NURS PATHO EXAM II|ACUTE RESPIRATORY
FAILURE GUIDE 2022/2023
Hypoxemic resp failure- oxygenation issue
-low sats
- above 93% is acceptable
-PaO2 is less than 60 they are in hypoxemic resp failure
-Tissue will not receive proper O2, become acidotic
-Has affect on Cardio system which can lead to dysrhythmia and impaired renal
function Interventions- put on o2 and increase liters as needed
Hypercapnic resp failure- elevate PaCO2
-35-45
- will be in 50’s and 60’s; PH will be on acid side
- have combo is hypoxemic, hypercapnia, and resp failure
- mismatch in supply
- body can’t meet demand
- abnormality- resp muscle fatigue, CNS- drug overdose, brainstem infarction- affect resp
center, spinal cord injury, structural problem in chest
Resp failure cause: vent mismatch, shunt, diffusion limitation leading to impaired gas exchange,
alveolar hypoventilation which is impaired ventilation
-lungs can’t meet demand
-with septic shock, tissue doesn’t absorb oxygen
Manifestations: gradual onset, decrease in PaCO2, acidotic, bradypnea, rapid breathing, tripod
position, SOB, pursed lip, accessory muscles
-If compensation fails, resp failure occur
*Mental Status change may occur early
-Early- tachy, mild HTN, morning headache
-Diag: Phys assess for baseline, ABG, chest xray, CBC; blood work for infection, EKG,
urinalysis, V/Q lung scan
Vent mismatch- when it is not one to one exchange with vent or perfusion: COPD,
ACTELACTISIS, PNEUMONIA
,NURS PATHO EXAM II|ACUTE RESPIRATORY
FAILURE GUIDE 2022/2023
- Amount of air coming in isn’t matching air being
perfused Shunt- bypass proper gas exchange
- Hole in between ventricles or capillaries
Diffusion limitation- destruction to alveolar; thickening of membrane
- PE, COPD, ARDS, PULM FIBROSIS, LUNG DISEASE, DIFFUSION LIMITATION
- Improper gas exchange
- Live with CO 2 of 60
ARDS- progress of acute resp failure
-required intubation; can’t breathe on own
-lots of inflammation damaging lung; injury to lung
- damage to alveolar cap membrane; fluid filled alveoli causing increased gas exchange
-mortality 70-90%
- decreased lung compliance affecting gas exchange
- lungs can become fibrotic
Early mani- restless, tachypneic, SOB
Late mani- decrease lung compliance, increased work of breathing, change in mental status
Treatment- ARDSNet protocol; small amount of tidal volume to allow PaCO2 hypercapnia,
giving positive pressure
Complication- barotrauma; rupture of alveoli, renal failure,
-Prevent Pneumonia; chest PT, mouth care, suction, head of bed 30
degrees Know H2 blockers and PPI
Medications
Bronchodilators
Interventions- monitor sats, give o2, PEEP to keep alveoli
open INCREASING PEEP CAN CAUSE HTN
ECMO- last resort, artificial lung to rest lung to divert blood to machine
Prone position
Intervention- proper nutrition, card monitor
PE-
, NURS PATHO EXAM II|ACUTE RESPIRATORY
FAILURE GUIDE 2022/2023
-catch early on
- treat with anticoagulant
-Manifestation- tachy, dyspnea, rule out PE
- check D-dimer shows evidence of clotting; will be elevated in PE
- CT angio- check for clots which use dye, can’t use for kidney injury patient
-Prevention- early ambulation, stocking, dvt prophylaxis
REVIEW AGENT FOR PE
Kecentra can reverse coumadin
Surg therapy- Embolectomy to go in and extract clot
Airway Management
- For oxygenation issue
- Low CO
- Depressed state; CNS
- Spinal cord injury
- Angioedema
Goal is to go into larynx into trachea
Open airway to get tongue out of way
Don’t give if have gag reflex
Measure from nostril to earlobe
Intubation
Need RSI kit; give sedative and paralytic before intubation
Make sure you have an amnesic, propofol or versed
Check for placement; will see in change in color from yellow to purple then listen to lung, then
chest Xray
If not proper; bag them then prepare to reintubate
Management
Risk for mucus plug; oral care, turn and mobilize patient, suction
Sedative
Complications- unplanned extubation; call for help
FAILURE GUIDE 2022/2023
Hypoxemic resp failure- oxygenation issue
-low sats
- above 93% is acceptable
-PaO2 is less than 60 they are in hypoxemic resp failure
-Tissue will not receive proper O2, become acidotic
-Has affect on Cardio system which can lead to dysrhythmia and impaired renal
function Interventions- put on o2 and increase liters as needed
Hypercapnic resp failure- elevate PaCO2
-35-45
- will be in 50’s and 60’s; PH will be on acid side
- have combo is hypoxemic, hypercapnia, and resp failure
- mismatch in supply
- body can’t meet demand
- abnormality- resp muscle fatigue, CNS- drug overdose, brainstem infarction- affect resp
center, spinal cord injury, structural problem in chest
Resp failure cause: vent mismatch, shunt, diffusion limitation leading to impaired gas exchange,
alveolar hypoventilation which is impaired ventilation
-lungs can’t meet demand
-with septic shock, tissue doesn’t absorb oxygen
Manifestations: gradual onset, decrease in PaCO2, acidotic, bradypnea, rapid breathing, tripod
position, SOB, pursed lip, accessory muscles
-If compensation fails, resp failure occur
*Mental Status change may occur early
-Early- tachy, mild HTN, morning headache
-Diag: Phys assess for baseline, ABG, chest xray, CBC; blood work for infection, EKG,
urinalysis, V/Q lung scan
Vent mismatch- when it is not one to one exchange with vent or perfusion: COPD,
ACTELACTISIS, PNEUMONIA
,NURS PATHO EXAM II|ACUTE RESPIRATORY
FAILURE GUIDE 2022/2023
- Amount of air coming in isn’t matching air being
perfused Shunt- bypass proper gas exchange
- Hole in between ventricles or capillaries
Diffusion limitation- destruction to alveolar; thickening of membrane
- PE, COPD, ARDS, PULM FIBROSIS, LUNG DISEASE, DIFFUSION LIMITATION
- Improper gas exchange
- Live with CO 2 of 60
ARDS- progress of acute resp failure
-required intubation; can’t breathe on own
-lots of inflammation damaging lung; injury to lung
- damage to alveolar cap membrane; fluid filled alveoli causing increased gas exchange
-mortality 70-90%
- decreased lung compliance affecting gas exchange
- lungs can become fibrotic
Early mani- restless, tachypneic, SOB
Late mani- decrease lung compliance, increased work of breathing, change in mental status
Treatment- ARDSNet protocol; small amount of tidal volume to allow PaCO2 hypercapnia,
giving positive pressure
Complication- barotrauma; rupture of alveoli, renal failure,
-Prevent Pneumonia; chest PT, mouth care, suction, head of bed 30
degrees Know H2 blockers and PPI
Medications
Bronchodilators
Interventions- monitor sats, give o2, PEEP to keep alveoli
open INCREASING PEEP CAN CAUSE HTN
ECMO- last resort, artificial lung to rest lung to divert blood to machine
Prone position
Intervention- proper nutrition, card monitor
PE-
, NURS PATHO EXAM II|ACUTE RESPIRATORY
FAILURE GUIDE 2022/2023
-catch early on
- treat with anticoagulant
-Manifestation- tachy, dyspnea, rule out PE
- check D-dimer shows evidence of clotting; will be elevated in PE
- CT angio- check for clots which use dye, can’t use for kidney injury patient
-Prevention- early ambulation, stocking, dvt prophylaxis
REVIEW AGENT FOR PE
Kecentra can reverse coumadin
Surg therapy- Embolectomy to go in and extract clot
Airway Management
- For oxygenation issue
- Low CO
- Depressed state; CNS
- Spinal cord injury
- Angioedema
Goal is to go into larynx into trachea
Open airway to get tongue out of way
Don’t give if have gag reflex
Measure from nostril to earlobe
Intubation
Need RSI kit; give sedative and paralytic before intubation
Make sure you have an amnesic, propofol or versed
Check for placement; will see in change in color from yellow to purple then listen to lung, then
chest Xray
If not proper; bag them then prepare to reintubate
Management
Risk for mucus plug; oral care, turn and mobilize patient, suction
Sedative
Complications- unplanned extubation; call for help
