ARDS
Capillary membrane that surround alveoli sac that leaks fluid in this sac
What is ARDS?
This medication is adjusted according to ABG's
What is Oxygen?
Air in pleural cavity
What is a Pneumothorax?
PaO₂ of 60 mmHg and oxygen saturation of 88%
What findings indicate hypoxemia?
Hypoxemia is defined as PaO₂ < 80 mmHg or SpO₂ < 90%.
Which patient would the nurse anticipate as the most appropriate candidate for RSI?
A. A stable patient scheduled for elective surgery
B. A patient with decreased level of consciousness who cannot protect the airway
C. A patient with mild dyspnea and anxiety
D. A patient who is alert and refusing intubation
A: Elective surgery uses controlled airway management, not RSI.
B: ✅ Inability to protect the airway is a key indication for RSI.
C: Mild dyspnea does not usually require intubation.
D: Informed refusal must be respected unless the patient lacks capacity.
A 72-year-old patient with COPD is admitted for shortness of breath. The nurse notes shallow respirations and decreased breath sounds. An ABG is drawn with the above results.
pH 7.30, PaCO₂ 55 mmHg, HCO₃⁻ 24 mEq/L.
What is uncompensated respiratory acidosis?
Assess airway and breathing.Encourage coughing, deep breathing. Prepare for bronchodilators or oxygen therapy
Pneumothorax, Hemothorax, Post operative thoracotomy and trauma to the chest area.
This mixture of lipids and proteins that coats the inner surface of the lungs, reducing surface tension at the air-water interface of the alveoli, thereby preventing alveolar collapse and lowering the work of breathing.
What is surfactant?
Frequently administered to ARDS patients, this class of drugs helps reduce lung inflammation.
What are Corticosteroids?
While assessing a patient with a chest tube, the nurse notes a lack of fluctuation (tidaling) in the water-seal chamber; this finding most likely indicates this.
What is Lung Re-expansion or an Obstruction/Kink in the tubing?
An acid–base imbalance is seen in a patient with pH 7.28 and PaCO₂ 55 mmHg.
What is Respiratory acidosis?
Low pH with elevated CO₂ indicates respiratory acidosis due to hypoventilation.
After RSI medications are administered, which nursing action is the highest priority?
A. Document the medications given
B. Initiate enteral feeding
C. Monitor oxygen saturation and cardiac rhythm
D. Apply restraints
A: Documentation is important but not the priority.
B: Enteral feeding is inappropriate immediately post-intubation.
C: ✅ Airway, breathing, and circulation must be continuously monitored.
D: Restraints may be needed later but are not the immediate priority.
A patient in the ICU has serial ABGs drawn after surgery. The nurse must recognize whether the patient is developing acidosis or alkalosis based on pH changes.
What is 7.35–7.45?
Trend ABGs
Recognize early deterioration
Report critical pH values promptly
Cyanosis of lips and nail beds
What is a late sign of hypoxia?
Cyanosis occurs after prolonged or severe oxygen deprivation.
A mechanical ventilation setting that offers respiratory assistance.
What is PEEP?
PEEP- Positive End Expiratory Pressure
A preferred sedative for emergency rapid sequence intubation (RSI) due to its rapid onset and dissociative properties. It acts on NMDA receptors to maintain blood pressure, making it useful for hemodynamically unstable patients, those with asthma, or COPD.
What is Ketamine?
Blood in the pleural space
An increased PaCO₂
What ABG change is expected in a patient with hypoventilation?
Hypoventilation causes CO₂ retention.
Which medication would the nurse expect to administer as a paralytic agent during RSI?
A. Propofol
B. Midazolam
C. Succinylcholine
D. Fentanyl
A: Propofol is a sedative-hypnotic, not a paralytic.
B: Midazolam is a benzodiazepine sedative.
C: ✅ Succinylcholine is a commonly used neuromuscular blocking agent for RSI.
D: Fentanyl is an opioid analgesic.
A postoperative patient is receiving IV opioids for pain and becomes drowsy with a decreased respiratory rate. The nurse suspects CO₂ retention.
This organ primarily regulates PaCO₂ levels.
What are the lungs?
Monitor respiratory rate and depth
Assess for opioid-induced respiratory depression
Encourage incentive spirometry
This action of placing gauze placed over the intended site, taped on three sides
What is the appropriate action of the dislodged chest tube?
The part of the lungs that is functional unit that exchanges Co2/O2
What is the Alveoli sac?
These medications (e.g., Rocuronium, Succinylcholine) are used to manage ventilator dyssynchrony in severe ARDS.
What are Neuromuscular blocking agents?
Allows air out but not in.
What is a Water-Seal Chamber?
Continuous bubbling in the water-seal chamber
What finding indicates an air leak?
Continuous bubbling suggests air escaping from the pleural space.
The nurse understands that the primary purpose of Rapid Sequence Intubation (RSI) is to:
A. Provide sedation for patient comfort
B. Secure the airway quickly while reducing the risk of aspiration
C. Establish long-term ventilatory support
D. Improve oxygenation without medications
A: Sedation is part of RSI, but comfort is not the primary goal.
B: ✅ RSI is designed to rapidly secure the airway while minimizing aspiration risk.
C: RSI is for emergency airway control, not long-term ventilation.
D: RSI always involves medications.
A patient with a bowel obstruction has been vomiting for two days and has an NG tube to suction. ABGs show elevated pH and bicarbonate levels.
A patient with prolonged vomiting is most likely to develop this imbalance.
What is metabolic alkalosis?
Monitor electrolytes (especially potassium)
Assess fluid status
Maintain NG tube patency
An intervention prevents atelectasis in postoperative patients
Incentive spirometry
Deep breathing promotes alveolar expansion and prevents collapse.
This term describes a state of low blood oxygen that persists despite the administration of 100% oxygen.
What is Refractory Hypoxemia?
Used in ARDS management targeting underlying infections(pneumonia sepsis), classes may include macrocodes, tetracyclines, oxazolidinones fluoroquinolone & Beta-lactams/Carbapenems.
What are Antibiotics?
I hold drainage from the lung. I should be serosangious, I should not produce large amounts of drainage per hour.
What is a collection chamber?
Tidaling in the water-seal chamber
What normal chest tube finding reflects lung expansion?
Tidaling corresponds with changes in intrathoracic pressure during breathing.
Which ventilator setting does the nurse recognize as having the greatest effect on oxygenation?
A. Respiratory rate
B. Tidal volume
C. Positive end-expiratory pressure (PEEP)
D. Inspiratory time
A: Respiratory rate primarily affects CO₂ elimination.
B: Tidal volume affects ventilation, not oxygenation.
C: ✅ PEEP keeps alveoli open and improves oxygenation.
D: Inspiratory time has less impact on oxygenation.
A patient with chronic kidney disease presents with fatigue and confusion. ABGs reveal a low bicarbonate level.
This ABG value reflects the metabolic component of acid–base balance.
What is HCO₃⁻ (bicarbonate)?
Monitor renal function labs
Administer sodium bicarbonate if prescribed
Prepare patient for possible dialysis
Crackles heard on auscultation
What lung sound indicates fluid in the alveoli?
Crackles occur when air moves through fluid-filled alveoli.
Leakage of fluid in the lung sac.
What is decreased gas exchange? OR
What is Hypoxemia?
While not a medication, in ARDS management involves turning the patient over to improve oxygenation.
What is Proning?
This class of medications, often used for pain relief, can be associated with ARDS when misused.
What are Opioids?
Elevated D-dimer
What lab finding suggests thrombus formation?
D-dimer reflects fibrin degradation.
The ventilator high-pressure alarm sounds. Which condition should the nurse assess for first?
A. Ventilator disconnection
B. Patient biting the endotracheal tube
C. Oxygen tank depletion
D. Excessive sedation
A: Disconnection causes a low-pressure alarm.
B: ✅ Biting or obstruction increases airway pressure.
C: Oxygen depletion does not trigger a high-pressure alarm.
D: Excessive sedation decreases effort but doesn’t raise pressure.
A young adult presents to the ED with anxiety, dizziness, and tingling in the fingers. The nurse observes rapid, shallow breathing.
pH 7.48, PaCO₂ 30 mmHg, HCO₃⁻ 22 mEq/L.
What is respiratory alkalosis?
Coach slow, controlled breathing
Reduce anxiety triggers
Monitor for hypocalcemia symptoms
Increased work of breathing
What occurs when surfactant levels are reduced?
Collapsed alveoli require more effort to reopen
In the later "fibrotic" phase of ARDS, the patient's ABGs typically shift from respiratory alkalosis to this acid-base imbalance due to muscle fatigue and alveolar hypoventilation.
What is Respiratory Acidosis?
With an onset of 60-90 seconds, this medication is frequently chosen for its rapid action in paralyzing skeletal muscles.
What is Rocuronium?
If a chest tube becomes disconnected from the drainage system, the nurse should perform this action immediately to prevent tension pneumothorax.
What is placing the end of the tube in a bottle of sterile water?
Type I pneumocytes
What cells are responsible for gas exchange?
They form thin alveolar walls for diffusion.
Which intervention is most effective in preventing ventilator-associated pneumonia (VAP)?
A. Keeping the head of the bed elevated 30–45 degrees
B. Maintaining deep sedation continuously
C. Changing ventilator circuits daily
D. Limiting oral care to once per shift
A: ✅ Elevation reduces aspiration risk—key VAP prevention.
B: Deep sedation increases VAP risk.
C: Routine circuit changes are not recommended.
D: Frequent oral care reduces VAP risk.
A patient with diabetic ketoacidosis is breathing rapidly and deeply. The nurse recognizes this as a compensatory response.
In metabolic acidosis, the body compensates by doing this.
What is hyperventilation?
Monitor blood glucose and ketones
Administer insulin as ordered
Assess respiratory pattern (Kussmaul respirations)
Painless tracking of air underneath the subcutaneous tissue. It may be seen in the chest wall, down limbs, around drain sites, or around the head or neck. When the skin is palpated, it feels similar to having tissue paper trapped beneath the skin.
What is Subcutaneous emphysema?
Partial or complete collapse of the lung
What is Atelectasis?
Midazolam, fentanyl, propofol, ketamine are titratable medications
What are sedative medications?
This specific laboratory ratio is used to determine the severity of ARDS by comparing the partial pressure of arterial oxygen to the fraction of inspired oxygen.
What is the P/F Ratio (PaO2/FiO2 ratio)?
Type II pneumocytes
What cells produce surfactant?
Surfactant reduces alveolar collapse.
Which assessment finding indicates the patient may be ready for weaning from mechanical ventilation?
A. High oxygen requirements
B. Increased work of breathing
C. Stable vital signs with adequate spontaneous breathing
D. Ongoing need for neuromuscular blockers
A: High oxygen needs indicate poor readiness.
B: Increased work of breathing suggests intolerance.
C: ✅ Stability and spontaneous breathing indicate readiness.
D: Paralytics prevent spontaneous respirations.
A patient with long-standing COPD has a pH of 7.36, PaCO₂ of 60 mmHg, and elevated HCO₃⁻. The patient appears stable.
This term describes a normal pH with abnormal PaCO₂ and HCO₃⁻ values.
What is fully compensated acid–base imbalance?
Recognize compensation rather than normal status
Avoid overcorrecting oxygen therapy
Monitor for acute changes
An are early clinical signs of hypoxia
Shortness of breath and use of accessory muscles
Increased work of breathing occurs as the body attempts to compensate for low oxygen levels