Focus On Respiratory Failure: "Nursing Management: Respiratory Failure and Acute Respiratory Distress Syndrome,"

Focus on
Respiratory Failure
Nursing Management: Respiratory Failure
and Acute Respiratory Distress Syndrome,
Copyright 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Acute Respiratory Failure

Results from inadequate gas
exchange
Insufficient
Hypoxemia
Inadequate
O2 transferred to the blood

CO2 removal
Hypercapnia
Gas Exchange Unit
Fig. 68-1

Not a disease but a condition
Result of one or more diseases
involving the lungs or other body

systems

Classification
Hypoxemic respiratory failure
Hypercapnic respiratory failure
Classification of Respiratory
Failure
Fig. 68-2

Hypoxemic respiratory failure
PaO2 <60 mm Hg on inspired O2
concentration >60%

Hypercapnic respiratory failure
PaCO2 above normal ( >45 mm Hg)
Acidemia (pH <7.35)
Range of V/Q Relationships
Fig. 68-4
Hypoxemic Respiratory Failure

Etiology and Pathophysiology
Causes
Ventilation-perfusion (V/Q) mismatch
COPD
Pneumonia
Asthma
Atelectasis
Pulmonary embolus

Causes
Shunt
Anatomic shunt
Intrapulmonary shunt
An extreme V/Q mismatch

Causes
Diffusion limitation
Severe emphysema
Recurrent pulmonary emboli
Pulmonary fibrosis
Hypoxemia present during exercise
Diffusion Limitation
Fig. 68-5

Causes
Alveolar hypoventilation
Restrictive lung disease
CNS disease
Chest wall dysfunction
Neuromuscular disease

Interrelationship of mechanisms
Combination of two or more
physiologic mechanisms
Hypercapnic Respiratory Failure

Imbalance between ventilatory
supply and demand

Airways and alveoli
Asthma
Emphysema
Chronic bronchitis
Cystic fibrosis

Central nervous system
Drug overdose
Brainstem infarction
Spinal chord injuries

Chest wall
Flail chest
Fractures
Mechanical restriction
Muscle spasm

Neuromuscular conditions
Muscular dystrophy
Multiple sclerosis
Respiratory Failure
Tissue Organ Needs
Major threat is the inability of the
lungs to meet the oxygen demands of

the tissues
Respiratory Failure
Clinical Manifestations
Sudden or gradual onset
A sudden decrease in PaO2 or rapid
increase in PaCO2 indicates a serious

condition
Respiratory Failure
When compensatory mechanisms
fail, respiratory failure occurs

Signs may be specific or nonspecific
Respiratory Failure
Severe morning headache
Cyanosis
Late sign
Tachycardia and mild hypertension

Early signs
Respiratory Failure
Consequences of hypoxemia and
hypoxia
Metabolic
acidosis and cell death

Decreased cardiac output
Impaired renal function
Respiratory Failure
Specific clinical manifestations
Rapid, shallow breathing pattern
Tripod position
Dyspnea
Respiratory Failure
Specific clinical manifestations
Pursed-lip breathing
Retractions
Change in I:E ratio
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)

Nursing and Collaborative Management
Nursing Assessment
Health information
Health history
Medications
Surgery

Nursing Assessment
Functional health patterns

Health perceptionhealth management
Nutritional-metabolic
Activity-exercise
Sleep-rest
Cognitive-perceptual
Copingstress tolerance

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

Nursing Diagnoses
Impaired gas exchange
Ineffective airway clearance
Ineffective breathing pattern
Risk for fluid volume imbalance
Anxiety
Imbalanced nutrition: Less than body
requirements

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

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

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

Respiratory therapy
Mobilization of secretions
Hydration and humidification
Chest physical therapy
Airway suctioning
Effective coughing and positioning
QuickTime an d a
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Augmented Cough
Fig. 68-6

Respiratory therapy
Positive pressure ventilation (PPV)
Noninvasive PPV
BiPAP
CPAP
Noninvasive PPV
Fig. 68-7

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

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

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

Medical Supportive Therapy
Treat the underlying cause
Maintain adequate cardiac output and
hemoglobin concentration

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

Gerontologic Considerations
Lifelong smoking
Poor nutritional status
Less available physiologic reserve
Cardiovascular
Respiratory
Autonomic nervous system

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Focus on

Acute Respiratory Failure

O2 transferred to the blood

Gas Exchange Unit

Acute Respiratory Failure

involving the lungs or other body

Acute Respiratory Failure

Acute Respiratory Failure

Acute Respiratory Failure

Range of V/Q Relationships

Hypoxemic Respiratory Failure

Hypoxemic Respiratory Failure

Hypoxemic Respiratory Failure

Hypoxemic Respiratory Failure

Hypoxemic Respiratory Failure

Hypercapnic Respiratory Failure

supply and demand

Hypercapnic Respiratory Failure

Hypercapnic Respiratory Failure

Hypercapnic Respiratory Failure

Hypercapnic Respiratory Failure

lungs to meet the oxygen demands of

increase in PaCO2 indicates a serious

fail, respiratory failure occurs

Tachycardia and mild hypertension

acidosis and cell death

CBC, sputum/blood cultures, electrolytes

Acute Respiratory Failure

Acute Respiratory Failure

Functional health patterns

Acute Respiratory Failure

Acute Respiratory Failure

Acute Respiratory Failure

Acute Respiratory Failure

Acute Respiratory Failure

Acute Respiratory Failure

Acute Respiratory Failure

Acute Respiratory Failure

Diuretics, nitrates if heart failure present

Acute Respiratory Failure

Acute Respiratory Failure

Acute Respiratory Failure

Acute Respiratory Failure

Acute Respiratory Failure

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