ARDS

Question 1

Hypoxemic respiratory failure vs. Hypercapnic respiratory failure

Answer 1

Hypoxemic: a PaO2 of less than 60 mm hg
Hypercapnic: a PaCO2 greater than 50 mm hg with acidemia

Question 2

1) What is O2 therapy used to treat?
2) How to give O2?
3) What to monitor?
4) What is the risk?

Answer 2

1) Hypoxemia
2) Always give at the lowest FIO2 possible
3) Changes in mental status, RR, ABGs
4) O2 toxicity when exposed to FIO2 greater than 60% for longer than 48hours

Question 3

What techniques are used to mobilize secretions?

Answer 3

• Positioning: elevated HOB 30 degrees or side lying
• Coughing: quad or huff coughing
• Hydration: Fluid intake of 2-3L a day to thin secretions
• Ambulation

Question 4

1) What is PEEP used for?
2) Advantage
3) Types
4) Who should not get it?

Answer 4

1) For pts who don’t improve oxygenation and ventilation
2) Helps decrease WOB and avoids need for intubation
3) CPAP and BiPAP
4) Pts with decreased LOC, high O2 requirements, facial trauma, hemodynamic instability or excessive secretions

Question 5

1) Function of corticosteroids
2) Examples
3) Disadvantage of ICS
4) What to monitor?

Answer 5

1) Reduce inflammation in the airways
2) Methylprednisone
3) Takes 4-5 days for optimum effects
4) Monitor potassium levels for hypokalemia

Question 6

1) Function of bronchodilators
2) Examples
3) How to use?
4) Side effects

Answer 6

1) Reduce bronchospasms
2) Albuterol
3) Give in 15 or 30min increments until a response occurs
3) Tachycardia and HTN

Question 7

1) What meds are used to relieve pulmonary congestion?

2) What to monitor?

Answer 7

1) Diuretics, morphine, or nitroglycerin

2) For changes in HR and decreases in BP

Question 8

1) ARDS

2) What is this caused by?

Answer 8

1) The alveolar capillary membrane becomes damaged and more permeable to intravascular fluid
2) Direct injury: aspiration of gastric contents, bacterial/viral pneumonia, and sepsis
Indirect injury: Sepsis, severe massive trauma, TBI, and shock

Question 9

1) What does ARDS result in?

2) Top 4 causes

Answer 9

1) Physiologic alterations: V/Q mismatch, decreased lung compliance, increased WOB
2) Sepsis, pneumonia, severe trauma, and aspiration of gastric contents

Question 10

S&S of ARDS

Answer 10

• Acute resp. Failure
• Dry cough
• Fever
• Fine crackles
• Changes in mental status
• Refractory hypoxemia
• Tachypnea
• Retractions

Question 11

1) What does CXR show?
2) Lab findings
3) What is used to evaluate the severity of hypoxemia?

Answer 11

1) White out: widespread infiltrates throughout the lung
2) Initially resp alkalosis and then acidosis
3) The PaO2/FIO2 ratio; normally is greater than 400 but ARDS causes it to be lower

Question 12

Complications of ARDS

Answer 12

• Abnormal lung function
• VAP
• Barotrauma
• Stress ulcers
• VTE
• AKI

Question 13

1) Risk factors for VAP

2) Prevention

Answer 13

1) Impaired host defenses, invasive monitoring devices, aspiration of GI contents, and prolong mechanical ventilation
2) Elevate HOB 30-45 degrees, hand hygiene, sterile technique during suctioning, and frequent oral care

Question 14

1) How to minimize the risk of barotrauma
2) Prophylactic Tx for stress ulcers
3) Prophylactic Tx for VTE
4) What to monitor for AKI? Tx?

Answer 14

1) Provide ventilation with smaller and varying amounts of PEEP
2) Antiulcer drugs: pantoprazole and sucralfate
3) Compression stokings, heparin, and ambulation
4) Intake and output, daily creatinine and urea levels; Treated with continuous renal replacement therapy

Question 15

Nursing Dx for ARDS

Answer 15

• Anxiety
• Impaired gas exchange
• Altered nutrition
• Depression
• Decreased cardiac output
• Knowledge deficit

Question 16

What should the nurse asses in patients with ARDS?

Answer 16

• Sputum production
• Oxygenation: continuous pulse ox
• Heart sounds: diminished
• Lung sounds: crackles
• Urinary output
• Cardiac Rhythm: hypoxia leads to tachypnea

Question 17

1) How is effectiveness of O2?
2) Tx of mild hypoxemia
3) Tx of moderate to severe

Answer 17

1) Monitor SPO2
2) High flow O2 delivery and BiPAP
3) Mechanical ventilation

Question 18

What techniques are used for respiratory management?

Answer 18

-O2 administration
-Mechanical ventilation
-Low tidal volume ventilation
-Permissive Hypercapnia
-PEEP
-Prone positioning
ECMO

Question 19

1) What tidal volume should pts be ventilated with?
2) Permissive hypercapnia
3) What should be monitored?

Answer 19

1) Low Vt of 4-8 ml/kg
2) When the PaCO2 rises up to 60mm hg when delivering low VTE
3) ABGs

Question 20

1) How should PEEP be given?

2) Side effects

Answer 20

1) In increments of 3-5cm H2O until oxygenation is adequate with an FIO2 of 60% or less
2) Dramatic reductions in preload, CO, and BP

Question 21

1) Who is prone positioning used for?

2) How long can pts remain in prone?

Answer 21

1) For pts with refractory hypoxemia who don’t respond to other strategies
2) Up to 16 hours a day

Question 22

What medications are used to manage ARDS?

Answer 22

• Diuretics: Furosemide
• Antianxiety: benzos
• Neuromuscular
• Analgesics
• Antibiotics
• Dopamine to maintain BP
• Corticosteroids

Question 23

Interventions to maintain perfusion

Answer 23

• Maintain airway
• Maximize O2 transport
• Increase fluid volume
• Evaluate volume status
• Administer drugs

Question 24

1) How should an O2 delivery device be selected?

2) What are the most common early signs of ARDS?

Answer 24

1) Based on the pts condition and need for FIO2

2) Dyspnea and tachypnea