Acute Respiratory Failure

Prepared By
Dr/ Shimaa Abd Elhady Badawy
Domain No 1. Professional and Ethical Practice
Competency Key elements Subjects objectives Teaching Medi Assessment
Methods a methods
used

1.1 Demonstrate  List classifications

knowledge, 1.1.1Demonstrate of respiratory  Oral
understanding, understanding of
responsibility and failure exam
the legislative
accountability of framework and the  Writte
the legal role of the nurse  Explains clinical  On line  Pow n exam
obligations for learning on er
and its regulatory manifestations of  Clinica
ethical nursing telegram poin
functions. respiratory failure l exam
practice.  lecture t
 List factors Presen
 Brain tatio
affecting severity storming n
of Asphyxia
 Supervised
clinical
1.1.2 Apply value practice
 Identify the role sessions
statements in
nurses’ code of of nurse
ethics and
 Apply nursing
professional  Case study
conduct for ethical intervention for
decision-making. respiratory failur
Content Outline
• Introduction
• Definition
• Classification
• Causes
• Diagnostic Evaluation
• Clinical manifestations
• Therapeutic Management
• Nursing intervention
• Follow up activities
 Introduction
• Effective pulmonary gas exchange requires clear
airways, normal lungs and chest wall, and adequate
pulmonary circulation. Anything that affects these
functions or their relationships can compromise
respiration. In general, the term respiratory
insufficiency is applied to two situations:
(1) when there is increased work of breathing but gas
exchange function is near normal
(2) when normal blood gas tensions cannot be
maintained and hypoxemia and acidosis develop
secondary to carbon dioxide retention.
• It is the primary diagnosis in 50% of children
admitted to PICUs. Approximately 36% of
patients die during hospitalization. Respiratory
failure can occur as an emergency or may be
preceded by gradual and progressive
deterioration of respiratory function.
 Definition

• Respiratory failure is defined as the

inability of the respiratory system to
maintain adequate oxygenation of the
blood with or without carbon dioxide
retention. Which can lead to hypoxemia or
hypercapnia
Classification
• Type I: Hypoxemic respiratory failure is characterized
by an arterial oxygen tension (Pa O2) lower than 60
mm Hg with a normal or low arterial carbon dioxide
tension (Pa CO2). This is the most common form of
respiratory failure.
• Type II: Hypercapnic respiratory failure is
characterized by a PaCO2 higher than 45 mm Hg.
• Hypoxemia is common in patients with hypercapnic
respiratory failure who are breathing room air. The
pH depends on the level of bicarbonate, which, in
turn, is dependent on the duration of hypercapnia.
• 3- Type III:( Perioperative Respiratory failure)
is subtype of type I and result from lung or
alveolar atelectasis
 Causes of respiratory failure:
• 1- Common causes of type I (hypoxemic)
respiratory failure include the following:
• Chronic obstructive pulmonary disease COPD
• Pneumonia
• Pulmonary edema
• Pulmonary fibrosis
• Asthma
• Pulmonary embolism
• Pulmonary arterial hypertension
• Cyanotic congenital heart disease
• Acute respiratory distress syndrome (ARDS)
• Obesity
 2- Common causes of type II (hypercapnic)
respiratory failure include the following:
• COPD • Head and cervical cord

• Severe asthma injury

• Drug overdose • Obesity-hypoventilation

• Poisonings syndrome
• Myasthenia gravis • Pulmonary edema
• Poliomyelitis
• ARDS

• Tetanus
 Diagnostic Evaluation
• The diagnosis of respiratory failure is determined by
the combined application of 3sources ofinformation:
1. Presence or history of a condition that might
predispose the patient to respiratory failure
2. Observation of respiratory failure
3. Measurement of ABGs, including pH
• Nursing observation and judgment are vital to the
recognition and early management of respiratory
failure.
• Nurses must be able to assess a situation and initiate
appropriate action within moments ( Signs of
respiratory failure).
 Clinical Manifestations

• Cardinal Signs
• Restlessness
• Tachypnea
• Tachycardia
• Diaphoresis
• Early but Less Obvious Signs
• Mood changes, such as euphoria or depression

• Headache

• Altered depth and pattern of respirations

• Hypertension

• Exertional dyspnea

• Anorexia

• Increased cardiac output and renal output

• CNS symptoms (decreased efficiency, impaired
judgment, anxiety, confusion, restlessness,
irritability, depressed level of consciousness)

• Flaring nares

• Chest wall retractions

• Expiratory grunt

• Wheezing or prolonged expiration

• Signs of More Severe Hypoxia
• Hypotension or hypertension
• Altered vision
• Somnolence
• Stupor
• Coma
• Dyspnea
• Depressed respirations
• Bradycardia
• Cyanosis, peripheral or central
• CNS, Central nervous system.
 Therapeutic Management
• The interventions used in the management of
respiratory failure are often dramatic, requiring
special skills and emergency procedures.
• If respiratory arrest occurs, the primary
objectives are to recognize the situation and
immediately initiate resuscitative measures,
such as Opening the airway, Positioning,
Administering supplemental oxygen and
positive pressure ventilation, and
Cardiopulmonary resuscitation (CPR).
• When the situation is not an arrest, the
suspicion of respiratory failure is
confirmed by assessment; the severity
may be defined by ABG analysis.
• Interventions such as administering
supplemental oxygen, positioning,
stimulation, suctioning, CPAP, BiPAP, or
early intubation may avert an arrest.
• When the severity is established, an attempt is made
to determine the underlying cause by
thorough evaluation. The principles of
management are to
• Maintain ventilation and maximize oxygen
delivery
• Correct hypoxemia and hypercapnia,
• Treat the underlying cause
• Minimize extrapulmonary organ failure.
• Apply specific and nonspecific therapy to
control oxygen demands
• Anticipate complications.
• Monitoring the patient's condition closely is
critical.
 Nursing Care Management
For families whose child has a respiratory arrest, support is
aimed at keeping the family informed of the child's status
and helping them cope with a near-death experience or an
actual death
Traditionally, family members are not allowed to be present
during resuscitation efforts. However, studies indicate that
family presence during emergencies alleviates the family's
anger about being separated from the patient during a
crisis, reduces their anxiety, eliminates doubts about what
was done to help the patient, and facilitates the grieving
process if the patient dies (Meert, Clark, and Eggly, 2013).
• Nurses must consider the needs, fears, and
concerns of family members during CPR.
• If family presence is not permitted during CPR,
nurses should arrange for someone to remain
with the family.
• After the child's recovery or death, the family
will continue to need support and thorough
medical information regarding lifesaving
measures, the prognosis if the child survives,
and the cause of death if the child dies.
 Nursing Diagnoses
• Impaired gas exchange
• Ineffective airway clearance
• Ineffective breathing pattern
• Imbalanced nutrition: Less than body
requirements
• Anxiety
• Risk for infection
 Nursing Intervention
• Monitor respiratory status for rate, effort,
use of accessory muscles, sputum
production, and breathe sounds.
• Monitor pulse oximetry to check oxygen
saturation levels and notify for < 90%
• Monitor sputum for changes in color
and amount.
• Monitor vital signs for changes.
• Place patient in high Fowler’s or semi-
Fowler’s position on bed rest to eliminate
respiratory effort by allowing optimal
diaphragmatic excursion.
• Change patient position every 2 hours to decrease chance
of skin breakdown.
• Monitor intake and output of fluids to check for balance.
Explain to the patient:
• The importance of doing coughing and deep-breathing
exercises to fully expand lungs and enhance the expelling
of mucous.
• How to identify the signs of respiratory distress.
• Provide emotional support to the client and family
members.
• Provide teaching in order to provide sufficient care at
home and to prevent future incidence.
 Nursing Evaluation

• Maintains adequate gas exchange.

• Alleviation of pain and discomfort.
• Maintains adequate airway clearance and
effective breathing patterns.
• Maintains adequate nutritional status.
• Absence of infection and complication.