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Focus on
Respiratory Failure
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Acute Respiratory Failure
Results from inadequate gas
exchange
Insufficient O
2
transferred to the blood
Hypoxemia
Inadequate CO
2
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
PaO
2
<60 mm Hg on inspired O
2

concentration >60%
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Acute Respiratory Failure
Hypercapnic respiratory failure
PaCO
2
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 PaO
2
or rapid
increase in PaCO
2
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 Assessment
Health information
Health history
Medications
Surgery
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Acute Respiratory Failure

Nursing Assessment
Functional health patterns
Health perceptionhealth management
Nutritional-metabolic
Activity-exercise
Sleep-rest
Cognitive-perceptual
Copingstress tolerance
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Acute Respiratory Failure

Nursing Assessment
Physical assessment
General
Integumentary
Respiratory
Cardiovascular
Gastrointestinal
Neurologic
Laboratory findings
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Acute Respiratory Failure

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

Planning: Overall goals
ABG values within patients
baseline
Breath sounds within patients
baseline
No dyspnea or breathing patterns
within patients baseline
Effective cough and ability to clear
secretions
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Acute Respiratory Failure

Prevention
Thorough history and physical
assessment to identify at-risk
patients
Early recognition of respiratory
distress
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Acute Respiratory Failure

Respiratory therapy
Oxygen therapy: Delivery system
should
Be tolerated by the patient
Maintain PaO
2
at 55 to 60 mm Hg or
more and SaO
2
at 90% or more at
the lowest O
2
concentration possible
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Acute Respiratory Failure

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

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

Drug Therapy
Relief of bronchospasm
Bronchodilators
Reduction of airway inflammation
Corticosteroids
Reduction of pulmonary congestion
Diuretics, nitrates if heart failure present

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Acute Respiratory Failure

Drug Therapy
Treatment of pulmonary infections
IV antibiotics
Reduction of severe anxiety, pain, and
agitation
Benzodiazepines
Narcotics

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Acute Respiratory Failure

Nutritional Therapy
Maintain protein and energy stores
Enteral or parenteral nutrition
Nutritional supplements
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Acute Respiratory Failure

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