6 Respiratory Failure Practice Questions
Recognize signs of acute respiratory deterioration, respond safely, and understand how oxygen and ventilatory support fit alongside treatment of the underlying cause.
Recognizing deterioration
is an emergency. Worsening breathlessness, altered mental status, cyanosis, or signs of exhaustion require prompt assessment and escalation. Oxygen and ventilatory support can help stabilize gas exchange while the care team treats the underlying cause.
Acting on signs of worsening
Treat new confusion, restlessness, or drowsiness as concerning when respiratory illness is worsening. In one deterioration pattern, a patient with pneumonia becomes restless and confused, has a respiratory rate of , falling oxygen saturation despite supplemental oxygen, and increased use of accessory muscles. The priority is to stay with the patient, promptly escalate care, and support breathing while help arrives—not to wait for a routine reassessment, encourage walking, or offer oral fluids without first establishing that swallowing is safe.
Increased work of breathing, altered consciousness, or persistent or worsening also warrants prompt escalation. Assess the patient and support airway and breathing according to protocol.
Matching respiratory support to the patient
A severe asthma attack can worsen even when wheezing becomes barely audible. Drowsiness, weakening respiratory effort, and markedly reduced wheezing may indicate poor airflow and , not recovery. Call for emergency help and prepare for advanced respiratory support. Do not dismiss the change as improvement, use a paper bag for breathing, or withhold prescribed oxygen while waiting for a blood gas result.
A patient with an acute COPD exacerbation may be alert yet have severe work of breathing and respiratory acidosis. For example, blood gas results of and support considering if there is no contraindication and the patient can protect their airway. Being awake alone is not a reason to withhold respiratory support, and routine sedation to reduce respiratory rate or discontinuing oxygen to prevent are not appropriate responses.
Monitor closely during NIV. Inability to protect the airway, intolerance, clinical worsening, or NIV failure requires urgent escalation and possible invasive ventilation.
Monitoring oxygen and ventilation
Reassess respiratory effort, mental status, oxygen saturation, and the patient's response to support. Check that the oxygen delivery device is correctly positioned and functioning. Titrate oxygen according to the prescribed target and local protocol.
An improving oxygen saturation alone does not establish that ventilation is adequate or rule out . Continue assessing the patient and adjust oxygen and other respiratory support in response to the patient's condition.
Responding to possible causes
Sudden, unexplained shortness of breath, pleuritic chest pain, and a rapid heart rate may indicate and require immediate medical evaluation. Promptly notify the clinical team and initiate urgent assessment. Do not assume the symptoms are expected with pneumonia, wait for a scheduled round, massage the calves, or encourage ambulation before reassessment.
Pneumonia can cause shortness of breath and impaired oxygenation. For a patient who is short of breath with low oxygen saturation, position the patient upright, assess breathing and oxygenation, and provide oxygen as prescribed or under protocol while further assessment and treatment are arranged. Reassess the patient's response and escalate worsening findings promptly.
Interpreting changes and treating the cause
New confusion and increasing drowsiness can signal high carbon dioxide levels and worsening respiratory failure; assess promptly and escalate according to the patient's condition and protocol. A mild, unchanged cough, stable appetite, or warm hands after a meal does not carry the same significance for in the scenarios described.
Prioritize airway, breathing, and rapid recognition of deterioration. Respiratory support stabilizes gas exchange, but treatment of the underlying cause—such as asthma, COPD exacerbation, pneumonia, or —is essential alongside that support.