ARDS

Question 1

acute respiratory failure is the failure of

Answer 1

oxygenation, ventilation, or both

Question 2

if a pt vomits/aspirates (direct injury) we have a problem with oxygenation or ventilation

Answer 2

ventilation?

Question 3

hypoxemia/hypoxic PaO2 values

Question 4

metabolic hypercapnia PaCO2 value

Answer 4

PaCO2 >50mmHg

Question 5

acidotic value

Answer 5

pH

Question 6

how failure of oxygenation happens

Answer 6

hypo-ventilation
intrapulmonary shunting*** no oxygenation going on
ventilation-perfusion mismatch
diffusion defects
low cardiac output
low hemoglobin level
tissue hypoxia

Question 7

intrapulmonary shunting results in

Answer 7

ards

Question 8

what is hypo-ventilation

Answer 8

increased CO2

Question 9

what causes hypo-ventilation

Answer 9

drug overdose
neurological disorders (SCI - trauma)
abd/thoracic surgery r/t pain
low cardiac output

Question 10

what is intrapulmonary shunting

Answer 10

blood shunted from rt to lt side of heart w/o oxygenation

Question 11

what causes intrapulmonary shunting

Answer 11

pneumonia, pulmonary edema

Question 12

***why doesn’t oxygen administrations help shunt disorder

Answer 12

no connection/transfer with aveoli

Question 13

what is ventilation/perfusion mismatch

Answer 13

ventilation or perfusion is decreased it causes mismatch

Question 14

what causes ventilation/perfusion mismatch

Answer 14

clot - prevent

Question 15

what is a diffusion defect

Answer 15

fluid in alveoli - towards end of ARDS

Question 16

what causes low cardiac output

Answer 16

low cardiac output, low hemoglobin (95% of oxygen is bound)

Question 17

what is necessary to transport oxygen

Answer 17

hemoglobin

Question 18

tissue hypoxia results in

Answer 18

anaerobic metabolism and lactic acidosis

Question 19

respiratory failure secondary to hypo-ventilation with

Answer 19

neuromuscular disease

Question 20

what is failure of ventilation

Answer 20

hypercapnia - elevated carbon dioxide r/t decreased ventilation causing mismatch

Question 21

when assessing respiratory failure look for these signs

Answer 21

hypoxemia (restlessness, anxiousness)
respiratory (tachypnea)
cardiovascular (increased HR)
metabolic expenditure - feed patients!
ABG's
Pulse Ox

Question 22

interventions for resp. failure

Answer 22

maintain airway
ensure oxygenation
identify/trt cause
prevent complications
pain relief
bed rest
high fowlers position

Question 23

mgmt of resp failure

Answer 23

bronchodilators
O2
steroids (reduce inflammation)

Question 24

resp failure concerns

Answer 24

improve O2 delivery; decrease O2 demands

Question 25

what does pt look like in resp failure

Answer 25

tachycardia diaphoresis nasal flare muscle working

Question 26

to maximize airway clearance

Answer 26

re-position pt every 2 hrs (mobilize secretions)

Question 27

*what is good lung down

Answer 27

fluids/inflammation in lungs - allows oxygenation to occur | mobilizes secretions

Question 28

how to calculate ratio to determine acute resp distress

Answer 28

PaO2/FiO2

Question 29

what is ARDS

Answer 29

noncardiogenic pulmonary edema

Question 30

dx criteria for ARDS

Answer 30

bilateral infiltrates | PaO2/FiO2 less than 200

Question 31

if a chest xray shows bilateral "white out' how do we trt

Answer 31

intubate (on our way to MODS)

Question 32

ARDS patho

Answer 32

``` SIRS stiff lungs release of mediators/histamines pulmonary edema damage to alveolar-capillary membrane increased capillary permeability shunting ```

Question 33

whose at risk for ARDS

Answer 33

smoker w/trauma accident | elderly

Question 34

**s/s of ARDS

Answer 34

``` hyperventilation dyspnea and tachypnea resp alkalosis increased temp/pulse white out on xray severe hypoxemia ```

Question 35

trt of ARDS

Answer 35

``` trt cause oxygenation and ventilation (peep) start w/non-invasive first trt pain/anxiety position (prone - good lung down) fluid/electrolyte balance support nutrition ```

Question 36

normal value for peep

Answer 36

5-10

Question 37

pressure on the lungs causes decreased cardiac output with peep, what is end result

Answer 37

hypotension

Question 38

complications of ARDS

Answer 38

DIC renal failure MODS

Question 39

the most avoidable preventable processes

Answer 39

VAP - ventilator assisted pneumonia | proper hand-washing*

Question 40

cause of VAP

Answer 40

dental plaque oral bacteria cross-colonization of hand/glove

Question 41

***VAP Bundle

Answer 41

``` elevate HOB 30-45 degrees awaken daily to assess readiness to wean/extubate (cough/deep breath) trt stress ulcers oral care (chlorhexedine 2x's/day) hand washing embolism prophylaxis ```

Question 42

what does pt look like with resp acidosis

Answer 42

anxiety | restlessness

Question 43

*what does pt look like with resp alkalosis

Answer 43

``` hyperventilation dizzy confused light-headed dry mouth SOB ```

Question 44

what does pt look like with metabolic acidosis

Answer 44

dehydrated | cause (liver/alcohol)

Question 45

what does pt look like with metabolic alkalosis

Answer 45

n/v