RESPIRATORY ARREST AND INSUFFICIENCY

DEFINITION

Respiratory failure is a syndrome of inadequate gas exchange due to dysfunction of one or more essential
components of the respiratory system:

 Chest wall

 Airways

 Alveolar- capillary units

 Pulmonary circulation

 Nerves

 CNS or brain stem

EPIDEMIOLOGY

About 360000 cases per year in the united states. 36% die during hospitalization.

CLASSIFICATION

 ACUTE RESPIRATORY FAILURE: Characterized by hypoxemia and hypercapnia and acidosis.

 CHRONIC RESPIRATORY FAILURE: Characterized by hypoxemia, hypercapnia with normal PH.

 COMBINED ACUTE AND CHRONIC RESPIRATORY FAILURE: Characterized by abrupt

increase in hypoxemia or hypercapnia with preexisting chronic respiratory failure

ETIOLOGY

 HYPOXEMIC RESPIRATORY FAILURE:

1. RESPIRATORY SYSTEM

 Acute respiratory distress syndrome

 Pneumonia

 Toxic inhalation

 Massive pulmonary emboli

 Alveolar injury

2. CARDIAC SYSTEM

 Anatomic shunt

 HYPERCAPNIC RESPIRATORY FAILURE

 1. RESPIRATORY SYSTEM

 Asthma

 COPD

2. CENTRAL NERVOUS SYSTEM

 Brainstem injury

 Sedative and opoid overdose

 Spinal cord injury

 Severe head injury

3. CHEST WALL

 Thoracic trauma

 Kyphoscoliosis

 Pain

 Severe obesity

4. NEUROMUSCULAR SYSTEM

 Myasthenia gravis

 poliomyelitis

PATHOPHYSIOLOGY

Allergen enter the upper respiratory tract

Stimulation and activation of B lymphocytes

B lymphocytes produces immunoglobulin E(IgE)

IgE antibodies attached to mast cells and basophils in the bronchial wall

Mast cells degeration

Mast cells releases chemical mediators of inflammation

Histamine Bradykinin Postaglandins

Hyperventilation of alveoli/Narrowing of the airway

Increase work of breathing

Fatigue of the muscles of ventilation

 Inadequate exchange of O2 and CO2

Hypoxemia

Acute respiratory failure

CLINICAL MANIFESTATIONS

Hypoxemic respiratory failure

1. respiratory • Dyspnea
• Tachypnea
• Prolonged expiration
• Cyanosis
2. Cerebral • Disorientation
• Restlessness
• Confusion
• Decrease level of consciousness
3.Cardiac • Tachycardia
• Hypertension
Hypercapnic respiratory failure

1.Respiratory • Dyspnea
• Decrease tidal volume
2.Cardiac • Hypertension
• Tachycardia
3.Cerebral • Morning headache
• Disorientation
• Increase ICP

DIAGNOSTIC EVALUATION

 History and physical examination:

 Past health history such as chronic lung disease, tobacco use

 History of use of any medication
 History of surgery
 History of patients activity level, nutritional status
 Assess the patients vital signs
 Monitor the mental states of the patient
 Arterial blood gases:

 ABGs determine the levels of PaCO2,PaO2, bicarbonate and PH.

 Pulse oxymetry : it monitors oxygenation status. Here decreasing SPO2
  Chest X ray: It helps to identify possible causes of respiratory failure.

 CBC

 Serum electrolytes

 ECG

 Blood and sputum cultures

TREATMENT

 Respiratory therapy

 o2 therapy: supplemental oxygen administered at 1 to 3 L/min by nasal cannula or 24% to 32% by face
mask.

 Mobilization of secretion

 Hydration and humidification

 Chest physiotherapy

 Positioning

 Positive pressure ventilation

 Drug Therapy

Goals of drug therapy are:

 Relief of bronchospasm

 Reduction of airway inflammation and pulmonary congestion

 Treatment of pulmonary infection

 Relief of bronchospasm: short acting bronchodilators- metoproterenol, albuterol

 Reduction of airway inflammation: corticosteroid used- methyleprednisolone

 Reduction of pulmonary congestion: IV diuretics- frusemide, morphine and nitroglycerine

 Treatment of pulmonary infections: antibiotics used

 Reduction of severe anxiety, pain, agitation: lorazepam, morphine, fentanyl used.

NURSING MANAGEMENT

Nursing assessment:

 Monitor closely and document complete assessments

 Perform thorough systematic assessment, including mental status, vital signs, respiratory states and
cardiovascular status
  Evaluate signs of hypoxia
 Notify appropriate health care provider of significant findings of hypoxia
 Determine vital capacity

NURSING DIAGNOSIS:

 Impaired gas exchange related to alveolar hypoventilation, intrapulmonary shunting and diffusion
impairment

Nursing Intervention:

 Administer oxygen to maintain Pao2

 Administer antibiotic cardiac medications and diuretics as ordered for underlying disorder
 Monitor fluid balance by intake output measurement, daily weight
 Provide measures to prevent atelectesis and promote chest expansion as ordered( incentive spirometer,
nebulization, head elevated 30 degrees)
 Compare, monitored values with criteria indicating need for mechanical ventilation

 Ineffective airway clearance related to excessive secretions, decreased level of consciousness, pain,
neuromuscular dysfunction

Nursing Intervention:

 Provide proper position to the patient( elevate head of the bed to 30 degrees)
 Chest physiotherapy provided
 Administer corticosteroids to reduce inflammation
 Deep breathing exercise provided to the patient

 Ineffective breathing pattern related to neuromuscular impairment of respirations, pain, anxiety,

decreased level of consciousness, respiratory muscle fatigue and bronchospasm.

Nursing Intervention:

 Assess the respiratory rate of the patient

 Provide proper position (semi fowler)
 Provide deep breathing exercise if patient is able to do
 Administer medication to treat underlying disease
 Administer 02 to the patient

 Anxiety related to fear of death

Nursing Intervention:

 Assess the level of anxiety

 Encourage patient to ventilate his/her feelings
 Provide knowledge regarding disease, its treatment, prevention
 Provide comfortable environment