Lesson Objectives for Respiratory Failure

• Understanding Respiratory Failure:
  • Define respiratory failure as a condition in which the respiratory system is unable to maintain adequate gas exchange, leading to a mismatch between oxygen supply and demand and impaired removal of carbon dioxide.
• Types and Causes of Respiratory Failure:
  • Differentiate between hypoxemic and hypercapnic respiratory failure and identify common causes, including lung diseases, neuromuscular disorders, chest wall abnormalities, and central nervous system dysfunction.
• Clinical Manifestations:
  • Recognize the signs and symptoms of respiratory failure, such as dyspnea, tachypnea, altered mental status, cyanosis, and respiratory distress. Understand the importance of early identification for prompt intervention.
• Diagnostic Approaches:
  • Explore diagnostic methods for assessing respiratory failure, including arterial blood gas analysis, chest imaging (X-ray, CT scan), pulmonary function tests, and other relevant laboratory tests. Understand the significance of these assessments in determining the underlying cause.
• Management and Nursing Interventions:
  • Learn about the principles of managing respiratory failure, including oxygen therapy, mechanical ventilation, bronchodilator therapy, and supportive care. Understand the role of nursing interventions in monitoring respiratory status and providing comprehensive care to patients.

Pathophysiology of Respiratory Failure

• Impaired Oxygenation:
  • Respiratory failure involves a disruption in the exchange of oxygen and carbon dioxide in the lungs. In hypoxemic respiratory failure, there is inadequate oxygenation of the blood, leading to decreased oxygen levels in arterial blood.
• Ventilation-Perfusion Mismatch:
  • Hypoxemic respiratory failure often results from a ventilation-perfusion mismatch, where the airflow to certain lung areas does not match the blood flow, impairing the exchange of gases. This can occur in conditions such as pneumonia or acute respiratory distress syndrome (ARDS).
• Alveolar Hypoventilation:
  • Hypercapnic respiratory failure is characterized by inadequate removal of carbon dioxide. This may occur due to conditions that affect the respiratory centers in the brain, neuromuscular disorders, or conditions leading to increased airway resistance.
• Alveolar Collapse and Atelectasis:
  • In some cases, respiratory failure may involve alveolar collapse and atelectasis, reducing the surface area available for gas exchange. This can occur in conditions such as acute lung injury or after surgery.

Etiology of Respiratory Failure

• Pulmonary Conditions:
  • Chronic obstructive pulmonary disease (COPD), asthma, pneumonia, and acute respiratory distress syndrome (ARDS) are common pulmonary conditions that can lead to respiratory failure.
• Neuromuscular Disorders:
  • Conditions affecting the neuromuscular system, such as Guillain-Barré syndrome, myasthenia gravis, or amyotrophic lateral sclerosis (ALS), can impair the muscles involved in breathing, contributing to respiratory failure.
• Chest Wall Abnormalities:
  • Chest wall deformities or injuries that restrict lung expansion, such as kyphoscoliosis or severe trauma, can lead to respiratory failure by limiting the ability of the lungs to inflate.
• Central Nervous System Dysfunction:
  • Disorders affecting the central nervous system, including brainstem injuries, strokes, or drug overdose, can disrupt the normal control of breathing, leading to respiratory failure.
• Environmental Factors:
  • Exposure to toxins, smoke inhalation, or near-drowning incidents can result in acute respiratory failure. Inhalation of harmful substances can damage lung tissue and compromise respiratory function.

Desired Outcome for Respiratory Failure

• Improved Oxygenation:
  • Achieve and maintain adequate oxygenation, as evidenced by normal or improved arterial blood gas values and relief of hypoxia-related symptoms.
• Effective Ventilation:
  • Ensure effective removal of carbon dioxide, demonstrating normalized or improved levels of partial pressure of carbon dioxide (PaCO2) and resolution of hypercapnia-related symptoms.
• Stabilized Respiratory Status:
  • Attain respiratory stability with a reduction in respiratory rate, improved lung sounds, and absence of signs of respiratory distress.
• Enhanced Mobility and Function:
  • Promote increased activity tolerance and mobility, indicating improved respiratory function and reduced fatigue.
• Patient and Family Education:
  • Provide education to the patient and their family regarding respiratory management, including medication adherence, recognizing early signs of respiratory distress, and when to seek medical attention.

Respiratory Failure Nursing Care Plan

Nursing Interventions and Rationales

• Maintain patent airway

• Obtain and evaluate labs (ABG)

• Complete a full respiratory assessment to detect changes or further decompensation as early as possible, and notify MD as indicated

• Provide supplemental oxygen as appropriate

• Ensure patient is in the optimal position to decrease work of breathing

• Prepare for rapid sequence intubation, if necessary

• Remove any negative/distracting stimuli: turn the TV off, encourage family members to be calm

• Prevent ventilator acquired pneumonia (VAP) if the patient is intubated

• Provide oral care

• Cluster care

• Promote appropriate nutrition

• Assist to treat underlying causes. If the patient has pneumonia, administering antibiotics is essential to healing, if the patient has a PE, administer appropriate blood thinners, if the patient has asthma, you’re auscultating lungs sounds before and after to evaluate effectiveness.

• Monitor for conditions that can increase the oxygen demands (fever, anemia)

• Prevent aspiration pneumonia in patients who cannot maintain their airway

• Manage secretions

• Assess ability to swallow safely post-intubation

Evaluation for Respiratory Failure

• Respiratory Status:
  • Regularly assess and document changes in respiratory rate, depth, and pattern. Evaluate the effectiveness of interventions in improving oxygenation and ventilation.
• Oxygen Saturation:
  • Monitor and evaluate oxygen saturation levels to ensure they remain within the target range. Adjust oxygen therapy as needed based on ongoing assessments.
• Ventilator Parameters:
  • Evaluate and document ventilator parameters for patients on mechanical ventilation. Assess the patient’s response to ventilation and collaborate with the respiratory therapy team to optimize settings.
• Patient Mobility:
  • Assess improvements in patient mobility and tolerance to activity. Document increased activity levels and collaborate with physical therapy for ongoing mobility support.
• Patient and Family Education:
  • Evaluate the patient and family’s understanding of respiratory management, including medication adherence, recognition of respiratory distress signs, and strategies for managing the patient’s condition at home. Reinforce education as needed.

References

• Respiratory Failure – MedlinePlus
• Caring for patients in respiratory failure – American Nurse Today