Acute Respiratory Failure

Question 1

What is Acute Respiratory Failure?

Answer 1

Impairment in Gas Exchange

Not a disease but a symptom

Question 2

Hypoxemic ARF:

Answer 2

PaO2<60 on 60% O2

Question 3

Hypercapnic ARF:

Answer 3

PaCO2>45

pH<7.35

Question 4

Hypoxemic/Oxygenation Failure is? and examples?

Answer 4

V/Q mismatch, Shunting, Impaired diffusion
• Pneumonia
• Pulmonary Embolism
• Pulmonary Edema
• ARDS

Question 5

Hypercapnic/Ventilatory Failure is? and examples?

Answer 5

Impaired ventilation, Impaired chest wall
movement
• Asthma
• COPD
• Pain
• Drug overdose
• Neurological disorders
– MG
– GB
– MS

Question 6

Failure of Oxygenation

Hypoxemic Failure

Answer 6

Ventilation-perfusion mismatch (V/Q
mismatch)
– Intrapulmonary shunting
– Increased dead space ventilation
• Diffusion defects
• Low cardiac output
• Low hemoglobin level

Question 7

Anatomic Shunt:

Answer 7

Blood passes through an
anatomic channel in the
heart bypassing the lungs.

Ventricular septal defect

Question 8

Physiologic Shunt:

Answer 8

Blood flows through the
pulmonary capillaries
without participating in
gas exchange….(Low V/Q)

Pneumonia
ARDS

Question 9

Diffusion Limitations

Answer 9

Thickened alveolar/capillary
membrane impairs gas exchange …

Greater distance CO2 and O2 have to travel.

Question 10

Failure of Ventilation

Hypercapnic Failure

Answer 10

Alveolar hypoventilation

• Respiratory muscle fatigue
• CNS depressants
• Head injury
• Chest wall abnormalities
• Neuromuscular conditions

Question 11

Hypoxemia Manifestations

Answer 11

• Tachycardic/Tachypneic
• Increased BP
• Restless
• Confusion
• Anxiety

Question 12

Hypercapnia Manifestations

Answer 12

• Tachycardic/Tachypneic
• Headache
• Decreased LOC
• Increased somnolence
• Dizzy
• Flushed

Question 13

ARF Manifestations:

Answer 13

•Pursed-lip breathing
• Retractions
• Orthopnea
• Tripod position – increases AP
diameter – decreases work of
breathing
• Inability to speak in full sentences

Question 14

Diagnosis

Answer 14

• History
• Chest x-ray
• Blood work
– Arterial blood gases
– SvO2
– H & H
– Sputum cultures
• Pulse oximetry

Question 15

Medical Management

Answer 15

• Oxygen/Respiratory Management
• Bronchodilators
• Corticosteroids
• Diuretics
• Hydration
• Nutrition
• Treatment of underlying cause

Question 16

Respiratory Management:

Oxygen delivery devices

Answer 16

• Nasal cannula: 1st line 
• Face mask
• Venturi mask: Color-coded to indicate
FiO2
• Non-rebreather

Noninvasive PPV
• BiPAP
• CPAP
Positive pressure ventilation (PPV): can do invasively and non invasive

Question 17

Nursing assessment

Answer 17

• Assessment
– VS/SpO2
– ABGs/Svo2
– Neurological assessment
– Breath sounds
– Cardiac monitoring

Question 18

Nursing Actions

Answer 18

• Oxygen management
• Medication management

• Secretion management
   -Chest physical therapy
   -Airway suctioning/effective coughing
   -Positioning – elevate HOB, OOB,
       • Good lung down

• Hydration and humidification

• Adequate fluid intake
• IV hydration/humidification
• Humidification devices