Diagnosis: Right-Sided Pneumonia Leading to Acute Respiratory Failure Diagnosis: Right-Sided Pneumonia Leading to Acute Respiratory Failure Question 1 Two days after Mr. Bukowski’s operation on the fractured right neck of femur, four key pieces of assessment data supporting the diagnosis of acute respiratory failure were observed. These includes abnormal respiration pattern, auscultation of breath sounds, measurement of arterial blood gases, and chest X-ray (CXR). The first key assessment data and the most observable symptom in the case of Mr. Bukowski is abnormal respiration pattern. The sympathetic nervous system is being stimulated by the increased carbon dioxide in the arterial blood, leading to increased heart rate and respiratory rate that helps the body to compensate for the hypercapnia and hypoxia (Smyth, 2005, 72).
This is demonstrated by the elevated respiratory rate of Mr. Bukowski two days after the operation which is 28 breaths per minute and the observance of deep and labored breathing pattern. There is indication that he has been experiencing limited chest expansion as evidenced by intercostal muscle recession thus, indicating also his right lung has collapsed and will not received enough ventilation (Higgins & Guest, 2008, 24).
The abnormal respiration pattern characterized by increased respiratory effort and collapsed of the right lung supports his diagnosis of Acute Respiratory Failure. In Mr. Bukowski’s case auscultation of breath sounds is the second key assessment data needed to support the diagnosis of acute respiratory failure. Kaynar & Shama (2010) indicate that the most common reason for respiratory failure is the mismatch in the ventilation/perfusion (V/Q) (n. p). Mr. Bukowski was diagnosed with pneumonia and includes physical findings such as crackles, rales, decreased intensity of breathing sounds and presence of rhonchi breathing sounds, and used of accessory muscles during respiration.
The presence of course crackles will lead to V/Q mismatch because course crackles in pneumonia indicate that he has existing secretions in the airway (Shackell & Gillespie, 2009, 18). Therefore, the contributing cause of respiratory failure in Mr. his case is diminished ventilation secondary to the presence of crackles and diminished entry sounds as revealed during the assessment process. The third key assessment data and the most definite indicator of acute respiratory failure is the measurement of arterial blood gases (ABG).
Acute respiratory failure is a state in which the respiratory system fails to perform the gas exchange function (Lightower, Vedzicha, Elliott & Ram, 2003, 185). The body fails to excrete carbon dioxide which leads to hypercapnea, a condition where the partial pressure of carbon dioxide (PaCO2) is more than 45mmHg (Delerme & Ray, 2008, 252; Mueller, 2008, 787).
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