Respiratory
Respiratory Failure and ARDS
Normal Respirations
Respiratory Failure




Not a disease process, sign of severe dysfunction
Lungs unable to oxygenate blood & remove CO2
Alveolar ventilation is inadequate to meet the
body’s need
Commonly defined in terms of ABG’s



PO2 of less than 50 mmHg
PCO2 greater than 50 mmHg
Arterial pH of less than 7.35
Respiratory failure & affect on
acid-base balance

1. Hypoxemia resp failure is failure of
oxygenation.



PO2 significantly reduced and PCO2 is at or below
normal
Metabolic acidosis results from tissue hypoxia
2. Hypercapnia resp failure results from
hypoventilation.


PCO2 rises rapidly and resp acidosis develops
PO2 drops more slowly
Causes of respiratory failure (p.1157)




Impaired ventilation
Impaired diffusion
Ventilation-perfusion mismatch (VQ)
COPD most common cause of resp failure
Common manifestations/complications of
respiratory failure



Hypoxemia
Hypercapnia
Underlying disease process symptoms (p. 1157)
Cyanosis
Therapeutic interventions for Resp Failure






Diagnostic tests- ABG’s; ETCO2; chest X-ray
Main treatment- correct underlying cause &
restore adequate gas exchange in lung
Elevate HOB
Medications
Oxygen therapy (O2 sat 90%; PaO2 60 mmHg)
Airway management
Tracheotomy
Endotracheal tube
Endotracheal tube
Make sure airway attached to lungs
Therapeutic interventions cont.



Mechanical
ventilation
Adeq gas exchange
& tissue perfusion
Criteria to put on



RR > 35-45
pCO2 >45
pO2 <50
Mechanical ventilation cont





Types
Modes
PEEP; CPAP
Ventilator settings- including alarms
Complications





Ventilate one lung
Nosocomial pneumonia
Barotraumas
Cardiovascular
Gastrointestinal
Nursing assessment specific to
respiratory failure


Health history
Physical exam
Pertinent nursing problems and interventions
specific to respiratory failure




Impaired spontaneous ventilation
Ineffective airway clearance
Anxiety
Home care
Acute respiratory distress syndrome- ARDS


Syndrome, sudden &
progressive acute resp
failure- not primary
Alveolar capillary
membranes damaged
more permeable>
noncardiac
pulmonary edema &
progressive refractory
hypoxemia
Pathophysiology of ARDS- Stages



Refer to BB course documents Module 2 for
video
Page 1170-1 illustrations of stages
Initiation of ARDS; onset pulmonary edema;
alveolar collapse; end-stage ARDS
surfactant keeping alveoli open
Common manifestations/complications
of ARDS





Symptoms develop 24-48 hrs after initial insult
Early symptoms
Later symptoms
Hallmark sign- progressive refractory hypoxemia
Noncardiac pulmonary edema
Therapeutic interventions for ARDS

Diagnostic tests




ABG’s- hypoxemia
Chest X-ray- snow
storm effect
Pulmonary function
tests
Hemodynamic
monitoring
Therapeutic intervention for ARDS cont.







Medications
Mainstay of treatment---Mechanical ventilation
with intubation
Correct underlying condition
Fluid replacement keep vascular volume
Nutrition positive protein balance
Heparin prevent thrombothebitis
‘Proning’
Independent Lung Ventilation
Prone Device
Benefits to Proning >
Nursing assessment specific to ARDS


Health history
Physical exam
Pertinent Nursing problems and interventions
for ARDS




Decreased cardiac output
Ineffective airway clearance; impaired tissue
perfusion; imbalance nutrition: less than body
requirements; risk for infection
Dysfunctional ventilatory weaning response
Home care