Download Respiratory Failure

Focus on
Respiratory Failure
(Relates to Chapter 68,
“Nursing Management: Respiratory Failure
and Acute Respiratory Distress Syndrome,”
in the textbook)
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Acute Respiratory Failure
 Results from inadequate gas
exchange
 Insufficient

Hypoxemia
 Inadequate

O2 transferred to the blood
CO2 removal
Hypercapnia
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Gas Exchange Unit
Fig. 68-1
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Acute Respiratory Failure
 Not a disease but a condition
 Result of one or more diseases
involving the lungs or other body
systems
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Acute Respiratory Failure
 Classification
 Hypoxemic respiratory failure
 Hypercapnic respiratory failure
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Classification of Respiratory
Failure
Fig. 68-2
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Acute Respiratory Failure
 Hypoxemic respiratory failure
 PaO2 <60 mm Hg on inspired O2
concentration >60%
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Acute Respiratory Failure
 Hypercapnic respiratory failure
 PaCO2 above normal ( >45 mm Hg)
 Acidemia (pH <7.35)
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Range of V/Q Relationships
Fig. 68-4
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Hypoxemic Respiratory Failure
Etiology and Pathophysiology
 Causes
 Ventilation-perfusion (V/Q) mismatch
 COPD
 Pneumonia
 Asthma
 Atelectasis
 Pulmonary embolus
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Hypoxemic Respiratory Failure
Etiology and Pathophysiology
 Causes
 Shunt
 Anatomic shunt
 Intrapulmonary shunt
 An extreme V/Q mismatch
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Hypoxemic Respiratory Failure
Etiology and Pathophysiology
 Causes
 Diffusion limitation
 Severe emphysema
 Recurrent pulmonary emboli
 Pulmonary fibrosis
 Hypoxemia present during exercise
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Diffusion Limitation
Fig. 68-5
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Hypoxemic Respiratory Failure
Etiology and Pathophysiology
 Causes
 Alveolar hypoventilation
 Restrictive lung disease
 CNS disease
 Chest wall dysfunction
 Neuromuscular disease
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Hypoxemic Respiratory Failure
Etiology and Pathophysiology
 Interrelationship of mechanisms
 Combination of two or more
physiologic mechanisms
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Hypercapnic Respiratory Failure
Etiology and Pathophysiology
 Imbalance between ventilatory
supply and demand
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Hypercapnic Respiratory Failure
Etiology and Pathophysiology
 Airways and alveoli
 Asthma
 Emphysema
 Chronic bronchitis
 Cystic fibrosis
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Hypercapnic Respiratory Failure
Etiology and Pathophysiology
 Central nervous system
 Drug overdose
 Brainstem infarction
 Spinal chord injuries
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Hypercapnic Respiratory Failure
Etiology and Pathophysiology
 Chest wall
 Flail chest
 Fractures
 Mechanical restriction
 Muscle spasm
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Hypercapnic Respiratory Failure
Etiology and Pathophysiology
 Neuromuscular conditions
 Muscular dystrophy
 Multiple sclerosis
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Respiratory Failure
Tissue Organ Needs
 Major threat is the inability of the
lungs to meet the oxygen demands of
the tissues
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Respiratory Failure
Clinical Manifestations
 Sudden or gradual onset
 A sudden decrease in PaO2 or rapid
increase in PaCO2 indicates a serious
condition
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Respiratory Failure
Clinical Manifestations
 When compensatory mechanisms
fail, respiratory failure occurs
 Signs may be specific or nonspecific
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Respiratory Failure
Clinical Manifestations
 Severe morning headache
 Cyanosis
 Late sign
 Tachycardia and mild hypertension
 Early signs
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Respiratory Failure
Clinical Manifestations
 Consequences of hypoxemia and
hypoxia
 Metabolic
acidosis and cell death
 Decreased cardiac output
 Impaired renal function
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Respiratory Failure
Clinical Manifestations
 Specific clinical manifestations
 Rapid, shallow breathing pattern
 Tripod position
 Dyspnea
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Respiratory Failure
Clinical Manifestations
 Specific clinical manifestations
 Pursed-lip breathing
 Retractions
 Change in I:E ratio
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Respiratory Failure
Diagnostic Studies
 History and physical assessment
 ABG analysis
 Chest x-ray
 CBC, sputum/blood cultures, electrolytes
 ECG
 Urinalysis
 V/Q lung scan
 Pulmonary artery catheter (severe cases)
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Acute Respiratory Failure
Nursing and Collaborative Management
 Nursing Assessment

Health information
 Health history
 Medications
 Surgery
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Acute Respiratory Failure
Nursing and Collaborative Management
 Nursing Assessment

Functional health patterns
 Health perception–health management
 Nutritional-metabolic
 Activity-exercise
 Sleep-rest
 Cognitive-perceptual
 Coping–stress tolerance
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Acute Respiratory Failure
Nursing and Collaborative Management
 Nursing Assessment
 Physical assessment
 General
 Integumentary
 Respiratory
 Cardiovascular
 Gastrointestinal
 Neurologic
 Laboratory findings
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Acute Respiratory Failure
Nursing and Collaborative Management
 Nursing Diagnoses
 Impaired gas exchange
 Ineffective airway clearance
 Ineffective breathing pattern
 Risk for fluid volume imbalance
 Anxiety
 Imbalanced nutrition: Less than body
requirements
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Acute Respiratory Failure
Nursing and Collaborative Management
 Planning: Overall goals
 ABG values within patient’s baseline
 Breath sounds within patient’s
baseline
 No dyspnea or breathing patterns
within patient’s baseline
 Effective cough and ability to clear
secretions
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Acute Respiratory Failure
Nursing and Collaborative Management
 Prevention
 Thorough history and physical
assessment to identify at-risk
patients
 Early recognition of respiratory
distress
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Acute Respiratory Failure
Nursing and Collaborative Management
 Respiratory therapy
 Oxygen therapy: Delivery system
should
 Be tolerated by the patient
 Maintain PaO2 at 55 to 60 mm Hg or
more and SaO2 at 90% or more at
the lowest O2 concentration possible
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Acute Respiratory Failure
Nursing and Collaborative Management
 Respiratory therapy
 Mobilization of secretions
 Hydration and humidification
 Chest physical therapy
 Airway suctioning
 Effective coughing and positioning
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Augmented Cough
Fig. 68-6
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Acute Respiratory Failure
Nursing and Collaborative Management
 Respiratory therapy
 Positive pressure ventilation (PPV)
 Noninvasive PPV
 BiPAP
 CPAP
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Noninvasive PPV
Fig. 68-7
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Acute Respiratory Failure
Nursing and Collaborative Management
 Drug Therapy
 Relief of bronchospasm

Bronchodilators
 Reduction

Corticosteroids
 Reduction

of airway inflammation
of pulmonary congestion
Diuretics, nitrates if heart failure present
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Acute Respiratory Failure
Nursing and Collaborative Management
 Drug Therapy
 Treatment of pulmonary infections
 IV antibiotics
 Reduction of severe anxiety, pain, and
agitation
 Benzodiazepines
 Narcotics
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Acute Respiratory Failure
Nursing and Collaborative Management
 Nutritional Therapy
 Maintain protein and energy stores
 Enteral or parenteral nutrition
 Nutritional supplements
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Acute Respiratory Failure
Nursing and Collaborative Management
 Medical Supportive Therapy
 Treat the underlying cause
 Maintain adequate cardiac output and
hemoglobin concentration
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Acute Respiratory Failure
Gerontologic Considerations
 Physiologic aging results in
 ↓ Ventilatory capacity
 Alveolar dilation
 Larger air spaces
 Loss of surface area
 Diminished elastic recoil
 Decreased respiratory muscle strength
 ↓ Chest wall compliance
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Acute Respiratory Failure
Gerontologic Considerations
 Lifelong smoking
 Poor nutritional status
 Less available physiologic reserve
 Cardiovascular
 Respiratory
 Autonomic nervous system
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