ARDS vs ARF
A patient has a PaO₂ of 48 mmHg on room air. Does this meet criteria for ARF? If so, what type?
⭐ Bonus Question:
What is the “50/50 rule”?
Yes. This meets criteria for hypoxemic acute respiratory failure.
⭐ Bonus Answer:
PaO₂ < 50 mmHg (hypoxemia) OR PaCO₂ > 50 mmHg with pH < 7.35 (hypercapnic respiratory failure).
A patient with ARDS has PaO₂ 54 mmHg while on a non-rebreather mask at 100% FiO₂. What is the nurse’s FIRST action?
⭐ Bonus Question:
Why is starting an IV not the priority here?
Prepare for intubation.
⭐ Bonus Answer:
Airway and breathing take priority over circulation; severe hypoxemia is immediately life-threatening.
A high-pressure alarm is sounding. What are two likely causes?
⭐ Bonus Question:
What is your FIRST action?
Possible causes:
• Kinked tubing
• Secretions/mucus plug
• Patient biting tube
• Decreased lung compliance
⭐ Bonus Answer:
Assess the patient first (work of breathing, breath sounds, agitation).
What does SAT stand for, and what is its purpose?
⭐ Bonus Question:
Why is daily SAT important in ventilated patients?
Spontaneous Awakening Trial — temporarily reducing or stopping sedation to assess neurologic status and readiness to wean.
⭐ Bonus Answer:
Reduces prolonged sedation, lowers risk of delirium, and helps determine readiness for extubation.
A 62-year-old patient with sepsis develops increasing dyspnea. ABG:
pH 7.32
PaCO₂ 48
PaO₂ 58
FiO₂ 0.80
What is happening?
⭐ Bonus Question:
Calculate the PF ratio and classify severity.
Acute respiratory failure with suspected ARDS.
⭐ Bonus Answer:
PF ratio = 58 ÷ 0.8 = 72.
Severe ARDS (<100).
A patient has PaO₂ 60 mmHg on FiO₂ 80%. Calculate the PF ratio. What severity of ARDS does this indicate?
⭐ Bonus Question:
Why does a lower PF ratio correlate with worse mortality?
PF ratio = 60 ÷ 0.8 = 75.
Severe ARDS (<100).
⭐ Bonus Answer:
Lower ratio reflects severe impairment in oxygen exchange due to alveolar collapse and inflammation.
After intubation, how does the nurse confirm proper endotracheal tube placement at the bedside?
⭐ Bonus Question:
What finding would indicate esophageal intubation?
End-tidal CO₂ detector color change, bilateral breath sounds, chest rise.
⭐ Bonus Answer:
Absent breath sounds and no CO₂ detection; abdominal distention may occur.
A low-pressure alarm is sounding. What does this usually indicate?
⭐ Bonus Question:
Why is this potentially dangerous?
A leak or disconnection in the system (ETT cuff leak, tubing disconnected).
⭐ Bonus Answer:
The patient may not be receiving adequate ventilation → rapid hypoxia.
🎯 Question:
What does SBT stand for, and what does it assess?
⭐ Bonus Question:
What ventilator settings are commonly used during an SBT?
Spontaneous Breathing Trial — assesses the patient’s ability to breathe without full ventilator support.
⭐ Bonus Answer:
Low pressure support (e.g., 5–10 cmH₂O), PEEP 5, FiO₂ ≤ 40%.
The patient is placed on AC mode:
Rate 14
Tidal Volume 400 mL
FiO₂ 100%
PEEP 8
Why is PEEP necessary here?
⭐ Bonus Question:
What complication can occur if FiO₂ remains at 100% too long?
PEEP prevents alveolar collapse and improves oxygenation.
⭐ Bonus Answer:
Oxygen toxicity and absorption atelectasis.
Why is PEEP used in ARDS?
⭐ Bonus Question:
What complication can excessive PEEP cause?
PEEP keeps alveoli open at end-expiration to improve oxygenation and prevent collapse.
⭐ Bonus Answer:
Hypotension due to increased intrathoracic pressure reducing venous return.
A ventilator alarm is sounding. The patient is visibly distressed. What is your FIRST action?
⭐ Bonus Question:
If you cannot quickly identify the cause of the alarm, what is your NEXT action?
Assess the patient first (not the machine).
⭐ Bonus Answer:
Disconnect from ventilator and manually bag with 100% oxygen.
A ventilated patient suddenly becomes restless, tachycardic, and SpO₂ drops to 85%. The ventilator alarm sounds, but tubing appears intact. What complication must you consider immediately?
⭐ Bonus Question:
What bedside intervention might quickly relieve this?
Mucus plug or acute airway obstruction.
⭐ Bonus Answer:
Suction the endotracheal tube.
During an SBT, the patient develops RR 40, BP 190/105, and anxiety. What does this indicate?
⭐ Bonus Question:
What is your immediate action?
Failed weaning attempt.
⭐ Bonus Answer:
Return to prior ventilator settings and notify provider; patient is not ready for extubation.
The patient is sedated with propofol. BP drops to 86/50. What is the likely cause?
⭐ Bonus Question:
What medication might be started to support BP?
Sedation-induced vasodilation → decreased systemic vascular resistance.
⭐ Bonus Answer:
Norepinephrine infusion (pressor support).
A patient with ARDS becomes suddenly agitated and “bucks the vent.” What is happening physiologically?
⭐ Bonus Question:
What is your priority intervention?
A patient with ARDS becomes suddenly agitated and “bucks the vent.” What is happening physiologically?
⭐ Bonus Question:
What is your priority intervention?
A ventilated patient becomes hypotensive after PEEP is increased. What is the likely mechanism?
⭐ Bonus Question:
What is your priority nursing response?
Increased intrathoracic pressure → decreased venous return → decreased cardiac output.
⭐ Bonus Answer:
Assess BP and perfusion immediately; notify provider and anticipate PEEP adjustment or fluid/pressor support.
A ventilated patient develops sudden hypotension, tracheal deviation, and absent breath sounds on one side. What is occurring?
⭐ Bonus Question:
What is the immediate priority intervention?
Tension pneumothorax (barotrauma from ventilation).
⭐ Bonus Answer:
Prepare for emergent needle decompression; notify provider immediately.
List 3 components of the VAP (Ventilator-Associated Pneumonia) bundle.
⭐ Bonus Question:
Why is head-of-bed elevation important?
• HOB 30–45°
• Daily sedation interruption
• Peptic ulcer prophylaxis
• DVT prophylaxis
• Oral care with chlorhexidine
⭐ Bonus Answer:
Reduces aspiration risk of gastric/oral secretions.
Suddenly, peak airway pressures rise, SpO₂ drops to 84%, and breath sounds are absent on the right. What complication has likely occurred?
⭐ Bonus Question:
What is your immediate action?
Tension pneumothorax (ventilator-associated barotrauma).
⭐ Bonus Answer:
Call for emergent decompression while providing oxygen support.
A patient with ARDS has worsening crackles, rising FiO₂ requirements, decreasing urine output, and increasing BUN.
What does this suggest about fluid status?
⭐ Bonus Question:
Why must fluid management be handled carefully in ARDS?
Likely fluid overload worsening pulmonary edema.
⭐ Bonus Answer:
Excess fluids worsen alveolar flooding, but under-resuscitation can cause organ hypoperfusion — delicate balance.
A ventilated patient is sedated with propofol and becomes bradycardic and hypotensive. What complication are you concerned about?
⭐ Bonus Question:
Why must propofol be titrated carefully?
Hemodynamic instability related to sedative-induced vasodilation.
⭐ Bonus Answer:
Propofol can cause significant hypotension and respiratory depression; requires continuous monitoring and titration.
During mechanical ventilation, peak pressures suddenly rise and the patient becomes difficult to ventilate. Breath sounds are coarse bilaterally. ABG shows rising CO₂. What is the most likely cause?
⭐ Bonus Question:
Why does CO₂ rise before oxygen levels drop in this scenario?
Mucus plugging or secretion buildup causing increased airway resistance.
⭐ Bonus Answer:
CO₂ retention occurs rapidly with inadequate ventilation because CO₂ diffuses more quickly than oxygen; ventilation failure shows up as hypercapnia early.
What does the ABCDEF bundle stand for, and why is it important in ICU care?
⭐ Bonus Question:
Which component directly addresses delirium?
A – Assess/manage pain
B – Both SAT & SBT
C – Choice of sedation
D – Delirium assessment
E – Early mobility
F – Family engagement
⭐ Bonus Answer:
D – Delirium assessment and management.
After 3 days, patient meets criteria for SBT. During the trial:
RR increases to 38
HR increases to 130
BP rises to 185/100
Patient anxious
What does this indicate?
⭐ Bonus Question:
Why can premature extubation be dangerous in ARDS patients?
Failed spontaneous breathing trial — not ready for extubation.
⭐ Bonus Answer:
Risk of respiratory collapse, re-intubation trauma, worsening hypoxemia.