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NUR 210-Exam 1 > ARDS > Flashcards

ARDS Flashcards

1
Q

Spontaneous breathing is a _______ pressure driven cycle.

A

Negative

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2
Q

What 2 muscles contract during normal inspiration?

A

Diaphragm and intercostals

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3
Q

Describe normal inhalation.

A

Diaphragm flatens during contraction creating more space in chest which means less pressure in chest compared to atmospheric pressure to air rushes in bc of the decrease in intrapleural pressure.

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4
Q

Describe normal exhalation?

A

Expiratory phase is passive where diaphragm returns to normal position and lungs recoil and air is exhaled out

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5
Q

Pressure in alveoli during breathing process remains _______ so diffusion of gases occurs.

A

Positive

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6
Q

Define ventilation.

A

Movement of air into and out of lungs

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7
Q

Define perfusion.

A

Movement of blood flow

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8
Q

Define diffusion.

A

Gas exchange (CO2 and O2 being transported-works best when alveoli and capillary are close together)

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9
Q

Define hemodynamic.

A

Movement of blood

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10
Q

What are the hemodynamic effects of normal spontaneous breathing?

A

Increases venous return to R. atrium during inspiration
Increases pulmonary blood flow during inspiration
Increases cardiac output during inspiration

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11
Q

What is the biforcation (splitting) of the right and left mainstem?

A

Carina

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12
Q

What is Acutre Respiratory Distress Syndrome (ARDS)?

A

Rapid onset of non-cardiac pulmonary edema

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13
Q

Which of the following are true statements regarding the A/P of the resp. system? Select all that apply.
A. @ the end of inspiration the pressure in the alveoli is -
B. The R. lung has 3 lobes.
C. Physiological dead space includes the trachea, bronchi and bronchioles.
D. Normal resp. is a - driven cycle
E. Cilia action and mucus production are protective mechanisms to prevent infection.

A

B, C, D, E

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14
Q

At the beginning of inspiration the pressure in the alveoli is what?

A

Negative

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15
Q

At the end if inspiration the pressure in the alveoli is what?

A

0, it’s equal to atmospheric pressure

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16
Q 
A pt. is diagnosed w/ a pulmonary emboli. This will primarily affect:
A. Ventilation
B. Perfusion
C. Diffusion
D. Osmosis
A

B. Perfusion

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17
Q 
The amount of air inhaled and exhaled w/ a normal breath is the:
A. Functional residual capacity
B. Vital capacity
C. Negative inspiratory force
D. Tidal volume
A

D. Tidal volume

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18
Q

The amount of air left in the lungs after a normal exhalation is what?

A

Functional residual capacity

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19
Q

What is vital capacity?

A

The greatest amount of air that can be forced from the lungs after max. inhalation

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20
Q

What is negative inspiratory force?

A

Volume of air that’s inspired or expired during regular breathing

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21
Q

Tidal volume is based on what?

A

IDEAL body weight

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22
Q

What will you see w/ pulmonary emboli?

A

Hypoxia

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23
Q 
The hemodynamic effects of normal spontaneous breathing is:
A. Increased HR
B. Decreased CO
C. Increased pulmonary blood flow
D. Vasoconstriction of pulmonary artery
A

C. Increased pulmonary blood flow

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24
Q

ARDS is a progressive refractory period; what does that mean?

A

Resistance to treatment; low pulse ox even after admin. of O2

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25
Q

What are the 2 most common causes of ARDS?

A

Trauma and sepsis

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26
Q

ARDS has extensive what?

A

Lung tissue inflammation

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27
Q

Aspiration pneumonia, inhaled toxins, pulmonary embolism and mechanical ventilation are examples of what type of injury?

A

Direct

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28
Q

Trauma, shock, sepsis, cardiac arrest, drug OD, acute pancreatitis, and O2 toxicity are examples of what type of injury?

A

Indirect

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29
Q

When do s/s start to appear w/ ARDS?

A

12-48hrs post injury

30
Q

ARDS is the syndrome of what?

A

Inflammation and increased permeability

31
Q

What keeps the alveoli open?

A

Surfactant

32
Q

ARDS causes damage to what?

A

Alveolar-capillary membrane (space b/t alveoli and capillary; alveoli fills w/ fluid causing inflamm. which decreases surfactant and decreases gas exchange)

33
Q

What is the goal of ARDS?

A

Preserve alveoli function (recruitment)

34
Q

In the 1st phase of ARDS: acute injury what occurs in the 1st 24hrs?

A

Mild hypoxemia, dyspnea, tachypnea, resp. alkalosis, subtle changes in mentation, slight temp elevation, normal breath sounds and an occasional dry cough

35
Q

What occurs in the latent period of ARDS b/t several hrs to 2 days?

A

Hypoxemi resistant to O2 therapy, may required use of mechanical ventilation, capillary congestion, microatelectasis

36
Q

What occurs in the exudative phase of ARDS b/t 2-10days?

A

Onset of acute resp. failure, alveoli becomes edematous, surfactant becomes diluted, alveoli collapse and consolidates, s/s of systemic inflammatory response (SIRS)

37
Q

What occurs in the fibroliferative phase of ARDS b/t 10days after injury?

A

Inflammation leads to fibrosis of alveolar-capillary membrane, severe physiologic abrnomalities, refractory hypoxemia, metabolic and resp. acidosis.

38
Q

What occurs in the recovery/repair phase of ARDS?

A

Increase tissue oxygenation, decrease O2 consumption, and prevent complications

39
Q

In the latent phase how does ARDS show up on a CXR and why?

A

Opacity bc normal alveoli is getting scarred

40
Q

What is SIRS?

A

Group of s/s that mean massive inflammation

41
Q

In the fibroproliferative phase pts become what bc they can’t get rid of the CO2?

A

Resp. acidosis

42
Q

CPAP is use when what?

A

Pt is awake/cooperative and can’t maintain a PO2 greater than 50mmHG on O2 of 50% (short-term)

43
Q

Mechanical ventilation does what?

A

Allows maintencance of adequate tissue oxygenation while correcting underlying cause and allowing lungs to heal

44
Q

On mechanical ventilation enough O2 must be provided to prevent what but not cause what?

A

Cellular hypoxia; O2 toxicity

45
Q

Increasing amounts of O2 cause cause more damage to what if a pt is on mechanical ventilation?

A

Damage to surfactant

46
Q

Positive End Expiratory Pressure (PEEP) is used to?

A

Increase pO2 w/ lower fiO2

47
Q

PEEP is used for pts who can’t what?

A

Maintain a pO2 greater than 60 on 50% O2 or less

48
Q

PEEP does what?

A

@ end of expiration sends out positive pressure to alveoli to keep it open for diffusion of gases

49
Q

PEEPs increases what?

A

Functional residual capacity and # and size of alveoli available

50
Q

What type of tidal volumes need to be used in pts w/ ARDS to prevent what?

A

Small; barotrauma and hemodynamic changes

51
Q

What is barotrauma?

A

High pressure in alveoli (want low)

52
Q

To minimize O2 demand we want to give what type of meds to minimize muscle use and anxiety?

A

Sedatives and muscle relaxants to paralyze and sedate

53
Q

What type of meds are used for pts w/ ARDS?

A

Corticosteriods, antibiotics, and nitric oxide

54
Q

Why are corticosteroids controversial?

A

Decreases inflammation and cellular permeability

55
Q

What is nitric oxide?

A

Local vasodilator, maximizes perfusion to improve oxygenation

56
Q

Why are prophylaxis antibiotics controversial?

A

Increases risk for infection

57
Q

What increases tissue oxygenation?

A

Prone positioning

58
Q

Do not use prone positioning with what?

A

Unresolved ICP, hemodynamic instability

59
Q

What decreases oxygenation consumption?

A

Rest and sleep, treating agitation, treating anxiety w/ sedatives or morphine-monitor RR

60
Q

How do you treat hyperthermia and pain in pts w/ ARDS?

A

Cooling blankets, antipyretics, low dose analgesics

61
Q

What is the goal of fluid management?

A

Maintain normal circulating blood volume

62
Q

How do you manage fluid in a pt. w/ ARDS?

A

Prevent fluid overload, treat hypotension w/ vasopressors and PRBCs, use diuretics w/ caution bc decreases BP, and sometimes do hemodialysis

63
Q

What is pulmonary hygiene in a pt w/ ARDS?

A

Prevent secondary infection, suction, chest PT and humidification

64
Q

How many calories a day should a pt w/ ARDS eat?

A

3000 calories

65
Q

How do you manage nutrition in a pt. w/ ARDS?

A

Enteral feedings and avoiding TPN

66
Q

How does enteral feedings help w/ nutrition?

A

Prevents muscle catabolism and weakness of resp. muscles and helps immune system mobilize defenses

67
Q

Why should you avoid TPN?

A

Increase risk for infection

68
Q

Too much fluid in a pt. w/ ARDS can cause what?

A

Worsening of ARDS

69
Q

Too little fluid in a pt. w/ ARDS can cause what?

A

Thickening of secretions

70
Q

Too much food @ 1 time can cause what which can lead to what?

A

Diarrhea; skin breakdown

71
Q

What is muscle catabolism?

A

Breakdown of muscles to get protein when it’s deficient

72
Q

What are complications of ARDS?

A

Multi-system organ failure and infection

NUR 210-Exam 1 (9 decks)

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