Honey Bee S.

Platolon Date: 10/15/2022

NSG 128 (ER)

ACUTE RESPIRATORY FAILURE

I- DEFINITION

Acute respiratory failure occurs when fluid builds up in the air sacs in your lungs.
When that happens, your lungs can’t release oxygen into your blood. In turn, your
organs can’t get enough oxygen-rich blood to function. You can also develop acute
respiratory failure if your lungs can’t remove carbon dioxide from your blood.

Respiratory failure happens when the capillaries, or tiny blood vessels, surrounding
your air sacs can’t properly exchange carbon dioxide for oxygen. The condition can be
acute or chronic. With acute respiratory failure, you experience immediate symptoms
from not having enough oxygen in your body. In most cases, this failure may lead to
death if it’s not treated quickly.

II- 4 TYPES OF ACUTE RESPIRATORY FAILURE

1. Type 1 (Hypoxemic) - also known as “oxygen failure”, is categorized by a

low level of oxygen in the blood without an increased level of carbon dioxide
in the blood. Type I respiratory failure is typically caused when the volume of
air flowing in and out of the lungs is uneven with the flow of blood to the
lungs. PO2 < 50 mmHg on room air. Usually seen in patients with acute
pulmonary edema or acute lung injury. These disorders interfere with the
lung's ability to oxygenate blood as it flows through the pulmonary
vasculature.

2. Type 2 (Hypercapnic/ Ventilatory) - also known as “ventilatory failure,”

takes place when alveolar ventilation is unable to efficiently remove carbon
dioxide from the blood, causing it to build-up in the body. PCO 2 > 50 mmHg (if
not a chronic CO2 retainer). This is usually seen in patients with an increased
work of breathing due to airflow obstruction or decreased respiratory system
 compliance, with decreased respiratory muscle power due to neuromuscular
disease, or with central respiratory failure and decreased respiratory drive.

3. Type 3 (also called perioperative respiratory failure) This is generally a

subset of type 1 failure but is sometimes considered separately because it is
so common. General anesthesia can cause collapse of dependent lung
alveoli. Patients most at risk for type 3 respiratory failure are those with
chronic lung conditions, excessive airway secretions, obesity, immobility, and
tobacco use, as well as those who’ve had surgery involving the upper
abdomen. Type 3 respiratory failure also may occur in patients experiencing
shock, from hypoperfusion of respiratory muscles. Normally, less than 5% of
total cardiac output flows to respiratory muscles. But in pulmonary edema,
lactic acidosis, and anemia (conditions that commonly arise during shock), up
to 40% of cardiac output may flow to the respiratory muscles.

4. Type 4 (Shock) - secondary to cardiovascular instability.

III- PATHOPHYSIOLOGY
 IV- LABORATORY PROCEDURES

1. ARTERIAL BLOOD GAS (ABG): An arterial blood gas analysis (ABG) measures
the balance of oxygen and carbon dioxide in your blood to see how well your
lungs are working. It also measures the acid-base balance in the blood. Your
kidneys and lungs work to keep your acid-base levels in balance. You need this
for the enzyme systems in your body to work at their best. When there is an
imbalance, your blood has too much acid (acidosis) or too much base (alkalosis).
Untreated, the imbalance can be harmful and even life-threatening.

2. CHEST X-RAY: A chest X-ray is an imaging test that uses X-rays to look at the
structures and organs in your chest. It can help your healthcare provider see how
well your lungs and heart are working. Certain heart problems can cause
changes in your lungs. Certain diseases can cause changes in the structure of
the heart or lungs.

3. ELECTROCARDIOGRAM: An electrocardiogram (ECG or EKG) is one of the

simplest and fastest tests used to evaluate the heart. Electrodes (small, plastic
patches that stick to the skin) are placed at certain spots on the chest, arms, and
legs. The electrodes are connected to an ECG machine by lead wires. The
electrical activity of the heart is then measured, interpreted, and printed out. No
electricity is sent into the body.

4. PULSE OXIMETER: Pulse oximetry is a test used to measure the oxygen level
(oxygen saturation) of the blood. It's an easy, painless measure of how well
oxygen is being sent to parts of your body furthest from your heart, such as the
arms and legs. A clip-like device called a probe is placed on a body part, such as
a finger or ear lobe. The probe uses light to measure how much oxygen is in the
blood. This information helps the healthcare provider decide if a person needs
extra oxygen.

V- SURGICAL MANAGEMENT:
Surgery may be necessary depending on the severity of your respiratory failure
and its underlying cause. Possible surgical interventions include:

 Lung transplantation- A lung transplant is a surgical procedure to replace a

diseased or failing lung with a healthy lung, usually from a deceased donor. A
lung transplant is reserved for people who have tried medications or other
treatments, but their conditions haven't sufficiently improved.
  Tracheostomy- an operation that creates a hole in the front of your neck and
into your windpipe. A tube is usually inserted into the opening to form an artificial
airway to improve breathing and remove lung secretions.

VI- MEDICAL MANAGEMENT:

Your doctor may prescribe medicines to improve your symptoms or treat

the cause of your respiratory failure.

 Antibiotics can treat bacterial lung infections such as pneumonia.

 Bronchodilators work by opening your airways.
 Corticosteroids control inflammation in the airways.

VII- NURSING MANAGEMENT:

Nursing care can have a tremendous impact in improving efficiency of the patient’s
respiration and ventilation and increasing the chance for recovery. To detect changes in
respiratory status early nurse should:

 Assess the patient’s tissue oxygenation status regularly. Evaluate ABG results
and indices of end-organ perfusion. Keep in mind that the brain is extremely
sensitive to O2 supply; decreased O2 can lead to an altered mental status. Also,
know that angina signals inadequate coronary artery perfusion. In addition, stay
alert for conditions that can impair O2 delivery, such as elevated temperature,
anemia, impaired cardiac output, acidosis, and sepsis.

 As indicated, take steps to improve V/Q matching, which is crucial for improving
respiratory efficiency. To enhance V/Q matching, turn the patient on a regular
and timely basis to rotate and maximize lung zones. Because blood flow and
ventilation are distributed preferentially to dependent lung zones, V/Q is
maximized on the side on which the patient is lying.

 Regular, effective use of incentive spirometry helps maximize diffusion and

alveolar surface area and can help prevent atelectasis. Regular rotation of V/Q
lung zones by patient turning and repositioning enhances diffusion by promoting
a healthy, well-perfused alveolar surface. These actions, as well as suctioning,
help mobilize sputum or secretions.

 Provide appropriate education to the patient and family to promote adherence

with treatment and help prevent the need for readmission.

 Explain the purpose of nursing measures, such as turning and incentive

spirometry, as well as medications.
 At discharge, teach patients about pertinent risk factors for their specific
respiratory condition, when to return to the healthcare provider for follow-up care,
and home measures they can take to promote and maximize respiratory function.