B's Creativity Column
systemic ______ may occur in ARDS as a result of hypovolemia secondary to leakage of fluid into the interstitial spaces and depressed CO from high levels of PEEP therapy
what is hypotension
A. midazolam
B. pancuronium
C. ezetimibe
D. amitriptyline
what is A
initially, ARDS closely resembles severe?
what is pulmonary edema
the primary focus in the management of ARDS is???
the patient must be ventilated before the nurse administers what class of medication? why?
expected finding upon chest x-ray of a patient with ARDS
what is increasing bilateral infiltrates
a pt in the ER complains of dyspnea, upon being assessed, the nurse notes bilateral crackles. what diagnostic test would the nurse expect after the BNP was inconclusive?
A. 12 lead EKG
B. transthoracic echocardiography
C. pulmonary artery catheterization
D. amniocentesis
what is B
ARDS is marked by a rapid? within less than ____ after the precipitating event
what is onset of dyspnea, 72 hours
Within the initial hypoxic state, we initially treat them with? And as the hypoxemia progresses we prepare for?
what is supplemental oxygen and intubation and mechanical ventilation
_____ may be required to decrease the patient's oxygen consumption, allow the vent to provide full support, and decrease the pt's anxiety?
what is a sedative
the blood that is returning to the lungs, is it being oxygenated? if not, why?
what is no, the damaged alveoli is the key indicator of ARDS, it is a lung functioning issue, not heart
what is 35-45 kcal/kg/day
mild ARDS PaO2/FIO2?
moderate ARDS PaO2/FIO2?
severe ARDS PaO2/FIO2?
what is
>200 but <300
>100 but <200
<100
The concentration of oxygen and vent settings and modes are determined by the patient's status. this is monitored by what 3 things?
what is ABGs, pulse ox, and bedside PFTs
ventilators are known to cause an increase in _______ in the patient?
what is anxiety
pulmonary edema can be a result of congestive heart failure as well as from ARDS, what lab or diagnostic test can the nurse expect the provider to order to rule out CHF?
what is BNP
after assessing a pt diagnosed with ARDS the nurse charts the following: UOP of 30ml/2hrs, diminished bowel sounds x4, BP 99/60, HR 99, RR 22, bilateral crackles in lower lobes x2. which order would the nurse question?
A. administer enteral feeding as ordered
B. administer albuterol via nebulizer
C. place HOB at 35 degrees
D. apply oxygen at 2L nasal cannula
what is A
the pt has increased _____ _____ space and typically has decreased ______ _______?
what is alveolar dead space and pulmonary compliance
Providing vent ____ support is a critical part of the treatment of ARDS? what does this support physically do in the patient?
what is PEEP, it keeps the alveoli open at the end of expiration, preventing alveolar collapse
_____ ______ is important as well, because the pt cannot ______, increasing the risk of _____ _______ as a result from neuromuscular blocking agents
what is eye care, blink, and corneal abrasions
_____ is essential to limit oxygen consumption and reduce oxygen needs?
what is rest
a pt has been placed on a ventilator and given a neuromuscular blocking agent. the HCP is about to assess whether or not the agent has worked effectively. what test/assessment should the nurse expect to be completed?
what is "train of four"
The pt is thought to be in the recovery phase if these 3 things happen?
what is... hypoxemia gradually resolves, chest x-ray improves, lungs become more compliant
the 2 goals of PEEP
what is a PaO2 >60mmHg or a O2 stat >90%
if the PEEP level cannot be maintained using _____, _____ may be given
what is sedatives and neuromuscular blocking agents