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NCM118 > ARDS > Flashcards

ARDS Flashcards

1
Q

is a term commonly used to describe mild ARDS

A

Acute lung injury

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2
Q

is a clinical syndrome characterized by a severe inflammatory process causing diffuse alveolar damage

A

ARDS

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3
Q

Results of ARDS

A

sudden and progressive pulmonary edema, increasing bilateral infiltrates on chest x-ray, hypoxemia unresponsive to oxygen supplementation regardless of the amount of PEEP, and the absence of an elevated left atrial pressure

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4
Q

A wide range of factors are associated with the development of ARDS including

A

Direct injury to the lungs (smoke inhalation)
Indirect insult (shock)

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5
Q

ARDS has been associated with a mortality rate ranging from

A

27% to 50%

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6
Q

Patients who survive the initial cause of ARDS may die later, commonly from

A

HCAP or sepsis

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7
Q

Risk factors

A

Aspiration (gastric secretions, drowning, hydrocarbons)
COVID-19 pneumonia
Drug ingestion and overdose
Fat or air embolism
Hematologic disorders (disseminated intravascular coagulation, massive transfusions, cardiopulmonary bypass)
Localized infection (bacterial, fungal, viral pneumonia)
Major surgery
Metabolic disorders (pancreatitis, uremia)
Prolonged inhalation of high concentrations of oxygen, smoke, or corrosive substances
Sepsis
Shock (any cause)
Trauma (pulmonary contusion, multiple fractures, head injury)

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8
Q

ARDS closely resembles

A

Severe pulmonary edema

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9
Q

The acute phase of ARDS is marked by a

A

rapid onset of severe dyspnea
occurs less than 72 hours after the precipitating event

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10
Q

ARDS is classified according to the

A

Severity of Hypoxemia

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11
Q

Clinical manifestations

A

severe pulmonary edema
rapid onset of severe dyspnea
Arterial hypoxemia, no response to oxygen
Chest xray similar to cardiogenic pulmonary edema
fibrosing alveolitis
increased alveolar dead space
decreased pulmonary compliance

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12
Q

ventilation to alveoli but poor perfusion

A

alveolar dead space

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13
Q

recovery phase

A

hypoxemia gradually resolves, the chest x-ray improves, and the lungs become more compliant

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14
Q

Assessment and dx

A

PA: intercostal retractions and crackles
Dx: plasma brain natriuretic peptide (BNP) levels, echocardiography, and pulmonary artery catheterization

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15
Q

helpful in distinguishing ARDS from cardiogenic pulmonary edema

A

BNP

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16
Q

may be used if the BNP is not conclusive

A

Transthoracic echocardiography

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17
Q

Medical mgt

A

Supportive Therapy
*ET intubation
*Mechanical ventilation
Circulatory support
Adequate fluid volume
Nutritional support
Supplemental oxygen
PEEP Support
Inotropic or vasopressor agents

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18
Q

The primary focus in the management of ARDS include

A

identification and treatment of the underlying condition

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19
Q

This supportive therapy almost always includes

A

ET intubation and mechanical ventilation

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20
Q

is used as the patient begins the initial spiral of hypoxemia

A

Supplemental oxygen

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21
Q

The concentration of oxygen and ventilator settings and modes are determined by the patient’s status. This is monitored by

A

arterial blood gas analysis,
pulse oximetry,
bedside pulmonary function testing

22
Q

is a critical part of the treatment of ARDS

A

Providing ventilatory PEEP support

23
Q

usually improves oxygenation, but it does not influence the natural history of the syndrome.

A

PEEP

24
Q

The use of PEEP helps

A

increase functional residual capacity and reverse alveolar collapse
by keeping the alveoli open

25
Q

By using PEEP, a lower FiO2 may be required. The goal is a

A

PaO2 greater than 60 mm Hg or an oxygen saturation level of greater than 90% at the lowest possible FiO2

26
Q

may occur in ARDS as a result of hypovolemia secondary to
leakage of fluid into the interstitial spaces and depressed cardiac output from high levels of PEEP therapy

A

Systemic hypotension may

27
Q

must be carefully treated without causing further overload. Inotropic

A

Hypovolemia

28
Q

Additional supportive treatments may include

A

prone positioning, sedation, paralysis, and nutritional suppo

29
Q

Pharmacologic Theraphy

A

No specific
Neuromuscular blocking agents,
sedatives
and analgesics

30
Q

may be used to improve patient–ventilator synchronization and help to decrease severe hypoxemia

A

Neuromuscular blocking agents, sedatives, and analgesics

31
Q

Nutritional support

A

is vital in the treatment of ARDS

32
Q

Patients with ARDS require … to meet caloric requirements

A

35 to 45 kcal/kg/day

33
Q

is the first consideration; however, … also may be required.

A

Enteral feeding
parenteral nutrition

34
Q

Nrsg mgt: GENERAL MEASURES

A

Respiratory modalities:
oxygen administration,
nebulizer therapy,
CPT
ET intubation or tracheostomy,
mechanical ventilation suctioning
bronchoscopy

Others:
Positioning
Oxygenation
Devices and specialty beds
Reduce pt anxiety
Rest

35
Q

The nurse turns the patient frequently to improve ventilation and perfusion in the lungs and enhance secretion drainage

A

Positioning

36
Q

Oxygenation in patients with ARDS is sometimes improved in the …; this seems to be particularly true for patients with COVID-19 and ARDS

A

prone position

37
Q

are available to assist the nurse in placing the patient in a prone position

A

Devices and specialty beds

38
Q

It increases oxygen expenditure by preventing rest.

A

Anxiety

39
Q

is essential to limit oxygen consumption and reduce oxygen needs.

A

Rest

40
Q

Nrsg. Mgt: VENTILATORY CONSIDERATIONS

A

patient-ventilator dyssynchrony
sedation
neuromuscular blocking agents (paralytic agents)
Peripheral nerve stimulators
Eye care
Analgesia with neuromuscular blocking agents

41
Q

to decrease the patient’s oxygen consumption, allow the ventilator to provide full support of ventilation, and decrease the patient’s anxiety

A

Sedation

41
Q

patient-ventilator dyssynchrony

A

Peep problems

41
Q

PEEP, which causes…..is an unnatural pattern of breathing and feels strange to the patient

A

increased end-expiratory pressure

42
Q

Sedatives

A

lorazepam, midazolam, dexmedetomidine, propofol, and shortacting barbiturates

43
Q

Paralytic agents

A

pancuronium, vecuronium, atracurium, and rocuronium

44
Q

are used to assess nerve impulse transmissions at the neuromuscular junction of select skeletal muscles when neuromuscular blocking agents are used.

A

Peripheral nerve stimulators

45
Q

may be used to measure the level of neuromuscular blockade.

A

Train of four

46
Q

important as well, because the patient cannot blink, increasing the risk of corneal abrasions.

A

Eye care

47
Q

Neuromuscular blockers predispose the patient to

A

venous thromboembolism (VTE)
muscle atrophy
foot drop
stress ulcers that may cause hemorrhage
and skin breakdown.

48
Q

must be given concurrently with neuromuscular blocking agents

A

Analgesia

NCM118 (23 decks)

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