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NUR 265 ADVANCED MED SURG > Unit 4 Chapter 29 Acute Respiratory Failure, Acute Respiratory Distress Syndrome > Flashcards

Unit 4 Chapter 29 Acute Respiratory Failure, Acute Respiratory Distress Syndrome Flashcards

1
Q

What is Acute Respiratory Failure

A

Failure of the respiratory system to meet the body’s demands for oxygen delivery

PATIENT NEEDS ASSITANCE BREATHING

-Assault to the pulmonary system

-Respiratory distress

-Decreased lung compliance

-Severe respiratory failure

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2
Q

Are patients with Acute Respiratory Failure may need mechanical ventilation?
A. No
B. Yes

A

B. Yes

-these patients need assistance breathing

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3
Q

Which of the following is a cause of Respiratory Failure?

A. Overuse of morphine
B. Excercise 3x a week
C. occasional cigarette smoking
D. occasional alcohol use

A

A. Overuse of morphine

*Overdose of opioids or alcohol

  • Decreased respiratory drive.
  • Obstruction of the airways.
  • Trauma- gunshot wound , knife stab, motor vehicle accident, rib fracture, flail chest, pulmonary contusion
    -Injury to lung tissue or chest wall.
  • Dysfunction of the chest wall
  • Any condition that affects
    breathing.
  • Disorders:
    Sleep apnea=NEEDS CPAP , opens up soft tissues to prevent collapse**
    **     Pulmonary emboli
    *Overdose of opioids or alcohol
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4
Q

What are the Early signs and symptoms of Acute Respiratory Failure?

A

EARLY
*Impaired oxygenation
Restlessness
*Fatigue
Headache
Dyspnea=HALLMARK SIGN
*Air hunger
*Tachycardia
*Increased blood pressure
Irritable
*Hypoxia
Respirations less than 12

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5
Q

Your patient has been diagnosed with Acute Respiratory Failure. The results for the blood gas test are in. pH: 7.33, CO2: 48 mmHg, HCO3: 24mEq/L, PaO2: 50
PaSO2:77. What is the patients Acid Base Balance?

A. Respiratory acidosis

B. Respiratory alkalosis

C. Metabolic acidosis

D. Metabolic alkalosis

A

A. Respiratory acidosis

they are retaining CO2

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6
Q

pH: 7.33
CO2: 48 mmHg
HCO3: 24mEq/L

A. Normal

B. Respiratory acidosis

C. Respiratory alkalosis

D. Metabolic acidosis

E. Metabolic alkalosis

A

B. Respiratory acidosis

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7
Q

What is the treatment for Acute Respiratory Failure

A

*Oxygen therapy; to treat hypoxia
*Nebulizer; to keep bronchioles open to promote gas exchange
*Corticosteroids; decrease inflammation
*Analgesics; if patient is in pain
*Diuretic Therapy
*Antibiotic Therapy
*Mechanical Ventilation
*Encourage deep breathing and exercise
*HOB 30-45 degreea
*Relaxation techniques; to decrease oxygen demands

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8
Q

ABG CLASSIFICATION OF ARF

A

Progressive or sudden.
* Deterioration of the gas exchange function of the lungs.
* PaO2 of less than 60 mmHg (hypoxemia)
* PaCO2 greater than 45 mmHg (hypercapnia)
* pH less than 7.35

RESPIRATORY ACIDOSIS

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9
Q

Is intubation required for Mechanical Ventilation?
A. Yes
B. No

A

A. Yes

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10
Q

After intubation is completed and confirmed by x-ray. What is the nurses next priority action?
A. Assess O2 saturation
B. Draw post intubation ABG’S
C. Elevate the HOB to 60 degrees
D.Aminister diphenhydramine

A

B. Draw post intubation ABG’S

^^^It’ll be the only way we know how the patient is responding to the mechanical ventilator.

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11
Q

What should the nurse monitor for a patient with ARF and is on the mechanical ventilator

A

Monitor:
* Level of response
* Vital signs
ABGs
* Continuous pulse oximetry

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12
Q

Nursing Consideration Mechanical Ventilator

A

Prevent ventilator associated pneumonia.
* Peptic Ulcer Prophylaxis (IHI Guidelines)
* Venous thromboembolism prophylaxis (IHI
Guidelines)
* HOB elevated 30-45 degrees (IHI
Guidelines)

  • Chest PT
  • Humidification
  • Suctioning as necessary
  • Effective coughing
  • Monitor fluid intake to allow for
    secretions to be coughed
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13
Q

What is Acute respiratory distress syndrome (ARDS

A

Hypoxemia due to sudden,
progressive pulmonary edema with increasing bilateral infiltrates in lungs (INFILTRATED ALVEOLI, dilated surfactant)

Non–cardiac-associated bilateral pulmonary edema

Poorly inflated alveoli receive blood but cannot oxygenate it, increasing the shunt. Hypoxemia and ventilation-perfusion ( ) mismatch result.

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14
Q

Your client has been admitted due to shortness of breathe and his SaO2 is 85% . He is placed on Nasal Cannula 3L/min oxygen. On Assessment, you notice his SaO2 has not increased but instead decreased showing a SaO2 of 83%. What disorder do you suspect your patient to have?
A. Pulmonary Embolism
B. Pulmonary Edema
C. Myocardial Infarction
D. Acute Respiratory Distress Syndrome

A

D. Acute Respiratory Distress Syndrome

Hypoxemia that persists even when 100% oxygen is given (refractory hypoxemia, a cardinal feature of ARDS)

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15
Q

Can ARDS progress into respiratory failure?
A. Yes
B. No

A

A. Yes

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16
Q

What is a complication of Acute Respiratory Distress Syndrome?
A. Atelecetsis
B. Hypertention
C. Glascow score of 15
D. Pain level 2/10

A

A. Atelecetsis

collapse of the lung

17
Q

Pathophysiology of ARDS

A

Often occurs with disorders that fill
lungs with fluid, which dilutes the
surfactant and therefore the alveoli collapse

18
Q

Does a patient with Refractory Hyoxemia require mechanical ventilation?
A. Yes
B.No

A

A. Yes

The patient develops refractory
hypoxemia and often needs intubation and mechanical ventilation.

19
Q

X-ray finiding with patient dx with ARDS

A

The chest x-ray may show - diffuse haziness or a “whited-out”
- (ground-glass) appearance of the lung.

An ECG rules out cardiac problems and usually shows no specific changes.

20
Q

Direct Cause of ARDS

A

Aspiration
*Near drowning
* Prolonged inhalation of smoke, or corrosive
substances
* Infections
* Embolus

21
Q

Indirect Cause of ARDS

A

Sepsis
* Shock or prolonged hypotension * Non-thoracic trauma
* Cardiopulmonary bypass or other major surgery
* Head injury
Pancreatitis
* Multiple blood transfusions
* Diabetic coma
*Drug ingestion and overdose(.g., heroin, opioids, aspirin)
Infection(NOT CHANGING TPN TUBING
BURN PATIENTS

22
Q

A newly licensed nurse is in residency. The instructor asks her which out of the 4 patients are at highest risk for Acute Respiratory Distress Syndrome?

A. Patient who is diagnosed with Chronic Heart Failure
B. Patient with Chronic Obstructive Pulmonary Disease
C. The patient arrived in the emergency department with 4th-degree burns on the upper torso.
D. The patient with Pernicious Anemia.

A

C. The patient arrived in the emergency department with 4th-degree burns on the upper torso.

Often ARDS occurs after an acute lung injury (ALI) in people who have no pulmonary disease as a result of other conditions such as sepsis,
**burns*,
pancreatitis,
trauma, and transfusion.

23
Q

S/S of Acute Respiratory Distress Syndrome

A

REFRACTORY HYPOXEMIA
*Hypoxemia that persists even when 100% oxygen is given(Cardinal feature of ARDS)

Inspection
* Assess the work of breathing
* Posturing
* Nasal flaring
* Intercostal retractions
* Use of accessory muscles
* Assess rate/depth of respirations
* Tachypnea
* Hyerpnea
* Palpation
ATELECTSIS
* Assess lung expansion due to
decreased compliance
* Rapid onset of severe dyspnea
* Arterial hypoxemia
* ABGs show respiratory acidosis.
* Bilateral infiltrates in lungs
* Crackles
* Persistent, severe hypoxemia
* Increased alveolar dead space

24
Q

Medical Treatment for ARDS

A
  • Pulmonary specific vasodilators
  • Corticosteroids
  • Anti-inflammatories
  • Antibiotics
    *Surfactant replacement
25
Q

Medical Managment of ARDS

A

* Intubation
* Aggressive, supportive care.
* Mechanical ventilation
* PEEP – Positive End Expiratory Pressure
* Prone position to improve ventilation perfusion.
* Circulatory support
* Adequate fluid volume. *

Nutritional support
* 35-45 kcal/kg per day.
^ALBUMIN 3.5-5

26
Q

Are patients with ARDS at risk for Malnutrion?
A. Yes
B.No

A

The patient with ARDS is at risk for malnutrition, which further reduces respiratory muscle function and the immune response.

Nutritional support
* 35-45 kcal/kg per day.
^ALBUMIN 3.5-5

27
Q

Which nutritional intervention is best compatible for a patient diagnosed with ARDS who is sedated, intubated, and is on. a mechanical ventilator?
A. Total Parental Nutrition
B. Dysphagia diet
C. Oral rehydration
D. Oral feedings

A

A. Total Parental Nutrition

The interprofessional team must include a registered dietitian nutritionist.

Enteral nutrition (tube feeding) or parenteral nutrition is started as soon as possible.

28
Q

What is the best position for patient diagnosed with ARDS on a , mechanical ventilator?
A. supine
B. Sims position
C.Fetal position
D.Prone

A

D.Prone

Some patients do be er in the prone position, especially if it is started early in the disease course

*Prone positioning may be achieved using a mechanical turning device, although the turning equipment is awkward and care in the prone position is more difficult.

29
Q

What is the mode or setting of choice for a patient with Acute Respiratory Distress Syndrome on Mechanical ventilation to prevent to collapse of the lung and to keep the alveoli open?SELECT ALL THAT APPLY
A. Tidal Volume
B. Respiratory Rate
C. Peak Inspiratory Pressure(PIP)
D. Peak End Expiratory Pressure
E. Continuous positive airway pressure (CPAP)

A

D. Peak End Expiratory Pressure
E. Continuous positive airway pressure (CPAP)

The patient with ARDS often needs intubation and mechanical ventilation with positive end-expiratory pressure (PEEP) or continuous positive airway pressure (CPAP)

30
Q

The function of Peak End Expiratory Pressure(PEEP)

A

Application of posistive pressure to the airways at the end of expiration to distend the alveoli and prevent collapse

31
Q

Which of the following is complication of Peak End Expiratory Pressure(PEEP)?
A. Pulmonary Edema
B. Tension Pneumothorax
C. Hemothorax
D. Flail chest

A

B. Tension Pneumothorax

32
Q

Signs and Symptoms of Tension Pneumothorax

A

Tracheal deviation
JVD
Asymmetrical chest

33
Q

Nursing Management of ARDS

A

Assess lung sounds and vital signs at least hourly
* Suction PRN
* Monitor for tension pneumothorax
* Ensure adequate sedation; TO PREVENT EXTUBATION
* Nutrition 35-45K/CAL PER DAY
* Turn Q2h as tolerated
* Proning every 2 hrs. - reserved for refractory hypoxemia not
responding to other therapies – early stage

34
Q

What is the recommndied positioning for a patient diagnosed with ARDS?
A. left sims
B supine
‘C. high fowlers
D. prone

A

D. prone

Altered ventilation perfusion.- Use of prone positioning.

35
Q

What is the #1 Goal of a mechanical ventilator?

A

WEAN PATIENT OFF VENTILATOR

The longer the patient stays on the vent the worse the prognosis

36
Q

Prior to suctioning, what should you do?

A

STERILE TECHNIQUE

1. 100% HYPEROXYGENATION NOT VENTILATE

37
Q

1 goal of mechanical ventilator?

A

EXTUBATION& IMMPROVE TH EASE OF BREATHING AND GAS EXCHANGE

-THE LONGER THE PATIENT STAYS ON THE VENT THE LONGER THE PROGNOSIS
-Wean off the ventilator

NUR 265 ADVANCED MED SURG (53 decks)

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