exacerbations and Community Acquired Pneumonia- high-
risk

Definition

ARF is a common life threatening process with myriad causes. It is characterized by failure of oxygenation, or
ventilation, or both.
Precipitating
Schematic Diagram History of cigarette smoking
(starts at 17y.o & stops at
age 41y.o, 1pack/day)
Predisposing Occupational exposure
Age- 71 years old (missionary at Saudi Arabia
Hereditary- Asthma for 10 years now)
Low Immune System

Allergens enter the upper respiratory tract

Stimulation and activation of B Lymphocytes

B Lymphocytes produces Immunoglobulin E(IgE)

IgE antibodies attached to mast cells and basophils in the

bronchial walls
 Mast cells degranulation
Medication:
Hydrocortisone ( Solu- 29
Mast cells releases chemical mediators of inflammation
Cortef) 100mg IV q6H

Slow- reacting substance

Histamine bradykinin prostaglandins
anaphylaxis ( SRS- A)

Increase blood flow Increase mucus Chemical Contraction of the

to the area of insult production mediators induced bronchial smooth
capillary dilation muscles that encircles
the airway
Signs/ (bronchospasm)
symptoms: Edema of the
Crackles/Rales Deposition of
Attraction of WBC airway
Productive collagen below the
to the area Cough(whitish basement membrane
sputum in Airway constriction
minimal
or
amount)
Fluid shifting from bronchoconstriction Diagnostic Exam:
Chest X-ray
the vasculature
Minimal honeycomb
and to the alveoli Medication: changes in the
Medication:
NAC (Fluimucil) 600mg Salbutamol + ipratropium bases.
combivent Neb/ q6 Impression:
OD 1tab in 50mL H2O
Aminophylline Pulmonary
Side drip D5W 500cc at 15 emphysema,
Hyperinflation of gtts/min bilateral.
alveoli
Atherosclerosis
Narrowing of the airway thoracic aorta
Bronchiectasis both
Increase work of breathing
Decreased elastic recoil bases.

Increase resistance to airflow

Signs and
Fatigue of the muscles of symptoms:
ventilation Weak cough,
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Ventilation- Perfusion (V/Q)

Medication:
mismatch and shunt NAC(fluimucil) 600mg
1tab/ OD in 50 mL H2O

Inadequate exchange of O2 and CO2

Diagnostic Exam: Signs and symptoms:

Interventions: Hypoxemia ABG: O2: 99 % Tachycardia- 110bpm
>Oxygen Increase PaCO2 Paleness,BP- 140/80
administration Decrease PaO2 Capillary refill- 5
through mechanical Increase HCO3 Seconds,
ventilator attached Respratory Acidosis with fatigue,altered sleep
to ET Tube ACUTE RESPIRATORY adequate O2 pattern,
TV:500ml,RR:20cp FAILURE drowsiness,feeling of
m,FiO2:100%,AC physically drained
Mode
>Monitor pulse
oximetry
>Elevated head of
bed and advised to COMPLICATIONS:
sit-up in his bed. Tissue hypoxia
>Turned the client Recovery
Subsequent organ damage
on his side every 2 Chronic respiratory failure
hours. Tension pneumothorax
Lobar atelectasis
Death Pneumonia
Pulmonary edema

Medication:
Amiodarone (codarone)
200mg 1tab OD NGT
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Legend :

- Pathophysiology

Medications - signs/ symptoms

- Diagnostic Exams - complications

- Interventions