Acute Respiratory Failure

Categories: Respiratory System

Developing Critical Thinking through Understanding Pathophysiology Primary Problem (Medical Diagnosis) of patient: Acute Respiratory Failure (Type 1 Hypoxemia) Define and describe in your own words, the pathophysiology of the primary problem of your patient.

Acute respiratory failure (ARF) is the impairment of the gas exchange function of the lung(s), where either oxygen is unable to diffuse from the alveoli and into the blood and tissues or carbon dioxide is unable to diffuse out from the blood and into the alveoli, in some cases, it may be both.

Type I ARF, or hypoxemic ARF, is concerning the oxygenation problem with normal breathing abilities (Hinkle & Cheever, 2018; Lewis, Dirksen, Heitkemper, Bucher, & Harding, 2017; McCance & Huether, 2017). How would you explain and teach your patient about the pathophysiology of this medical problem using non-medical terminology?

Acute respiratory failure is when your lungs either are not able to allow oxygen into your blood and to the rest of your body, or they are not able to get rid of the carbon dioxide from the body and the blood, or both.

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In your case the buildup of fluid, mucus, and debris because of the pneumonia are causing your lungs to prevent adequate amounts of oxygen going into your blood. It is because of this that you are having a harder time breathing, and breathing faster. This is your body’s response to try to get more oxygen into your body. What body system(s) are directly impacted by this disease and how are those systems affected?

The respiratory system, central nervous system, and cardiac system are directly impacted by ARF.

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The respiratory system is affected because the lungs are working harder by breathing faster and deeper to get sufficient amount of oxygen into the blood and into the organs and tissues. The patient may be seen using their accessory muscles, for example the intercostal, sternocleidomastoid, and scalene muscles, to help expand the thoracic cavity to pull in atmospheric air into lungs. The patient may experience fatigue because they are overusing their accessory muscles, which in turn may affect the patient’s ability to speak in complete sentences because they will need to pause frequently to breathe. The central nervous system is affected because the brain is very sensitive to changes to the oxygen, carbon dioxide, and acid-base balances. When an insufficient amount of oxygen is being delivered to the brain a patient may present with signs and symptoms which may include agitation, disorientation, restlessness or combative behavior, delirium, confusion, decreased level of consciousness, or coma (late sign). The cardiovascular system is affected because it works closely with the respiratory system to pump blood to the lungs for oxygenation and carbon dioxide expulsion. In hypoxemic ARF, the blood is not adequately oxygenated and cannot supply the organs and tissues with sufficient amount oxygen to function properly.

To compensate the heart works harder by pumping faster (tachycardia). This compensatory response is not sustainable and the heart will begin to pump abnormally, which manifest as irregular heart rate (dysrhythmias). What are the PRIORITY nursing assessments with this disease? (Refer to body system that is most affected). What assessment findings may be abnormal as a result of this illness? The priority nursing assessments with hypoxemic ARF is collecting a focused health history, which include current and past respiratory or cardiac conditions, smoking history, any injury or trauma to the heart and lungs, previous procedures, what is their current medication regimen (if yes, is the patient taking them as directed?)

The physical assessment will include the ABCDE assessment (airway, breathing, circulation, disability, exposure). Does the patient have effective airway clearance, is the patient breathing effectively on their own or will they did assistance, Is the patient heart pumping effectively or is sufficient blood volume circulating, is/are their disability that is affecting the patient ability to function or affect possible medical and nursing interventions, does the patient’s have any exposures that may worsen their condition? When assessing the respiratory system, one may note rapid, shallow breathing along with the accessory muscles use. One may observe for chest retractions, paradoxical chest and abdominal movement, and asymmetrical chest wall movement. When auscultating lungs sounds, one may note adventitious or diminished breath sounds. When assessing the cardiovascular system, one may note tachycardia in the early stage that progresses to bradycardia, dysrhythmias and extra heart sounds (S3 and S4) may be present in late stage of the disease process. Hypertension is seen in the early stage that progresses to hypotension.

The patient may present with jugular vein distention, bounding pulse, pulsus paradoxus, and pedal edema. When assessing the central nervous system, the patient may exhibit confusion, slurred speech, delirium, somnolence, tremors, seizures, and agitation. What lab tests are altered by this problem? How are those lab tests affected? Does the altered lab test affect any physical assessment findings? Arterial Blood Gas (ABG) test and chest x-ray are two important tests when it comes to ARF. ABGs is a more reliable test to determine arterial oxygen and carbon dioxide levels, along with acid-base balances. Chest x-ray helps identify if there are anatomical pathology of the lungs that may indicate the underlying cause of ARF (Hinkle & Cheever, 2017). Basic metabolic panel, complete blood count, and culture studies are performed to provide a comprehensive picture of the patient’s condition. ABGs will show abnormalities in serum electrolytes, hemoglobin, and hematocrit levels. WBC count levels may also show abnormal levels (Hinkle & Cheever, 2017). What medications are most commonly used to manage this problem?

The most commonly prescribed medications to treat ARF due to pneumonia include supplemental oxygen and antibiotics for bacterial pneumonia (Lewis et al, 2018). A provider may prescribe a macrolide antibiotic such as azithromycin or clarithromycin, fluoroquinolones such as ciprofloxacin or levofloxacin, and tetracycline (Lewis et al, 2018). The supplemental oxygenation addresses the decreased PaO2, while the antibiotic is used to treat the underlying bacterial pneumonia.


  1. Hinkle, J.L. & Cheever, K.H. (2018). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (14th ed.).
  2. Philadelphia: Wolters Kluwer. Lewis, S.L., Dirksen, S.R., Heitkemper, M.M., Bucher, L., & Harding, M.M. (2017).
  3. Medical-Surgical Nursing: Assessment and Management of Clinical Problems (10th ed.). St. Louis: Elsevier. McCance, K.L. & Huether, S.E. (2017).
  4. Understanding Pathophysiology: The Biologic Basis for Disease in Adults and Children (6th ed.). St. Louis: Elsevier/Mosby. (Hinkle & Cheever, 2018)
  5. (Lewis, Dirksen, Heitkemper, Bucher, & Harding, 2017) (McCance & Huether, 2017)

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Acute Respiratory Failure. (2021, Oct 12). Retrieved from

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