Respiratiory insufficiency

1. RESPIRATIORY INSUFFICIENCY
Prepared by:
Prabita Shrestha

2. INTRODUCTION
• Respiratory insufficency/failure is a sudden and
life-threatening deterioration of the gas
exchange function of the lung. It exists when the
exchange of oxygen for carbon-dioxide in the
lungs cannot keep up with the rate of oxygen
consumption and carbon-dioxide production by
the cells of the body.

3. • It is categorized into two groups i.e.acute and
chronic respiratory failure.
1. Acute respiratory failure:It is defined as a fall in
arterial oxygen tension(pao₂)to less than 50
mmhg and a rise in arterial carbon dioxide
tension(pac0₂)to greater than 50 mm of
hg(hypercapnia), with an arterial pH of less
than 7.35.In ARF, ventilation or perfusion
mechanisms in the lungs are impaired.
INTRODUCTION

4. 2.Chronic respiratory failure:It is defined as a
deterioration in the gas exchange function of the
lung that has developed insidiously or has
persisted for a long period after an episode of
ARF.
INTRODUCTION

5. CAUSES:
 Common causes of type1(hypoxemic) respiratory failure
include the following:
• COPD
• Pneumonia
• Pulmonary edema
• Pulmonary fibrosis
• Asthma
• Pneumothorax
• Pulmonary embolism
• Pneumoconiosis
• Pulmonary arterial hypertension
• Granulomatous lung disease

6. • Acute respiratory distress syndrome(ARDS)
• Fat embolism syndrome
• Obesity
 Common causes of type 2(hypercapnic) respiratory failure
include the following:
 COPD
 Severe asthma
 Drug overdose
 Poisonings
 Myasthenia gravis
 Polyneuropathy
 Poliomyelitis
CAUSES:

7.  Primary muscle disorders
 Head and cervical cord injury
 Primary alveolar hypotension
 Pulmonary edema
 ARDS
 Tetanus
CAUSES:

8. PATHOPHYSIOLOGY
Impaired ventilation or perfusion mechanism of the lung
Decreased respiratory drive
Dysfunction of lung
parenchyma
Dysfunction of chest wall
Impair the normal response
of chemoreceptors in brain
to normal respiratory
stimulation
Impaired respiratory system mechanism
Interfere with ventilation
by preventing
expansion of the lung
Impaired transmission of
impulses arising from
respiratory center to receptor
in the muscle of respiration
Causes:
Severe brain injury, multiple
sclerosis, use of sedatives,
metabolic disorder
Causes:
Musculoskeletal disorder,
neuromuscular disorders,
spinal cord disorders
Causes:
Pleural effusion,
hemothorax, pneumothorax,
upper airway obstructions

9. CLINICAL MANIFESTATION
• Early signs are those associated with impaired oxygenation
and may include restlessness, fatigue, headache, dyspnea.
air hunger, tachycardia, increased blood pressure.
• As the hypoxemia progresses confusion, lethargy,
tachypnea, central cyanosis, diaphoresis and finally
respiratory arrest.
• Physical findings are those of ARD, including use of
accessory muscles, decreased breath sounds.

10. DIAGNOSTIC EVALUATION
1. ABG analysis: shows changes in pao2,paco2,PH and
possibly Hco3 patients normal.
2. Pulse oximetry :decreasing spo2
3. End tidal co2 monitoring: elevated
4. Complete blood count, serum electrolytes, chest x-
rays, urinalysis, electrocardiogram(ECG), blood and
sputum cultures: to determine underlying causes and
patients condition.

11. Management of Respiratory
Failure.
 Cardiopulmonary resuscitation (CPR)treatment of the
underlying cause is required.
 Endo tracheal intubation and mechanical ventilation are
required in cases of severe respiratory failure (PaO2 less
than 50 mmHg).
 Respiratory stimulants such as doxapram are rarely
used, and if the respiratory failure resulted from an
overdose of sedative drugs such as opioids or
benzodiazepines, then the appropriate antidote
(naloxone or flumazenil, respectively) will be given.

12. Contd…
 There is tentative evidence that in those with respiratory
failure identified before arrival in hospital, continuous
positive airway pressure can be useful when started
before conveying to hospital.
 Oxygenation is required while underlying cause is
corrected.

13. NURSING MANAGEMENT

14. NURSING ASSESMENT
1. Note changes suggesting increased work of
breathing(dyspnea, tachypnea, diaphoresis,
intercostal muscle retraction).
2. Assess breath sounds. crackles may indicate
ineffective airway clearance, fluid in the lungs,
wheezing indicates narrowed airway and
bronchospasm, Rhonchi and crackles suggest
ineffective secretion clearance.
3. Assess level of conscious(loc) and ability to tolerate
increased work of breathing.
4. Assess for signs of hypoxemia and hypercapnia.

15. 5.Analyze abg and compare previous value.
6.Determine vital capacity(vc) and respiratory rate.

16. NURSING DIAGNOSIS
• Impaired gas exchange related to inadequate respiratory
centre activity or chest wall movement, airway
obstruction or fluid in lungs.
• Ineffective airway clearance related to increased or
tenacious secretions.

17. NURSING INTERVENTIONS
1. Improving Gas Exchange
i. Administer oxygen to maintain pao2 of 60 mm Hg or
sao2 greater than 90% using oxygen mask, aerosol
mask, mechanical ventilation.
ii. Administer antibiotics, cardiac medications and diuretics
as ordered for underlying disorders.
iii. Monitor fluid balance by intake and output
measurements, daily weight and pulmonary capillary
wedge to detect presence of hypervolemia or
hypervolemia.

18. iv. Provide measures to promote chest expansions and
secretion clearance like spirometer, nebulization,
head of bed elevated etc.
v. Monitor adequacy of alveolar ventilation by frequent
measurement of spo2,ABG levels, respiratory rate etc.
vi. Compared monitor values and report it.

19. 1. Airway clearance
 Perform respiratory assessment
 Airway patency-rate, rhythm and depth of breathing,
chest and diaphragmatic excursion
 Auscultation of breath sounds.
 Assess secretion for state of hydration.
 Monitor body temperature and WBC profile.
 Monitor for sign/symptoms of bronchodilators therapy
toxicity.

20. 2.Initiate chest physiotherapy technique.
 Assess respiratory function:
 Rate, rhythm, depth and pattern of breathing
 Symmetry of chest wall and diaphragmatic excursion
 Co-ordination of contraction of inspiratory and
expiratory muscles.
 Auscultation of breathe sounds
 Assist patient into position of comfort and to allow for
best lung expansion.
 Teach breathing technique.

21. Maintain adequate ventilation

22. Maintain adequate ventilation
1. Deep breathing and coughing exercises and use of
incentive spirometer to encourage lung expansion.
2. Chest physiotherapy: percussion, assisted cough and
postural drainage when indicated.
3. Oxygen, when ordered.
4. Elevation of the head of the bed with a foam wedge or
hospital bed to ease shortness of breath and provide
comfort during sleep.
5. When air hunger is chronic and distressing, help monitor
and titrate medications that will help provide comfort.
6. Provide information and opportunities to discuss options
for mechanical ventilation.