PROBLEMS IN

VENTILATORY
FUNCTION
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PATHOPHYSIOLOGY
OF RESPIRATORY
FAILURE

The Processes Involved

1. The abnormal state of the respiratory

system (caused by associated
conditions):
a. Alterations of gas exchange organ
(lungs)
b. Alteration of the pump organ
(respiratory muscle and respiratory
control mechanism)

11. Arterial oxygen fails and tissue cells

become hypoxix

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PATHOPHYSIOLOGY
OF RESPIRATORY
FAILURE

The Processes Involved

11. Arterial oxygen fails and tissue cells

become hypoxic
Physiologic Criteria in ARF:
 PaO2 of 50 mmHg or less
(measured on room air)
 PaCO2 of 50 mmHg or more
 pH of 7.35 or less
Physiologic Criteria in CRF:
 Hypercapnia and hypoxemia S/Sx
 pH usually stays within the range of
7.35 to 7.40 because of
compensation

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Prognosis:
Poor if complications may set in
CRF may develop into AOCRF as a
secondary insult to the compromised
pulmonary system (usually infection).
When this happens the client can no
longer compensate for the altered lung
function
Clinical criteria:
 dramatic decrease in pH (below
7.35mmHg)
 Severe hypoxemia
 Hypercapnia (retention of carbon
dioxide
 Client may display few S/Sx related
to pH and PaO2

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The basis for the clinical manifestations

associated with respiratory failure is
UNDERLYING BLOOD GAS
ALTERATIONS
Diagnostic Test: ABG

Since the blood gas derangements

causing hypoxemia, hypercapnia and
respiratory acidosis occur
simultaneously and is not stable, it is
important for the nurse to recognize
that the S/Sx depends more on the rate
of change of the value of the ABG
rather than on absolute value.

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 CLINICAL
MANIFESTATIONS
Respiratory Failure

SECONDARY TO HYPERCAPNIA,
HYPOXEMIA, RESPIRATORY
ACIDOSIS
 Headache
 Irritability
 Confusion
 Increasing somnolence, coma
 Asterixis (flapping tremor)
 Cardiac dysrhythmia
 Tachycardia
 Hypotension
 cyanosis

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 CLINICAL
MANIFESTATIONS
Respiratory Failure

SECONDARY TO INCREASED WORK

OF BREATHING
 Dyspnea
 Exhaustion

SECONDARY TO PRESSURE IN THE

RIGHT SIDE OF THE HEART
 Peripheral edema
 Neck vein distension
 hepatomegaly

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 CLINICAL
MANIFESTATIONS
Respiratory Failure

HOW DOES PRESSURE IN THE

RIGHT SIDE OF THE HEART OCCUR
IN RESPIRATORY FAILURE?
 Vessel obliteration, pulmonary
vasoconstriction, micro thrombosis
caused by hypoxia, hypercapnia and
imbalance in vasoactive mediators
RESULT TO
pulmonary hypertension, ( changes in
the small blood vessels inside the
lungs that can lead to increased
blood pressure in the right side of
the heart.

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 CLINICAL
MANIFESTATIONS
Respiratory Failure

pulmonary hypertension will

eventually result to
Cor pulmonale - a condition that
causes the right side of the heart to
fail. Long-term high blood pressure
in the arteries of the lung and right
ventricle of the heart can lead to Cor
pulmonale.

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