Respiratory Failure

Siswoyo & Wantiyah

Resp Failure:one or both exchanging systems
is inadequate (air to lung or lung to blood)
Blood Supply to Lung
 Respiratory Failure
Not a disease process, sign of severe dysfunction
Predisposing Factors:
Airways/alveoli
CNS
Chest wall
Neuromuscular
Commonly defined in terms of ABGs:
PO2 of less than 60 mmHg
PCO2 greater than 45 mmHg
Arterial pH of less than 7.35
Classification of Respiratory Failure
Hypoxemic Respiratory Failure
Oxygenation failure- inadequate O2 transfer
between alveoli & pulmonary capillary bed
PaO2 60 mm Hg or less on 60 % O2
Inadequate O2 saturation of hemoglobin
Causes tissue hypoxia > Metabolic acidosis; cell
death; decreased CO; impaired renal function
Common causes: disorders that interfere with O2
transfer into the blood- respiratory or cardiac
system
Hypoxemic Respiratory Failure
Mechanisms that may lead to Hypoxemia:
1. Mismatch ventilation & perfusion (V/Q mismatch)
V/Q: Volume blood perfusing lungs each minute
Each ml of air for each ml of blood
1:1= V/Q ratio of 1
Causes of V/Q mismatch:
Ventilation portion blocked (secretions in
airway/alveoli, airway/alveolar collapse, decreased
movement chest/ventilation)
Perfusion portion blocked (pulmonary embolus)
Hypoxemic Respiratory Failure
Range of ventilation to perfusion (V/Q relationship)
A. Absolute shunt, no
ventilation fluid in alveoli
B. Ventilation partially
compromised- secretions
C. Normal lung unit
D. Perfusion partially
compromised by emboli
obstructing blood flow
E. Dead space: no
perfusion- obstruction of
pulmonary capillary
Hypoxemic Respiratory Failure
Mechanisms that may lead to Hypoxemia:
2. Shunt- Extreme V/Q mismatch
Occurs when blood
leaves heart without gas
exchange
Types:
1. anatomic shunt: O2
blood does not pass
through lungs
2. intrapulmonary shunt-
alveoli fill with fluid
Treatment: Mechanical
ventilation to force O2
into lungs; treat cause
Hypoxemic Respiratory Failure
Mechanisms may lead to Hypoxemia:
3. Diffusion limitations
Alveoli membrane
thickened or destroyed
Gas exchange across
alveolar-capillary
membrane cant occur
Classic sign: hypoxemia
present during exercise,
not at rest
Treat the cause such as
pulmonary fibrosis;
ARDS
Hypoxemic Respiratory Failure
Mechanisms may lead to Hypoxemia:
Clinical manifestations of hypoxemia
Specific: Respiratory:
Nonspecific: Cerebral, cardiac, other
Treatment: treat cause, O2 and mechanical
ventilation
Hypercapnic Respiratory Failure

Ventatory failure: Inability of the respiratory system to

ventilate out sufficient CO2 to maintain normal PaCO2
PaCO2 greater than 45 mm Hg, Arterial pH less than 7.35
PCO2 rises rapidly and respiratory acidosis develops,
PO2 drops more slowly
Common causes include disorders that compromise lung
ventilation and CO2 removal (airways/alveoli, CNS, chest
wall, neuromuscular)
Clinical manifestations: specific respiratory, nonspecific
of cerebral, cardiac, neuromuscular
Treatment: adeq O2, airway, meds, treat underlying cause,
nutrition
Collaborative Care for Respiratory Failure:
Diagnostic tests
History/physical assessment
Pulse oximetry
ABG analysis
Chest X-ray
CBC, sputum/blood cultures, electrolytes
EKG
Urinalysis
V/Q scan- if pulmonary embolism suspected
Hemodynamic monitor/pulmonary function tests
Collaborative care for Respiratory Failure
Respiratory Therapy
Main treatment- correct underlying cause & restore
adequate gas exchange in lung
Oxygen Therapy (Maintain PaO2 at least 60 mm Hg,
SaO2 90%)
Mobilization of secretions
Effective coughing & positioning
Hydration & humidification
Chest physical therapy
Airway suctioning
Positive pressure ventilation
Noninvasive positive pressure ventilation
Intubation with mechanical ventilation
Collaborative Care for
Respiratory Failure cont
Drug Therapy
Relief bronchospasm; reduce airway inflam and
pulmonary congestion; treat pulmonary infections;
reduce anxiety, pain
Medical supportive therapy
Treat underlying cause
Nutritional therapy
Enteral; parenteral
Protein and energy stores
Collaborative Care: Artifical airways-
tracheostomy and endotracheal tubes
Endotracheal tube
Taping and inline suctioning of an
endotracheal tube
 Exhaled C02 (ETC02) normal 35-45

Used when trying to wean

patient from a ventilator
Independent Lung Ventilation
Collaborative Care:
Mechanical Ventilation
Provide adeq gas
exchange
Criteria to put on vent
RR > 35-45
pCO2 >45
pO2 <50
Types- Positive, Neg
Types: Negative pressure ventilator
Types: Positive pressure mechanical
ventilation with endotracheal tube (PPV)
Complications/Nursing Care of
Positive Pressure Mechanical ventilation
Cardiovascular: decreased CO; inc intrathoracic pressure
Pulmonary: Barotrauma; Volutrauma; alveolar
hypoventilation/hyperventilation; ventilator-associated
pneumonia
Sodium and water imbalance
Neurological: impaired cerebral bl flow>IICP
Gastrointestional: stress ulcer/GI bleed; gas; constipation
Musculoskeletal: dec muscle tone; contractures; footdrop;
pressure ulcers from BR
Psychosocial: physical & emotional stress; fight vent
Other problems
when on mechanical ventilation
Machine disconnection or malfunction
Nutrition needs
Nursing assessment specific to
Respiratory Failure
Assess both airway and
lungs
Refer to hypoxic and
hypercapnic respiratory
failure symptoms
Data:
Subjective data
Objective data
Nursing Diagnoses
Impaired spontaneous ventilation
Impaired gas exchange r.t mismatch
perfusion-ventilation
Relevant Nursing Problems related to
Respiratory Failure
Prevention of acute respiratory failure
Nursing Care Plans
Gerontology considerations
Nursing Care Plans Mechanical ventilation
Suctioning procedure and oral care
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