Acute Respiratory Failure

Acute respiratory failure happens due to fluid building in the lungs’ air sacs. The condition blocks the release of oxygen to the blood, which denies the organs sufficient oxygen-rich blood, tampering with organ functioning. Acute respiratory failure also occurs when the body cannot get rid of carbon dioxide (CO2) from the blood. In most cases, the capillaries surrounding the air sacs fail to exchange CO2 for oxygen properly. For acute respiratory failure, the patient experiences immediate symptoms from a lack of adequate oxygen supply in the body. The symptoms range from shallow and rapid breathing, arrhythmias or irregular heartbeats, profound sweating, loss of consciousness, and anxiety. The failure can cause death if not given immediate treatment in many cases (Scala & Heunks, 2018). The purpose of this paper is to explore acute respiratory concepts, including pathophysiology, methods for assessing acute respiratory failure patients, medical management of the condition, and a care plan for patients with acute respiratory failure.

Pathophysiology of Acute Respiratory Failure

Respiratory failure can result from defects in any part of the respiratory system, such as the central nervous system, airways, alveoli, respiratory muscle, chest wall, and peripheral nervous systems. Patients with hypovolemic, hypo-perfusion secondary to cardiogenic, and septic shock also present respiratory failure. Inflammation-facilitated disorders in alveolar-capillary permeability characterize the pathophysiology of acute respiratory failure, reduced alveolar clearance and derecruitment, edema formation, amplified pulmonary vascular resistance, and the resulting gas exchange irregularities because of ventilation-perfusion and shunting disparity. Mechanical ventilation, particularly in the location of regional disease heterogeneity, can cause ventilator-related injury patterns such as barotrauma and atelectrauma (Crotti et al., 2017). The conditions first result in acute respiratory distress, which develops into acute respiratory failure. When the patient develops acute respiratory failure, the regular exchange between carbon dioxide and oxygen is disrupted. Adequate oxygen supply to the brain, heart and other parts of the body is cut, leading to symptoms such as shortness of breath, loss of consciousness, and confusion (Scala & Heunks, 2018).

Methods for Assessing the Patient with Acute Respiratory Failure

The ability to conduct and document detailed respiratory assessments is a fundamental skill every nurse must possess. Respiratory failure is considered a syndrome and not a single disease process. Besides, the general occurrence of respiratory failure is not known (Scala & Heunks, 2018). Nurses employ several methods to assess the exact cause of acute respiratory. A prompt initial assessment is done to allow immediate assessment of the severity of the condition, and proper treatment actions may warrant initiation at this stage. The initial assessment is followed by comprehensive history taking. A clinical examination is then done, which entails inspection, percussion, palpation, and auscultation. The caregiver at this stage must consider a conducive environment, private, warm, and quiet for examination and appropriate patient positioning (Vignon et al., 2016).

The first assessment method of clinical examination is the inspection, which entails a comprehensive visual assessment. This is followed by palpation, where the caregiver uses tough to collect information. The physician examines for regions of tenderness, skin abnormalities, fremitus, and respiratory expansion during palpation. The physician palpates pain, bruises, and lesion areas of the back and frontal chest to assess areas of tenderness. A decelerating fremitus may be observed, mainly when the patient has obstructed bronchus, pneumothorax, and COPD (Vignon et al., 2016). The third stage is chest percussion, which involves striking or tapping the chest to establish the condition of the underlying tissue. Percussion is done systematically from the patient’s upper chest to the lower chest, while the physician compares the resonance between the right and left sides of the chest (Vignon et al., 2016). Percussion is conducted from the front and back of the thorax. The fourth stage of clinical assessment involves the auscultation method, where the physician listens to and interprets the sound transmission through the chest wall using a stethoscope. Physicians’ lung areas utilizing the stethoscope are lung fields and encompass lateral anterior and posterior lung fields (Vignon et al., 2016). Further assessments can be conducted to confirm or negate suspected diagnoses.

Medical Management of the Patient with Acute Respiratory Failure

Medication management focuses on supporting patients with acute respiratory failure while the lungs heal. The primary objective of supportive care is to get adequate oxygen supply to the blood and deliver it to the body to prevent damage and remove injury that resulted in ARF developing. Added medications known as people with paralysis are administered upfront to help the patients adjust to the ventilators. For fluid management, the physician may administer medication known as a diuretic to escalate urination, which helps remove excess fluids from the patient’s body, which deter fluid from building up in the lungs. However, the medication must be administered cautiously because excessive removal of fluid from the body can reduce blood pressure and cause kidney problems. Drugs such as antibiotics also help treat infections of the lungs, including pneumonia. Bronchodilators are administered to open patients’ airways, treating asthma attacks. Corticosteroids help shrink swollen airways and treat inflammations (Scala & Heunks, 2018).

Plan of Care for the Patient with Acute Respiratory Failure

Nursing Intervention	Rationale
Assess the patient’s home environment for irritants causing impaired gas exchange. Assist the patient in adjusting to the home setting by installing air filters or other methods to decrease dust.	Environmental irritants reduce the patient’s ability to access oxygen effectively during breathing (Scala & Heunks, 2018).
Position the patient’s head of the bed at an elevated angle of about 450 when supine (semi-Fowler’s position).	Semi-Fowler’s or upright position enables increased thoracic capacity, diaphragm’s total descent, and amplified lung expansion, preventing abnormal fillings crowding (Scala & Heunks, 2018).
Frequently check the patient’s bed position to prevent cases of slumping down in bed.	Slumped positioning may lead to compressing the diaphragm by the abdomen, limiting full lungs expansions.
Check for unilateral lung disease, and if present, position the patient correctly to enhance ventilation-perfusion.	Study shows that hydrostatic pressure and gravity increase the ventilation and perfusion of dependent lungs, increasing oxygenation. The excellent side must be positioned downward, while the atelectasis or embolus should be up when the patient is placed with the side. But when conditions such as an abscess or lung hemorrhage are diagnosed, the impacted lung must be positioned downward to avoid draining the heathy/good lung (Li & Ma 2020).
Turn the patient every 2-3 hours	Turning the patient is critical to avoid complications due to immobility.
Assist with or encourage ambulation according to the doctor’s order.	Ambulation is essential to facilitate secretion clearance, lung expansion, and stimulating deep breathing (Scala & Heunks, 2018).
Provide reassurance and decrease anxiety.	Anxiety increases dyspnea and respiratory rate.
Administer medication according to the physician’s prescription.	Medication depends on the etiological factors, such as bronchodilators for COPD, antibiotics for pneumonia, and other drugs as prescribed (Scala & Heunks, 2018).

Conclusion

This paper has examined acute respiratory failure and related concepts, including pathophysiology, assessment methods, medication, and care plan for patients with the condition. As defined in this paper, acute respiratory failure occurs due to fluid building in the lungs’ air sacs blocking oxygen release to the blood, which denies body organs sufficient oxygen-rich blood, resulting in dysfunctional organ functioning.

References

Crotti, S., Bottino, N., Ruggeri, G. M., Spinelli, E., Tubiolo, D., Lissoni, A., … & Gattinoni, L. (2017). Spontaneous breathing during extracorporeal membrane oxygenation in acute respiratory failure. Anesthesiology, 126(4), 678-687.

Li, X., & Ma, X. (2020). Acute respiratory failure in COVID-19: is it “typical” ARDS?. Critical care, 24(1), 1-5.

Scala, R., & Heunks, L. (2018). Highlights in acute respiratory failure. European Respiratory Review, 27(147).

Vignon, P., Repessé, X., Vieillard-Baron, A., & Maury, E. (2016). Critical care ultrasonography in acute respiratory failure. Critical Care, 20(1), 1-11.