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NUR 213 > ARD/ARF > Flashcards

ARD/ARF Flashcards

1
Q

All of the following are risk factors for what?

Aspiration
Chest Trauma
Pneumonia (infectious or aspiration)
Pulmonary Contusion
Inhalation Injury (smoke; toxins)
Pulmonary Embolus
Sepsis, shock
Pancreatitis
Burns
Multiple Blood Transfusions
Cardiopulmonary Bypass
Drug/Alcohol Overdose

A

Acute Respiratory distress

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2
Q

Name some risk factors of ARDS

A

Aspiration
Chest Trauma
Pneumonia (infectious or aspiration)
Pulmonary Contusion
Inhalation Injury (smoke; toxins)
Pulmonary Embolus
Sepsis, shock
Pancreatitis
Burns
Multiple Blood Transfusions
Cardiopulmonary Bypass
Drug/Alcohol Overdose

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3
Q

The following describes what?

  • Acute onset of less than 7 days of non-cardiac pulmonary edema
  • Progressive refractory hypoxemia
  • Bilateral infiltrates
  • It is further classified in terms of severity through evaluation of the PaO2/FIO2 ratio, the ratio of the partial pressure of oxygen over the fraction of inspired oxygen
A

ARDS

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4
Q

The following describes what phase of ARDS

  • Occurs 24-48 hrs after injury
  • Inflammatory mediators activated and released
  • Disruption of Alveolar-Capillary Membrane (ACM)
  • Fluid moves from capillaries into the interstitial spaces and alveoli
A

Exudative Phase

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5
Q

THe following describe what phase of ARDS

  • Fluid continues to fill the alveoli
  • Edema results in severe V/Q mismatch
  • Pulmonary HTN develops
  • Hypoxemia results
  • R-sided heart failure
  • Lungs become stiff and non-compliant
A

Proliferative Phase

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6
Q

The following describes what phase of ARDS

  • Pulmonary HTN worsens
  • Heart failure worsens
  • Diffuse fibrosis and scarring
  • Severe tissue hypoxia and lactic acidosis
A

Fibrotic phase

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7
Q

Name some clinical manifestations of ARDS

A
  • Dyspnea, “can’t get enough air in”
  • Tachypnea
  • Crackles on auscultation (from non-cardiac pulmonary edema)
  • May have decreased breath sounds
  • Tachycardia
  • Severe hypoxemia DESPITE administration of 100% oxygen (REFRACTORY HYPOXEMIA)
  • Deteriorating ABG levels
  • Bilateral pulmonary infiltrates
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8
Q

How does a ARDS patients CHXR look?

A
  • Bilateral infiltrates
  • Ground-glass apperance
  • Whiteout effect/Snowscreen
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9
Q

What is this treatment for ARDS?

  • primary treatment for the refractory hypoxemia of ARDS.
  • It is initiated as lung compliance decreases, work of breathing increases, and oxygenation continues to be refractory regardless of interventions such as NPPV and other oxygen therapies.
  • There are several modes of used in ARDS.
A

Mechanical ventilation

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10
Q

What type of treatment for ARDS is this?

  • The high flow rate results in a “washout” of nasopharyngeal dead space.
  • Produces a CPAP effect
  • Decreased risk of nosocomial infection 40% failure rate
A

High flow nasal cannulas (HFNC)

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11
Q

What treatment for ARDS is this?

  • Uses a pump to circulate blood through an artificial lung outside of the body where oxygenation and CO2 removal takes place and the blood is returned
  • Recent technological improvements have made it safer Many risks
A

Extracorporeal Membrane oxygenation (ECMO)

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12
Q

What type of treatment for ARDS is this

  • A type of mechanical ventilation.
  • Lungs are filled with perfluorocarbon liquid to a volume less than or equivalent to function residual capacity and then vented using a standard mechanical vent
  • Decreases shunt associated with ARDS
  • Still has ongoing research to evaluate its efficacy
A

High-frequency oscillating ventilation

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13
Q

What phase of ARDS is this?

  • Occurs within 24-48 hrs after injury.
  • Fluid moved from capillaries to interstitial space to alveoli.
  • Protein moves from vascular space. All leads to pulmonary edema which causes V/Q mismatch
A

Exudative

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14
Q

The following are S/S of what phase of ARDS

  • Hyperventilation
  • Tachycardia
  • CHXR: Bilat infiltrates or pulmonary edema
  • V/Q Mismatch
  • Respiratory alkalosis
A

Exudative phase

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15
Q

What phase of ARDS is this?

V/Q Mismatch worsens>pulmonary HTN occurs>R-sided heart failure>Fibrotic changes occur in lungs which cause lungs to become “stiff” and “noncompliant” which increases work of breathing

A

Proliferative

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16
Q

The following are S/S of what phase of ARDS

  • Hypercarbia
  • Refractory Hypoxiemia
  • Lung Compliance deteriorates
  • If pt is vented inspiratory pressures rise d/t decreased lung compliance which requires more pressure
  • Increasing PaCO2
A

Proliferative

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17
Q

What phase of ARDS is this?

Fibrosis and scarring severely impair gas exchange and lung compliance. Pulmonary HTN worsens, R-sided heart failure worsens Decreased L-sided heart pre-load

A

Fibrotic

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18
Q

All of the following are S/S of what phase of ARDS

  • Hypotension
  • Decreased cardiac output
  • Severe V/Q Mismatch
  • Diffusion defects
  • Intrapulmonary shunting
  • Refractory hypoxemia
  • Tissue hypoxemia
  • Lactic Acidosis
A

Fibrotic

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19
Q

What are some s/s of the exudative phase of ARDS?

A
  • Hypotension
  • Decreased cardiac output
  • Severe V/Q Mismatch
  • Diffusion defects
  • Intrapulmonary shunting
  • Refractory hypoxemia
  • Tissue hypoxemia
  • Occurs within 24-48 hrs of injury
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20
Q

What are some S/S of the proliferitive phase of ARDS?

A
  • Hypercarbia
  • Refractory Hypoxiemia
  • Lung Compliance deteriorates
  • If pt is vented inspiratory pressures rise d/t decreased lung compliance which requires more pressure
  • Increasing PaCO2
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21
Q

What are some S/S of the fibrotic phase of ARDS

A
  • Hypotension
  • Decreased cardiac output
  • Severe V/Q Mismatch
  • Diffusion defects
  • Intrapulmonary shunting
  • Refractory hypoxemia
  • Tissue hypoxemia
  • Lactic Acidosis
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22
Q

What are some reasons you would not prone a patient with ARDS?

A
  • Spine instability
  • Conditions that increase intracranial pressure
  • Pregnancy
  • Abdominal wounds
  • Unstable peripheral fractures or rib fractures
  • Need for frequent airway access
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23
Q

When should you start proning a patient with ARDS?

A

Should be implemented withing 72 hrs of dx

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24
Q

How long should a patient remain in the prone position?

A

up to 20 hours per day

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25
Q

Name ways a patient can be placed in the prone position

A
  • Manually turning patient
  • using mechanical device
  • place the patient in trendelenburg or reverse tendelenburg as needed
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26
Q

What needs to be done an hour before proning a patient?

A

enteral feedings

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27
Q

Medications usde to treat ARDS

A
  • Antibiotics
  • Corticosteroids
  • Neuromuscular blocking agents
  • Sedatives
  • IV hydration
  • Nutrition: Enteral & Perenteral
  • Respiratory tmnt
  • Diuretics
  • Anticoags
  • Analgesics
  • Intropic medications
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28
Q

Describe how abx are used in the treatment of ARDS?

A

Broad spectrum ABX are used initially then after the C&S come back narrow spectum based on the results are started

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29
Q

Nursing Dx for ARDS

A
  • Impaired gas exchange
  • Anxiety
  • Imbalanced Nutrition
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30
Q

What is this?

This affects ability of the lungs to produce O2 and get rid of CO2. With ARDS and ARF lungs become stiff and noncompliant d/t fibrotic changes. As lungs become more stiff and noncompliant

A

Lung compliance

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31
Q

the volume of air moved with one breath, one inhalation and exhalation

A

Tidal volumes

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32
Q

What is this called?

damage d/t mechanical ventilation. Causes can be:
* Inflammatory-cell infiltrates
* Increased vascular permeability
* Pulmonary edema
* Barotrauma

A

Ventilator-Induced Lung Injury or VILI

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33
Q

What is air in mediastinal space called?

A

Pneumomediastinum

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34
Q

What is air in the pleural space called?

A

Pneumothorax

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35
Q

When is treatment for ARDS considered effective?

A

when pt returns to baseline. Ideally pt will be able to continue previous lifestyle with no long term respiratory issues.

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36
Q

The clinical manisfestations of ARDS are caused by what three things?

A
  • Refractory hypoxemia
  • Pulmonary edema
  • Lung tissue changes
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37
Q

EARLY signs of ARDS

A
  • Dyspnea
  • Tachypnea
  • Accessory muscle use
  • Crackles
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38
Q

LATE S/S of ARDS

A
  • Diminished or absent breath sounds
  • Atelectasis
  • Anxiety/Agitation
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39
Q

List components of the nursing assessment for a patient with ARDS

A
  • Hemodynamic monitoring
  • Neurological assessment
  • Respiratory assessment
  • Urine output
  • Mechanical ventilation
  • Laboratory tests
  • Skin assessment
  • CHXR
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40
Q

PRIORITY nursing actions for a patient with ARDS

A
  • Suction airway as needed
  • Administer meds as prescribed
  • Patient positioning
  • Prevet/protect from infection
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41
Q

when increasing oxygen delivery for a patient does not improve the hypoxia and the o2 stat worsens

A

Refractory Hypoxemia

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42
Q

Expected VS of a patient with ARDS

A

Tachycardia
Tachypnea
Hypotension
Hypoxemia

43
Q

What type of nutriton is this?

NG tube-preffered method. Associated with aspiration>elevate HOB and turn off feedings when supine

A

Enteral

44
Q

What type of nutrition is this?

IV nutrition-associated with infections at IV site

A

Parenteral nutrition

45
Q

How often should neuro assessments be done on a patient with ARDS?

A

At least every 1-2 hrs

46
Q

How does a patients with ARDS ABG present at the beginning vs as it progresses? What does it begin to look like if tmnt is not working?

A

Respiratory Alkalosis>Respiratory acidosis
If tmnt not adequate: Metabolic acidosis

47
Q

What is an early sign of poor oxygen delivery to tissues and/or shock?

A

Decreased urine output

48
Q

ARDS patients need to have their ECG monitored because hypoxemia can cause what?

A

Dysrhythmias

49
Q

The respiratory assessment of a patient with ARDS at the beginning of the disease process presents as what?

A

Crackles may be auscultated because of fluid buildup in the alveoli due to increased capillary permeability.

50
Q

The respiratory assessment of a patient with ARDS later in the disease process presents as what?

A

they may be diminished because of atelectasis and fibrotic changes in the lungs.

51
Q

How to prevent ARDS patients from developing thick, dry secretions?

A

Adequate fluid hydration

52
Q

S/S of inadequate nutrition

A

loss of 10% body mass
reduced respiratory muscle strength

53
Q

If adequate fluid hydration is not given to an ARDS patient what will happen?

A

CV output & BP will decrease causing decreased perfusion to organs. To correct this fluid resuscitation is required

54
Q

Labs used to dx and monitor ARDS

A
  • ABG
  • Lactic acid/serum lactate
  • Liver/Renal function
  • CBC
  • Blood & Sputum cultures
  • CHXR
55
Q

What will happen if ARDS is not properly treated?

A

It will progress to multi-organ Dysfunction syndrome

56
Q

What complication associated with ARDS is this?

Alveolar or Lung rupture which can lead to pneumomediastinum or pneumothorax

A

Barotrauma

57
Q

Name S/S of a pneumothorax

A

-Absent or markly decreased breath sounds
-Cyanosis
Decreased chest expansion unilaterally
-Dyspnea
-Hypotension
-Sharp chest pain
-Subcutaneous
-emphysema AEB crepitus on palpation
-Sucking sound with open chest wound
-Tachycardia
-Tachypnea
-Tracheal deviation to the
-unaffected side with tension pneumothorax

58
Q

What complication associated with ARDS is this?

Frequent complication of ARDS d/t hypotension and nephrotoxic drugs Prevent with close monitoring

A

Renal failure

59
Q

What complication associated with ARDS is this?

Fever
Leukocytosis
Increased respiratory effort
Prulent secretions
Sputum cultures will show infection

A

Ventilator associated Pneumonia or VAP

60
Q

The following are S/S of what?

-Absent or markly decreased breath sounds
-Cyanosis
Decreased chest expansion unilaterally
-Dyspnea
-Hypotension
-Sharp chest pain
-Subcutaneous
-emphysema AEB crepitus on palpation
-Sucking sound with open chest wound
-Tachycardia
-Tachypnea
-Tracheal deviation to the
-unaffected side with tension pneumothorax

A

Pneumothorax

61
Q

How to prevent barotrauma

A

Careful application of tidal volume and peep

62
Q

How to prevent Ventilator associated pneumonia or VAP

A
  • Early dx=early tmnt
  • Regular mouth care
  • Suctioning
  • Change vent circuit per hospital protocol
  • Use sterile water for humidification
63
Q

What complication associated with ARDS is this?

Results from prolonged hypoxemia, hemodynamic instability, inflammation associated with sepsis

A

Multi-organ dysfunction syndrome or MODS

64
Q

National patient safety goals for patients with ARDS

A
  • Identity patients correctly
  • Improve staff communication
  • Use medicines safely
  • Use alarms safely
  • Prevent infection
  • Identify safety risks
  • Prevent SX mistakes
65
Q

NPSG’s goals to improve communication with ARDS patients

A
  • Report abnormal test results to HCP ASAP
  • Include important information in hand off report
66
Q

NPSG’s goals for using medication safely in ARDs patients

A
  • Reconcile medications
  • Be cautions with high alert medications
67
Q

NPSG’s Goals for alarm safety with ARDS patients

A

Respond to alarms one time and make sure alarms are heard

68
Q

NPSG’s goals for preventing infection for patients with ARDS

A
  • Hand hygiene
  • Proper positioning for clients on mechanical ventilators
  • Mouth care every 2 hrs for vented patients
69
Q

V/Q

A

Ventilation-Perfusion ratio

70
Q

an extreme V/Q mismatch where there is no gas exchange

A

Intrapulmonary shunt

71
Q

NPPV

A

NONINVASIVE POSITIVE-PRESSURE-VENTILATION

72
Q

Meaning and reasoning behind “good lung down”

A

If the underlying disease is unilateral, positioning with the good lung down improves gas exchange by optimizing the V/Q ratio; gravity ensures the healthy lung maintains adequate blood flow to optimize ventilation to perfusion.

73
Q

Important teaching for ARDS patients and why it is important

A
  • Teach the patient and family about the Disease process.
  • The patient and the patient’s support system should understand the pathophysiology of ARDS, the severity of the disease, and the treatment required.
  • Understanding the medications, invasive lines, and mechanical ventilation may help decrease anxiety and provide some sense of control.
74
Q

It is importnat to allow ARDS patients family/friends to visit when possible why?

A

Providing time for visiting as possible may help the family stay engaged and involved in the family member’s care. Visiting also provides tremendous support for the patient.

75
Q

When the gas exchange functions of the lungs (oxygenation and carbon dioxide removal) are compromised. There are two kinds: Hypoxemic respiratory failure & hypercapnic respiratory failure

A

Acute respiratory failure or ARF

76
Q

Medications used to treat ARF

A

Bronchodilators: open airways
Inhaled steroids: Increase effects of bronchodilators
Diuretics: decrease pulmonary congestion
Sedation: for vented patients, to decrease anxiety and agitation
Abx
Sedation/anxiety
Steroids

77
Q

All of the following are S/S of what?

Dyspnea
Somnolence
Restlessness
Confusion
Tachycardia
HTN
Dysrythmias
Decreased LOC
HA
Change in respirations and breath sounds

A

ARF

78
Q

What kind of ARF is this?

PaO2 <60, normal or low PaCO2 D/T disease processes that produce V/Q mismatch i.e. pulmonary edema, PNA, PE
S/S: restless, confusion, anxiety, & agitation. If no adequate tmnt>cyonotic>coma

A

Hypoxemic or type 1

79
Q

What type of ARF is this?

  • Respiratory Acidosis PaCO2 >50, pH <7.35,
  • hypoxemia may or may not be present. D/T hypoventilation i.e. acute asthma, impaired chest wall movement, myasthenia gravis, OD, peripheral nervous system disorders, chest wall trauma
    S/S: HA, confusion, decreased LOC or increased somnolence, tachycardia, tachypnea, dizziness, flushed, a pink coloring to the skin
A

Hypercapnia or type 2

80
Q

Components of pulmonary rehabilitation for ARF patients

A
  • Breathing techniques
  • Energy Conservation
  • Exercise
81
Q

Breathing techniques for ARF patients

A

pursed-lip breathing and diaphragmatic

82
Q

To help teach an ARF patient energy conservation what should the nurse do?

A

Work with the patient to determine priorities in daily living.

83
Q

What kind of exercises should be taught to ARF patients to improve respiratory status?

A

Aerobic exercises

84
Q

Important teaching points for ARF patients

A
  • Disease process
  • Medications
  • Pulmonary rehabilitation
  • Infection
  • Diet and adequate hydration
  • Smoking cessation
85
Q

Important things to monitor in ARF patients what why?

A
  • Airway: Check for patency, dyspnea w/ exertion, need for suction
  • VS: BP, HR, & HR will be increased. Fever can develop r/t infection & inflammation
  • ABG’s
  • cardiac monitor-Monitor for dysrhythmias
  • neuro: change in LOC=impending resp failure
  • breath sounds: Crackles=pulmonary edema, rhonchi=PNA, COPD, Absent=hypoventilation
  • skin color: cyanosis or CO2 poisoning
86
Q

How do you treat ARF

A

Treat the underlying condition

87
Q

What is the goal when treating a patient with ARF

A

The goal is to have SpO2 greater that 94% unless COPD pt

88
Q

If supplemental oxygen, mechanical ventilation, and medications do not halt the progression of respiratory failure what will happen?

A

the patient is at high risk for cardiac failure, multiple organ dysfunction, and death.

89
Q

When is treatment for ARF considered successful?

A

When patient returns to baseline

90
Q

Nursing dx for ARF

A

Impaired Gas exchange
Ineffective breathing pattern

91
Q

Risk factors for ARF

A

V/Q Mismatch
Pulonary edema
PNA
PE
Asthma
Overdose
Myasthenia gravis
Anything that impairs ventilation
Anything that impairs chest wall movement

92
Q

Risk factors for Hypoxemic respiratory failure

A
  • Pulmonary edema
  • Pnemonia
  • Pulmonary edema
  • Think obstructed airway
93
Q

Risk factors for Hypercapnic Respiratory Failure

A
  • Asthma
  • Narcotic ovedose
  • Myasthenia gravis
  • Think pump failure
94
Q

The following are S/S of what kind of ARF

restless, confusion, anxiety, & agitation. If no adequate tmnt>cyonotic>coma

A

Hypoxemic respiratory failure

95
Q

The following are S/S of what kinf of ARF?

HA, confusion, decreased LOC or increased somnolence, tachycardia, tachypnea, dizziness, flushed, a pink coloring to the skin

A

Hypercapnic respiratory failure

96
Q

EARLY s/s of ARF

A
  • dyspnea
  • restlessness
  • anxiety
  • fatigue
  • Increased BP
  • Tachycardia
  • Tachypneic
97
Q

INTERMEDIATE s/s of ARF

A
  • Confusion
  • Lethargy
  • Pink skin color
98
Q

LATE s/s of ARF

A
  • Cyanosis
  • Coma
99
Q

Labs and Radiology tests used for ARF

A
  • ABG
  • Venous blood gas (venous O2 stat)
  • HGB&HCT
  • CHXR
  • CT Scan
  • Sputum culture
100
Q

Nursing interventions for ARF

A
  • Administer O2 as ordered
  • Elevate HOB - high fowlers
  • Position patient “good lung down”
  • Chest physiotherapy and suctioning
  • Administer IV fluids/hydration
  • Nutritional support
  • Be prepared for vent support
101
Q

Examples of Impaired airways or things that would cause hypoventilation

A
  • Airway obstruction
  • Respiratory muscle weakness/paralysis (Neuromuscular disease such as myasthenia gravis)
  • Chest-wall injury
  • Anesthesia
  • Opioid administration

These would all be causes of Hypoxic respiratory failure

102
Q

Examples of conditions that would cause V/Q Mismatch

A
  • COPD
  • Restrictive lung diseases (sarcoidosis, pulmonary fibrosis)
  • Atelectasis
  • Pulmonary Embolism
  • Pneumothorax
103
Q

Examples of conditions that impair alveolar diffusion

A
  • Pulmonary edema
  • ARDS

These would be causes of Hypercapnic Respiratory Failure

104
Q
A

NUR 213 (29 decks)

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