Monday
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
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
The nurse inspects the chest of a patient with ARDS and notices the musculature in between the ribs "dipping in" with breathing. This would be accurately documented as:
Intercostal retractions, signifying increased work of breathing
Priority Nursing Diagnosis for a patient with ARDS.
Ineffective Gas Exchange
These are the two key pathophysiologic problems in ARDS.
What are increased permeability of alveolar-capillary membrane and decreased production of surfactant by Type II cells?
expected finding upon chest x-ray of a patient with ARDS
what is increasing bilateral infiltrates (fluid in lungs)
Providing ____ via mechanical ventilation 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, supporting gas exchange
The nurse should implement which of the following interventions for a ventilator? 1. Spread out activities 2. Maintain HOB less than 30 degrees 3. Explain all care activities 4. Oral care once a day
3. Explain all care activities
For the diagnosis of ARDS, what alternative needs to be ruled out?
Cardiogenic pulmonary edema
Supportive therapy for ARDS, name 2.
What is O2, ventilation, cardiac output support, prone positioning, sedation, paralytic (need only two)
the primary focus in the management of ARDS is???
what is identification and treatment of the underlying condition
_____ 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?
What is your name?
Depends on who you ask!
Applies positive pressure at end of expiration. Decreases intra-pulmonic shunting. Decreases need for high FiO2 (opens alveoli)
What is PEEP?
This patient position improves lung regions for better ventilation/perfusion.
What is prone position?
the decrease of arterial oxygen despite the administration of oxygen at high flow rates
What is refractory hypoxemia?
PEEP is increased from 5 to 10 for a patient with ARDS. What is a major pulmonary complication the nurse should assess for related to this change?
Barotrauma (such as pneumothorax)
Which of the following is not a way to reduce anxiety in the patient and family members?
1. Explain all the alarm sounds and what they mean
2. Explain to the family that their loved one can't hear them so its okay to talk over or about the patient.
3. Encourage frequent family visits
4. Provide anxiolytics as needed
2. explain the patient can hear and understand so important not to talk over or about the patient. But talking to the patient about every day things reduces patient sense of isolation and fear.
damages surfactant-producing cells leading to a deficit in surfactant, increased alveolar surface tension, and alveolar collapse with atelectasis
What does the overall inflammatory process do?
These are possible causes of a high pressure alarm on the ventilator.
What is kinks in tubing, water in vent circuit, increased or thick secretions, bronchospasm, coughing, gagging, or "fighting" the ventilator breath
These are the 4 most common causes of ARDS
What is sepsis (indirect), aspiration of gastric content (indirect), pneumonias (direct), and trauma (direct)
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 nurse is assessing a patient on a ventilator who started a "weaning trial" 30 minutes ago. Provide three (3) assessment findings indicative the trial is unsuccessful and needs to be stopped?
1. Tachypnea 2. Tachycardia 3. Labored breathing 4. O2 saturation dropping 5. Any other signs of increasing respiratory distress
Nursing Interventions for a patient with ARDS? (List 3)
What is nutritional support, repositioning q2hours, oral care, skin care, eye care, DVT prevention, prone position, treat anxiety, fluid management, maintain O2 saturation?
Diagnostic criteria for ARDS
Timing: within one week of injury or worsening respiratory symptoms.
Chest imaging: Bilateral opacities with no obvious effusions, lobar/lung collapse or nodules.
Origin of edema: respiratory failure not able to be explained by heart failure or fluid overload.
Oxygenation: mild to severe decrease in alveolar function.