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NUR 210-Exam 1 > ARDS > Flashcards

ARDS Flashcards

(72 cards)

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1
Q

Spontaneous breathing is a _______ pressure driven cycle.

A

Negative

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2
Q

What 2 muscles contract during normal inspiration?

A

Diaphragm and intercostals

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3
Q

Describe normal inhalation.

A

Diaphragm flatens during contraction creating more space in chest which means less pressure in chest compared to atmospheric pressure to air rushes in bc of the decrease in intrapleural pressure.

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4
Q

Describe normal exhalation?

A

Expiratory phase is passive where diaphragm returns to normal position and lungs recoil and air is exhaled out

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5
Q

Pressure in alveoli during breathing process remains _______ so diffusion of gases occurs.

A

Positive

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6
Q

Define ventilation.

A

Movement of air into and out of lungs

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7
Q

Define perfusion.

A

Movement of blood flow

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8
Q

Define diffusion.

A

Gas exchange (CO2 and O2 being transported-works best when alveoli and capillary are close together)

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9
Q

Define hemodynamic.

A

Movement of blood

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10
Q

What are the hemodynamic effects of normal spontaneous breathing?

A

Increases venous return to R. atrium during inspiration
Increases pulmonary blood flow during inspiration
Increases cardiac output during inspiration

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11
Q

What is the biforcation (splitting) of the right and left mainstem?

A

Carina

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12
Q

What is Acutre Respiratory Distress Syndrome (ARDS)?

A

Rapid onset of non-cardiac pulmonary edema

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13
Q

Which of the following are true statements regarding the A/P of the resp. system? Select all that apply.
A. @ the end of inspiration the pressure in the alveoli is -
B. The R. lung has 3 lobes.
C. Physiological dead space includes the trachea, bronchi and bronchioles.
D. Normal resp. is a - driven cycle
E. Cilia action and mucus production are protective mechanisms to prevent infection.

A

B, C, D, E

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14
Q

At the beginning of inspiration the pressure in the alveoli is what?

A

Negative

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15
Q

At the end if inspiration the pressure in the alveoli is what?

A

0, it’s equal to atmospheric pressure

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16
Q 
A pt. is diagnosed w/ a pulmonary emboli. This will primarily affect:
A. Ventilation
B. Perfusion
C. Diffusion
D. Osmosis
A

B. Perfusion

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17
Q 
The amount of air inhaled and exhaled w/ a normal breath is the:
A. Functional residual capacity
B. Vital capacity
C. Negative inspiratory force
D. Tidal volume
A

D. Tidal volume

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18
Q

The amount of air left in the lungs after a normal exhalation is what?

A

Functional residual capacity

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19
Q

What is vital capacity?

A

The greatest amount of air that can be forced from the lungs after max. inhalation

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20
Q

What is negative inspiratory force?

A

Volume of air that’s inspired or expired during regular breathing

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21
Q

Tidal volume is based on what?

A

IDEAL body weight

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22
Q

What will you see w/ pulmonary emboli?

A

Hypoxia

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23
Q 
The hemodynamic effects of normal spontaneous breathing is:
A. Increased HR
B. Decreased CO
C. Increased pulmonary blood flow
D. Vasoconstriction of pulmonary artery
A

C. Increased pulmonary blood flow

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24
Q

ARDS is a progressive refractory period; what does that mean?

A

Resistance to treatment; low pulse ox even after admin. of O2

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25
What are the 2 most common causes of ARDS?
Trauma and sepsis
26
ARDS has extensive what?
Lung tissue inflammation
27
Aspiration pneumonia, inhaled toxins, pulmonary embolism and mechanical ventilation are examples of what type of injury?
Direct
28
Trauma, shock, sepsis, cardiac arrest, drug OD, acute pancreatitis, and O2 toxicity are examples of what type of injury?
Indirect
29
When do s/s start to appear w/ ARDS?
12-48hrs post injury
30
ARDS is the syndrome of what?
Inflammation and increased permeability
31
What keeps the alveoli open?
Surfactant
32
ARDS causes damage to what?
Alveolar-capillary membrane (space b/t alveoli and capillary; alveoli fills w/ fluid causing inflamm. which decreases surfactant and decreases gas exchange)
33
What is the goal of ARDS?
Preserve alveoli function (recruitment)
34
In the 1st phase of ARDS: acute injury what occurs in the 1st 24hrs?
Mild hypoxemia, dyspnea, tachypnea, resp. alkalosis, subtle changes in mentation, slight temp elevation, normal breath sounds and an occasional dry cough
35
What occurs in the latent period of ARDS b/t several hrs to 2 days?
Hypoxemi resistant to O2 therapy, may required use of mechanical ventilation, capillary congestion, microatelectasis
36
What occurs in the exudative phase of ARDS b/t 2-10days?
Onset of acute resp. failure, alveoli becomes edematous, surfactant becomes diluted, alveoli collapse and consolidates, s/s of systemic inflammatory response (SIRS)
37
What occurs in the fibroliferative phase of ARDS b/t 10days after injury?
Inflammation leads to fibrosis of alveolar-capillary membrane, severe physiologic abrnomalities, refractory hypoxemia, metabolic and resp. acidosis.
38
What occurs in the recovery/repair phase of ARDS?
Increase tissue oxygenation, decrease O2 consumption, and prevent complications
39
In the latent phase how does ARDS show up on a CXR and why?
Opacity bc normal alveoli is getting scarred
40
What is SIRS?
Group of s/s that mean massive inflammation
41
In the fibroproliferative phase pts become what bc they can't get rid of the CO2?
Resp. acidosis
42
CPAP is use when what?
Pt is awake/cooperative and can't maintain a PO2 greater than 50mmHG on O2 of 50% (short-term)
43
Mechanical ventilation does what?
Allows maintencance of adequate tissue oxygenation while correcting underlying cause and allowing lungs to heal
44
On mechanical ventilation enough O2 must be provided to prevent what but not cause what?
Cellular hypoxia; O2 toxicity
45
Increasing amounts of O2 cause cause more damage to what if a pt is on mechanical ventilation?
Damage to surfactant
46
Positive End Expiratory Pressure (PEEP) is used to?
Increase pO2 w/ lower fiO2
47
PEEP is used for pts who can't what?
Maintain a pO2 greater than 60 on 50% O2 or less
48
PEEP does what?
@ end of expiration sends out positive pressure to alveoli to keep it open for diffusion of gases
49
PEEPs increases what?
Functional residual capacity and # and size of alveoli available
50
What type of tidal volumes need to be used in pts w/ ARDS to prevent what?
Small; barotrauma and hemodynamic changes
51
What is barotrauma?
High pressure in alveoli (want low)
52
To minimize O2 demand we want to give what type of meds to minimize muscle use and anxiety?
Sedatives and muscle relaxants to paralyze and sedate
53
What type of meds are used for pts w/ ARDS?
Corticosteriods, antibiotics, and nitric oxide
54
Why are corticosteroids controversial?
Decreases inflammation and cellular permeability
55
What is nitric oxide?
Local vasodilator, maximizes perfusion to improve oxygenation
56
Why are prophylaxis antibiotics controversial?
Increases risk for infection
57
What increases tissue oxygenation?
Prone positioning
58
Do not use prone positioning with what?
Unresolved ICP, hemodynamic instability
59
What decreases oxygenation consumption?
Rest and sleep, treating agitation, treating anxiety w/ sedatives or morphine-monitor RR
60
How do you treat hyperthermia and pain in pts w/ ARDS?
Cooling blankets, antipyretics, low dose analgesics
61
What is the goal of fluid management?
Maintain normal circulating blood volume
62
How do you manage fluid in a pt. w/ ARDS?
Prevent fluid overload, treat hypotension w/ vasopressors and PRBCs, use diuretics w/ caution bc decreases BP, and sometimes do hemodialysis
63
What is pulmonary hygiene in a pt w/ ARDS?
Prevent secondary infection, suction, chest PT and humidification
64
How many calories a day should a pt w/ ARDS eat?
3000 calories
65
How do you manage nutrition in a pt. w/ ARDS?
Enteral feedings and avoiding TPN
66
How does enteral feedings help w/ nutrition?
Prevents muscle catabolism and weakness of resp. muscles and helps immune system mobilize defenses
67
Why should you avoid TPN?
Increase risk for infection
68
Too much fluid in a pt. w/ ARDS can cause what?
Worsening of ARDS
69
Too little fluid in a pt. w/ ARDS can cause what?
Thickening of secretions
70
Too much food @ 1 time can cause what which can lead to what?
Diarrhea; skin breakdown
71
What is muscle catabolism?
Breakdown of muscles to get protein when it's deficient
72
What are complications of ARDS?
Multi-system organ failure and infection

NUR 210-Exam 1 (9 decks)

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