Respiratory Failure Medical Conditions - Research Paper Example

? Respiratory Failure Respiratory Failure Medical Conditions Introduction While it is not a disease per se, respiratory failure occurs as a result of a myriad of other health condition that interferes with the normal capacity to breathe. The respiratory system serves to facilitate adequate supply of oxygen to the blood and subsequent expulsion of carbon dioxide. This process marks the respiratory cycle that consists of inhalation and exhalation during which gaseous exchange occurs in the lungs. It is important to note that respiratory failure occurs when the ability to take up oxygen or eliminate carbon dioxide is largely impaired. The cessation of these active processes indicates the severity of the patient’s condition, which results in mechanical interventions to sustain life (Hu et al, 2009). The use of medical interventions such as mechanical ventilation is subject to debate based on the ethical nature of the application. Opponents and proponents alike present heavy and valid arguments to oppose or support their position. With this in mind, this paper seeks to explore various aspects of respiratory failure include pathophysiological changes in the affected organs. Moreover, the paper explores ethical issues surrounding the use of mechanical intervention to restore respiratory functions to the affected patient. As already established, respiratory failure occurs following the incapacitation of one or both of the gas-exchanging processes; that is oxygenation of venous blood and/or removal of carbon dioxide. Respiratory failure may be acute or chronic where the clinical presentation of each is different. Acute respiratory failure is usually characterised by life-threatening levels in blood gases resulting imbalanced acid-base status while chronic respiratory failure is more passive and bears unapparent clinical manifestations. Numerous underlying factors contribute to respiratory failure with each part of the body system resulting in a distinct type of failure. In essence, failure of the lungs owing to pneumonia, emphysema among other lung diseases, results in hypoxemia or type I respiratory failure. Similarly, failure of respiratory controllers such as the chest wall and muscles leads to hypoventilation and hypercapnia or type II respiratory failure. The two conditions may coexist as illustrated in patients with chronic obstructive pulmonary disease, severe pulmonary oedema, or asthma. Owing to numerous underlying factors that contribute to respiratory failure, the condition has emerged among the major causes of illness and death in the United States. The high prevalence of chronic respiratory conditions serves to enhance the risk of respiratory failure, which in turn leads to loss of productivity and shortened lives. However, it has been difficult to define mortality rates related to respiratory failure since the underlying conditions are indicated in such cases. The effects of chronic diseases become widespread much earlier, and can be felt as strain to a country’s economic development, which affects the low and middle income countries because chronic disease creates a double burden besides infectious diseases. Increased prevalence of chronic diseases is seen as an underlying cause of poverty, which hinders development in most countries. According to World Health Organization (WHO), approximately 16 million deaths occur each year in people under the age of 70, which the working and income-generating class. This nullifies the notion that only the aged are affected. Hypothetical Scenario A patient complains of heightened fatigue and shortness of breath after undertaking in relatively light duties. The patient indicated no breathing problems while at rest. However, the patient was not well rested following a night’s sleep and the morning were characterised by persistent headaches. Patient’s history illustrated a severe trauma to the head and chest in a car accident a few years ago. The patient also indicated that he was a moderate smoker taking less than a pack a day. A physical examination revealed diminished chest wall movement suggesting weakness in the respiratory muscles. Diagnostic investigations revealed that the patient’s pulmonary function was sharply affected due to the inability to sustain a maximal breathing volume. Analysis of blood gases using ABG illustrated significant abnormalities with high carbon dioxide levels and low oxygen. The abnormalities noted can be associated with morning headaches owing to the high levels of carbon dioxide, which serve to increase pressure in the brain. This is a classic case of the development of chronic respiratory failure following progressive neuromuscular condition. For the purposes of effective management of the chronic condition, the patient was advised on the effects of smoking and the risk posed under the current situation. In efforts to normalise the blood gases levels, a ventilator was prescribed for use at night to improve the sleeping problem (Amanda, 2010). Signs and Symptoms Respiratory failure is characterised by a myriad of signs and symptoms of which most relate to difficulty in breathing. Early signs include an increased respiratory and heart rates as the body tries to compensate for the diminishing capacity, which results in grunting, retractions, and nasal flaring. Besides a pale skin, patients demonstrate a delayed capillary refill. As the condition progresses, the patient experiences severe retractions, decreased chest movements, and diminishing breath sounds on auscultation. At this stage, level of consciousness is depressed and the patient’s extremities begin to cool. Cyanosis is definitive of late signs of respiratory failure where peripheral pulses are markedly absent. Prior to respiratory failure, there are episodes of apnea accompanied by bradycardia and hypotension. Pathophysiological Changes The pathophysiology of respiratory failure is demonstrated differently in accordance to the classification. Consequently, different organs are affected by the pathophysiological mechanisms that account for various types of respiratory failure. Type I, hypoxemic failure is associated with ventilation/perfusion inequality, increased shunt, and alveolar hypoventilation. The organ of interest in this case is the lung and its functional components whose inadequacies coupled with other factors contribute to respiratory distress. In the event of decreased ventilation to regions that are normally perfused or vice versa results in abnormal ventilation/perfusion ratio, and thus hypoxemia. Increased shunts are characteristic of congenital heart diseases resulting in venous admixture, which is common in patients with pulmonary oedema. Hypoventilation occurs when the demand of oxygen is higher than the rate of replenishing the same causing the concentration of alveolar carbon dioxide to rise. Interventions to relieve this involve supplementing inspired oxygen to meet the deficit where the administration is done in modality to overcome the distress. Type II or hypercapnic respiratory failure results following insufficiency in the exchange or removal of carbon dioxide from the alveolar. This type of respiratory insufficiency is attributed to failures in the ventilator pump such that there is inadequate output by the respiratory centres. This follows mechanical or functional defects of the chest wall that contributes weakened respiratory muscles that fail to respond effectively to stimulation (“Respiratory Failure” n.d.). The central nervous system (CNS) controls respiration and muscular dystrophies and myopathies of the chest cavity result in hypoventilation of the brain. This may result from an underlying condition involving head trauma, anaesthesia, or CNS infection. Under normal circumstances, CNS transmissions with regard to respiration are transferred relevant muscles via the spinal cord and peripheral nerves. As such, any disorder that hinders functional adequacy of this pathway, results in insufficient activity of the chest cavity, which is essential in regulating intrathoracic pressure. Similarly, mechanical defects of the chest wall are predisposing entities to alveolar hypoventilation. Notably, pathological effects resulting in acute carbon dioxide retention can be associated with functional defects of the CNS, impairment of neuromuscular transmission, and mechanical defects of the chest cavity. The Impact of Care on Healthcare in General and Nursing The much-needed intervention that is mechanical ventilation has a valid number of impacts on the health care sector as a whole, and others limited to nursing care. The first aspect is based on government funding of the public healthcare system where a significant amount of the gross domestic product in the entire country is spent on healthcare. However, as the prevalence underlying chronic respiratory conditions continues to increase at rapid rate, the already thinly stretched budget is strained further. As a result, the economy is negative affected owing to additional allocations to the health sector, resources that could have been otherwise used to cater for other development projects. High prevalence of conditions leading to respiratory failure hold the capacity to influence the quality of one life in the society. This is evidenced by decreased productivity at national levels leading to loss of the work force. A wide majority of patients at risk of respiratory failure since most are exposed to various risk factors and are diagnosed at later stages of the condition. Moreover, patients have to cater for much of their treatment since not all insurance policies cater for progressed chronic illnesses. This contributes to the loss of productivity as a large proportion of funds are directed towards healthcare for treatment of previously avoidable diseases. In most cases, mechanical ventilation is required for patients with end stage respiratory failure caused underlying conditions such as asthma, lung cancer, cardiogenic shock among others. This provides a unique opportunity for medical personnel, especially nurses to learn as they perform their duties. Duty of care seeks to stress the need for selflessness among healthcare personnel, especially those involved in providing direct basic care to patients. Consequently, nurses are placed at a patient’s personal service through expression of kindness, moral worth, and dignity of the self and others. This is irrespective of one’s cultural similarities and differences, thus placing more value on accessibility of health care services to all. In addition, duty of care adds value towards an informed decision-making, which examines the meaning and implication of information provided to them. Debate The most difficult ethical decision facing patients and their families relates to the choice of prolonging life or ending based prognostic outcomes. This is especially so if the condition has a fast progression rate as in the case of lung cancer or is incurable such as neuromuscular conditions. With this in mind, patients and their next of kin make their decisions based on financial implications, psychological impacts, and the hope of new interventions. Patients with end stage respiratory failure may consider dying on their own terms and call for the withdrawal of mechanical interventions when their conditions worsens. However, promising research towards alternative interventions facilitates hesitation from affected patients leading to confusion and conflict. The conflict emanates from religious beliefs, which stand firm against taking one’s life and state that only God has the power to do so. These are among issues that a patient and the immediate family must address to provide guidelines to end life. For long, these matters have been the points of concern even for medical professionals who are charged with the uphill task of caring for terminally ill. The main concern lies with the conflict that lies between the code of conduct in the profession and societal moral with regard to termination of life. In essence, it lies squarely on medical professional to preserve life and act in the best interest of the patient. As the debate to the end lives of patients with end stage respiratory illnesses, it is prudent to stand for interventions aimed at restoring a patient’s respiratory functions. Numerous principles guide the process of allocating mechanical interventions where the biomedical ethics are adhered to in order to serve the needs of the patient. When an adult patient of sound mind is provided with the necessary information, he/she bears the capacity to make a sound decision on when to withdraw intervention. Medical professionals should consider the beneficence of the intervention while shelving personal or institutional interests in the alternative (CDC, 2011). This serves to ensure that necessary measures are taken to cater for the needs of the patient by ensuring maximum comfort. However, the provision of such information should be impartial and reflect on the truth without any alterations. Conveyance of inaccurate information normally raises the expectations of patients and is subject to public scrutiny fuelling concerns on professionalism. Moreover considered is patient’s financial capabilities, which ensures that resources are distributed effectively without causing strain to the immediate family. Such decisions are often within family resolution and upon consensus, care providers can chart the way forward. The administration services to restore respiratory functions are also subject to availability of the resources at the said institution. Notably, the scarcity of the much needed facilities raises an ethical dilemma on how best to distribute the limited resources and how best to ensure fairness in the process. Responsibilities that revolve around distribution of such resources can be delegated to independent institutions, as is the case of transplantation board. The proper administration and oversight of all ethical hurdles facilitates accountability, which work to enhance the quality of life of terminally ill patients. Having addressed ethical and moral issues, mechanical interventions to restore normal functions to the respiratory system are an effective way of improving the quality of life for the patients and thus, are recommended. Moreover, non-invasive mechanical interventions have been demonstrated to reduce the rate of failure of other methods of oxygen therapy such as the use of steroids and bronchodilators (McBrien, 2009). References CDC (2011). Ethical Considerations for Decision Making Regarding Allocation of Mechanical Ventilators during a Severe Influenza Pandemic or Other Public Health Emergency. Retrieved from http://www.cdc.gov/about/advisory/pdf/VentDocument_Release.pdf Hu et al (2009). Incidence, management and mortality of acute hypoxemic respiratory failure and acute respiratory distress syndrome from a prospective study of Chinese paediatric intensive care network. Acta P?diatrica 99, pp. 715–721. McBrien, B (2009). Non-invasive ventilation: A nurse-led service. Emergency Nurse Vol 17, No 6, pp. 30-35. Amanda, P (2010). Nocturnal hypoventilation -- identifying & treating syndromes. Indian J Med Res 131, February 2010, pp 350-365 “Respiratory Failure” (n.d.). Retrieved from http://www.thoracic.org/education/breathing-in-america/resources/chapter-20-respiratory-failure.pdf Read More