Acute Respiratory Failure

Introduction:

The lungs are unable to adequately exchange oxygen and carbon dioxide because
of insufficient ventilation. The body is not able to maintain enough oxygen or the
body may not get rid of enough carbon dioxide. A respiratory illness can deterio-rate into acute respiratory failure. Central nervous system depression (due to
trauma or medication) or disease can also lead to acute respiratory failure.

PROGNOSIS
Patients with respiratory failure are not getting enough oxygen. This may be a sudden
event or a decompensation of a chronic respiratory condition such as emphysema or
chronic bronchitis. Supplemental oxygen and bronchodilating medications are used
to enhance airflow to the lungs. The underlying cause needs to be identified and cor-
rected to reverse the problem and return the patient to normal respiratory status.

SIGNS AND SYMPTOMS

• Accessory muscles used to breathe as body works harder to move air
• Difficulty breathing (dyspnea) due to lack of oxygen
• Difficulty breathing when lying down (orthopnea) due to increased work of
breathing in this position; diaphragm has to work harder; posterior chest wall
does not expand well
• Fatigue due to work of breathing and lack of oxygenation
• Coughing may be due to inflammation, bronchospasm, fluid, or underlying
lung condition
• Blood in sputum (hemoptysis) due to irritation of airways
• Respiration greater than 20 breaths per minute (tachypnea) in attempt to get
more air and oxygen into lungs
• Sweating (diaphoresis) as body works harder to move air, using more muscles
• Cyanosis due to hypoxemia
• Anxiety due to air hunger and lack of oxygenation
• Rales (crackles) heard in the lungs if fluid builds up in alveoli and smaller
airways
• Wheezing (rhonchi) due to inflammation within airways
• Diminished breath sounds due to decreased air movement

TREATMENT

• Oxygen therapy to meet body’s needs via nasal canula or mask.
• Administer bronchodilators to enhance airflow through airways in lungs:
• albuterol, levalbuterol, metaproterenol, terbutaline
• Administer anticholinergics to treat bronchospasm:
• ipratropium
• Intubation to maintain patent airway and assist mechanical ventilation.
• Administer anesthetic to ease intubation:
• propofol
• Mechanical ventilation to support respiratory effort.
• omeprazole, esomeprazole, lansoprazole, rabeprazole, pantoprazole
• Administer antibiotics to treat infection (or may be preventative):
• selected according to results of culture and sensitivity study

NURSING DIAGNOSES
• Ineffective breathing pattern
• Ineffective airway clearance
• Anxiety

NURSING INTERVENTION
• Monitor respiratory status for rate, effort, use of accessory muscles, sputum
production, and breath sounds.
• Monitor pulse oximetry to check oxygen saturation levels.
• Monitor sputum for changes in color and amount.
• Monitor vital signs for changes.
• Place patient in high Fowler’s or semi-Fowler’s position on bedrest to ease
respiratory effort by allowing optimal diaphragmatic excursion.
• Monitor ventilator settings if appropriate.
• Change patient position every 2 hours to decrease chance of skin breakdown.
• Monitor intake and output of fluids to check for balance.
• Explain to the patient:
• The importance of doing coughing and deep-breathing exercises to fully
expand lungs and enhance the expelling of mucous.
• How to identify the signs of respiratory distress.
• Administer neuromuscular blocking agent to ease mechanical ventilation so
the patient won’t fight ventilator:
• pancuronium, vecuronium, atracurium
• Administer steroids to decrease inflammatory response within lungs:
• hydrocortisone, methylprednisolone, prednisone
• Administer anticoagulant to reduce risk of clot formation:
• heparin, warfarin
• Administer analgesic for discomfort and to decrease myocardial oxygen
demand:
• morphine
• Administer histamine-2 blockers or proton pump inhibitors to reduce chances
of stress-induced gastric ulcer:
• famotidine, ranitidine, nizatidine, cimetidine