OVERVIEW  Complications

 occurs when fluid builds up in the air sacs in  Pulmonary complications:

your lungs.  Barotrauma
 may lead to death if it’s not treated quickly.  Pulmonary fibrosis
 Two types:  Nosocomial pneumonia
a. Acute hypercapnic  Acute lung injury
 Develops over minutes to hours  Cardiovascular complications:
 there’s too much carbon dioxide in your  Hypotension
blood, and near normal or not enough  Reduced cardiac output
oxygen in your blood.  Arrhythmia
 pH is less than 7.3  Endocarditis
 Causes:  Acute myocardial infarction
 COPD  GI complications:
Severe asthma  Hemorrhage
 Drug overdose  Gastric distention
 Poisonings  Ileus
 Head and cervical injury  Diarrhea
 Pulmonary edema  Pneumoperitoneum
 ARDS  Ulceration
b. Acute hypoxemic  Acute renal failure
 Don’t have enough oxygen in your  Abnormalities of electrolytes and acid-
blood, but your levels of carbon dioxide base homeostasis
are close to normal.  Malnutrition
 Causes:
 COPD DIFFERENTIAL DIAGNOSIS
 Pneumonia
 Pulmonary edema
 Pulmonary fibrosis
 Asthma
 Pneumothorax

CLINICAL PRESENTATION
 Common manifestations of Acute Respiratory
Failure
depend on its underlying cause and the levels of
carbon dioxide and oxygen in your blood.

 People with a high carbon dioxide

level may experience:
• rapid breathing
• confusion
 People with low oxygen levels may
experience:
• an inability to breathe
• bluish coloration in the skin,
fingertips, or lips
 People with acute failure of the lungs
and low oxygen levels may
experience:
• restlessness
• anxiety
• sleepiness
• loss of consciousness
• rapid and shallow breathing
• racing heart
• irregular heartbeats
WORKUP
a. Laboratory Studies 8. Corticosteroids
 ABG a. Methylprednisolone
 A complete blood cell (CBC) count
 serum creatine kinase with fractionation and TREATMENT AND MANAGEMENT
troponin I Medical Management
b. Radiography The objectives of treatment are:
 Chest radiography a.) to correct the underlying cause
c. Echocardiography b.) to restore adequate gas exchange in the lung.
d. Pulmonary Function Test  Intubation and mechanical ventilation
may be required.
MEDICATION
 Goal: Nursing Management
o to achieve a pulmonary capillary wedge Nursing management of patients with acute respiratory
pressure of 15-18 mm Hg failure includes:
o a cardiac index greater than 2.2 a.) Assisting with intubation and maintaining
L/min/m2 while maintaining adequate mechanical ventilation.
blood pressure and organ perfusion b.) Assess respiratory status
1. Diuretics c.) Assess the entire respiratory system and
 inhibits sodium chloride reabsorption in the implements strategies
ascending loop of Henle. d.) Assess the patient’s understanding of the
a. Furosemide (Lasix) management strategies that are used and initiates
b. Metolazone (Zaroxolyn) some form of communication
e.) Finally, the nurse must address the problems
2. Nitrates that led to the acute respiratory failure:
 reduces myocardial oxygen demand by lowering
preload and afterload. Treatments:
a. Nitroglycerin sublingual
b. Nitroprusside sodium (Nitropress)  pain medications or other medicines
 Oxygen
3. Opioid Analgesics  breathing tube / ventilator to help you breathe.
 Morphine IV is an excellent adjunct in the  tracheostomy may be necessary.
management of acute pulmonary edema.
 venodilation, Other Treatments Help You Breathe
 It also causes arterial dilatation
 rocking bed consists of a mattress on a motorized
4. Inotropic Agents platform.
a. Dopamine
b. Norepinephrine (Levophed)
Fluids
c. Dobutamine
 You may be given fluids to improve blood flow
5. Beta2 Agonists  Too much fluid can fill the lungs and make it hard
 act to decrease muscle tone in both small and for you to get the oxygen you need.
large airways in the lungs.  Not enough fluid can limit the flow of oxygen-rich
a. Terbutaline (Brethaire, Bricanyl) blood to the body's organs.
b. Albuterol (Proventil)

6. Xanthine Derivatives
 may relax smooth muscle of the bronchi.
a. Theophylline (Elixophyllin Elixir, Theo-24)

7. Anticholinergics,
 antagonize the action of acetylcholine with
muscarinic receptor on bronchial smooth
muscle.
a. Ipratropium bromide (Atrovent HFA)