NORCET -4 , 2023
Medical & Surgical Nursing
Medium
A patient develops type 2 respiratory failure. Which is a probable cause of this?
Appeared in: NORCET -4 , 2023
Explanation
- Type 2 respiratory failure, also known as hypercapnic failure, is defined by inadequate alveolar ventilation, leading to a high arterial carbon dioxide level (PaCO2 greater than 50 mmHg).
- Flail chest is a direct cause of ventilatory or 'pump' failure. It occurs when a segment of the chest wall is detached due to multiple rib fractures.
- The paradoxical movement of the flail segment severely impairs the mechanics of breathing, preventing the effective removal of carbon dioxide and causing it to accumulate in the blood.
Why Other Options Were Wrong
- Option A: Interstitial lung disease causes scarring and fibrosis of the lung tissue, which primarily impairs oxygen diffusion across the alveolar-capillary membrane. This leads to hypoxemia with a normal or low PaCO2, which is characteristic of Type 1 respiratory failure.
- Option C: Pulmonary oedema involves fluid filling the alveoli, creating a physical barrier to oxygen transfer from the air to the blood. This is a primary cause of oxygenation failure, leading to Type 1 (hypoxemic) respiratory failure.
- Option D: Acute Respiratory Distress Syndrome (ARDS) is a condition of widespread lung inflammation and fluid leakage that severely impairs oxygenation. It is a classic example of Type 1 (hypoxemic) respiratory failure.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Differentiating causes of Type 1 (Hypoxemic) and Type 2 (Hypercapnic) Respiratory Failure to guide bedside assessment, documentation, and the next nursing action.
- Recognizing the underlying cause of respiratory failure is critical for nurses, as it dictates priority interventions. Type 2 failure requires immediate support of ventilation (e.g., non-invasive or mechanical ventilation), whereas Type 1 may initially be managed with supplemental oxygen.
- A patient with flail chest requires careful pain management and may need positive pressure ventilation to stabilize the chest wall and improve gas exchange.
- What if? If the patient had a history of myasthenia gravis and presented with shallow breathing and increasing drowsiness, this would also indicate Type 2 respiratory failure due to neuromuscular weakness, requiring urgent ventilatory support.
How to Approach the Question
- First, identify the core concept: the question asks for a cause of 'Type 2 respiratory failure'.
- Recall the definition of Type 2 respiratory failure: it is hypercapnic failure, meaning a problem with ventilation (the 'pump') that leads to CO2 retention.
- Analyze each option to determine if it primarily affects ventilation (the pump) or oxygenation (the lung tissue).
- Flail chest is a chest wall injury, a clear 'pump' problem. Interstitial lung disease, pulmonary oedema, and ARDS are all 'lung tissue' problems affecting oxygenation.
- Conclude that flail chest is the cause of Type 2 failure, while the others cause Type 1 failure.
Concept Tested & Keywords
- Concept Tested: Differentiating causes of Type 1 (Hypoxemic) and Type 2 (Hypercapnic) Respiratory Failure.
- Stem keywords: type 2 respiratory failure, probable cause
- Lead-in keywords: Which is
- Negative lead-in flag: false
Question ID
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Reference Book
E6 Medicine Davidson Principles Practice 24e p. 585-587
E6 Medicine Harrison 22e Part 2 p. 199-201
Practise the full NORCET -4 , 2023
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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