ARDS Flashcards
If a patient has evidence of respiratory failure or compromise airway, what is indicated?
Endotracheal intubation and mechanical ventilation
What is mechanical ventilation?
Positive or negative pressure breathing device that can maintain ventilation oxygen delivery for a prolonged period time
What clinical evidence might you see if a patient is in need of endotracheal intubation and mechanical ventilation?
The patient will have a continuous decrease oxygenation (pao2), and increase in arterial carbon dioxide levels, (paco2), and persistent alkalosis initially (increased pH)
Which type of ventilator is noninvasive?
Negative pressure ventilators
What type of ventilator expands the chest using negative pressure and releases the pressure causing a breath?
Negative pressure ventilator
What is inspiratory reserve volume?
The maximum volume of air that can be inhaled after a normal inhalation.
The volume of air your lungs can hold on a regular inspiration
Tidal volume
What is expiratory reserve volume?
The maximum volume of air they can be exhaled forcibly after a normal exhalationmm
What is vital capacity?
The maximum volume of air exhaled from the point of maximum inspiration
What is residual volume?
The volume of air remaining in the lungs after a maximum acceleration.
What is total lung capacity?
The volume of air in the lungs after a maximum inspiration.
How are positive pressure ventilators classified?
According to the mechanism that ends inspiration and starts expiration
How do positive pressure ventilators work?
Inflate the lungs by exerting positive pressure on the airway, pushing air in, and forcing the alveoli to expand during inspiration
Which positive pressure ventilator delivers a preset volume of air with each inspiration and cycles off allowing passive exhalation? It can cause barotrauma?
Volume cycled ventilators
Which positive pressure ventilator delivers a flow of air until it reaches a preset pressure and then cycles off allowing expiration to occur.
Pressure cycled ventilators
Which positive pressure ventilator is used to open the alveoli in situations characterized by closed small airways such as atelectasis and ARDS
High frequency oscillatory Support ventilators
In this mode of ventilation there’s a fixed rate and tidal volume. Breaths are initiated automatically.
Controlled mode of ventilation
Name a disadvantage of controlled ventilation
If the patient attempts to initiate a breath, the ventilator alarms and blocks the patient from initating a breath
How is controlled ventilation and assist-control ventilation similar and different?
They both have a preset tidal volume and ventilation rate but the assist - control ventilator allows the patient to take occasional breaths without alarming
Which mode of ventilation has a tidal volume and a ventilator rate preset and can respond to the patient’s inspiratory effort if a breath is initiated?
Assist-controlled ventilation
Name a disadvantage of assist-controlled ventilation
If the patient’s spontaneous rate increases the ventilator continues to deliver a preset tidal volume with each breath
Which ventilator allows spontaneous breathing at the patient’s own rate and tidal volume giving breaths between at a set tidal volume and read
Synchronize intermittent mandatory ventilation/ intermittent mandatory ventilation
If you were attempting to wean a patient off of ventilator, and what order would you expect the ventilators to be used?
Assist-controlled (a/c), then simv/imv, then cpap/bipap
An iron lung is considered what type of in a liter?
A negative pressure ventilator
What type of patients might have a body wrap?
ALS patients or myasthenia gravis patients
True or false? Weight and size of the patient determines the size of Ambu bag used?
True
True or false.? You can use a positive pressure ventilators with or without intubation
False. You always need to be intubated to use positive pressure ventilators
What kind of patient would you expect to need a controlled ventilator?
Coma patients
What is bucking the vent? What should you do if a patient does this?
When the patient is trying to breathe over the ventilator. If the patient is on the vent to rest the brain from a motor vehicle accident we might use drugs to sedate the patient. Otherwise in cases like pneumonia we would get ABGs to see if the patient can take steps to wean off the ventilator
Can all ventilators provide just pressure support?
Yes
A cpap/bipap is what kind of ventilator?
Pressure support ventilator
With which ventilator does the patient determine the respiratory rate and duration?
Pressure support ventilator
What are the advantages of using pressure support ventilators?
It provides inspiratory pressure support decreasing the workload of breathing while now the patient to determine the respiratory rate and duration
True or false? There’s no pressure into the lungs in continuous flow or flow by ventilators?
True
What can be used for a patient before intubation is necessary to support oxygenation?
A continuous flow or flow by
What kind of patient would you use continuous flow by for flow by before in to bathing?
CF patients or COPD patients. COPD patients because they are difficult to get off the ventilator because they lose their respiratory drive
What is the advantage of using intubation for hypothermic patients?
This type of patient can be intubated so that we can provide warm humidified air to help increase body temperature
The percentage of oxygen given to the patient
FiO2
Normal respiratory rate
12 - 20 per minute
Causes of non breathing in between regular breasts
Sigh
True or false? It is important for the nurse to make sure that the sigh is set on a ventilator
False sighs are no longer used
The pressure provided by the ventilator to the patient
Flow
When monitoring the trends of peak airway pressure also known as pip and you notice an increase what could be happening?
Increased airway resistance from increased amount of secretions, pulmonary edema, or decreased pulmonary compliance
Select all that will trigger a high pressure alarm. An increase compliance of the lung, patient not breathing, pneumothorax, patient bucking the vent, ET tube in esophagus
Pneumothorax, patient book in advance, and ET tube in the esophagus. It would not be an increase compliance of the lung but a decrease and if the patient was not breathing a low pressure alarm will sound
Which alarm is a higher priority? High pressure or low pressure?
Low pressure alarm
How do you give nutritional support to ventilator patients? And what type of line?
You would give T TN and a central line and PPN in a peripheral IV or a PICC line
Which is preferred a peripheral line or peripheral IV line for nutrition
Central line
What’s line is preferred central line or a PICC line?
A PICC line is for long-term care and has a decrease risk of infection compared to the central line
If a patient is on a CPAP or SIMV and the low pressure alarm sounds, what could have happened?
The patient could have stopped simultaneous breathing
what is hypoxemia even 100% oxygen with ABGs that show the patient is acidotic
refractory hypoxemia
ARDS has pulmonary edema with an absence of volume overload and absence of depressed left ventricular function true or false
True. It is non cardiac
Select all that apply ard s is characterized by pulmonary edema, bilateral lung infiltrates, refractory hypoxemia non cardiac pulmonary and increased surfactant production
Bilateral lung infiltrates, refractory hypoxemia, noncardiac pulmonary edema.
Explain how shunting lead to multisystem organ failure
The alveoli contain progressively less gas and blood flows through them without being oxygenated leaving to deoxygenated blood circulating to organs which leads to refractory hypoxemia which leads to multisystem organ fail
Phase where the white blood cells attack the lungs and lead to pulmonary edema
Exudative phase
Name the phases of ARDS
Exudative phase, fibro- proliferative phase, fibrosis repair and recovery phase
Risk factors for ARDS. State indirect or non indirect lung injury. Severe sepsis, hypovolemic shock or burns, aspiration of gastric contents, severe thoracic trauma, severe non thoracic trauma
Indirect, indirect, Direct, direct, indirect
Indirect or non direct lung injury risk factors for ARDS? Non cardiac pulmonary edema, diffuse pulmonary infection, multiple long bone fractures, drug overdose, fat embolism
Indirect,Direct,indirect, indirect ,Direct,
Indirect or direct causes of lung injury related to a RDS? Hyper transfusion, reperfusion injury, severe pulmonary hemorrhage, anaphylaxis, near drowning, acute pancreatitis
indirect, indirect, direct, indirect, direct, indirect
what might you notice during a physical assessment of ARDS patient?
Adventitious lung sounds, altered respiratory rate, increase PVC’s, desaturtaion, tachycardia, Fusion recitation, and anxiety
What is normal ventilation (V)?
4L of air per minute
What is normal perfusion (Q)?
5L of blood per minute
Is the V / Q ratio is greater than 0.8, what do you have?
Ventilation exceeds perfusion (high )
What is the normal v /q ratio?
4/5 or 0.8
If the V / Q ratio is less than 0.8, would you have?
Perfusion exceeds ventilation (low)
What type of ABGs would you expect initially from ARDS patient?
Respiratory alkalosis because the patient will self hyperventilate. Pao2 less than 60 and paco2 less than 35 millimeters of mercury
After the initial stages of ARDS with continued shunting and refractory hypoxemia, what do you expect when you check the ABGs?
As ARDS worsens, respiratory acidosis and metabolic acidosis non compensating with declining O2 saturations
What is the only way to diagnose ARDS?
Chest x ray
Early or late stages? Diffuse bilateral infiltrates
Early
Early or late stages? Irreversible hypoxemia, white outs of both lungs
Later stages
Name two diagnostics test that can be used for an ARDS patient
Chest x-ray and pulmonary artery catheterization
What information does a pulmonary artery catheterization give? what is the normal range?
Pulmonary artery catheterization can give you the pulmonary capillary wedge pressure. The normal value is less than 18 millimeters of mercury
For ARDS patient what would you expect the pulmonary capillary wedge pressure to be? Increased, decreased or normal
Normal
Intravascular pressure as measured by a catheter wedged into the distal pulmonary artery. Is used to measure indirectly the mean left arterial pressure
Pulmonary artery wedge pressure
What is the normal range for pulmonary artery wedge pressure?
4 - 12 millimeters of mercury
What is the expected pulmonary artery wedge pressure values for an ARDS patient
Low to normal PAWP because it is non cardiac pulmonary edema, not cardiac. That PAWP would be greater than 18
What position is used to relieve pressure on the back and aveoli, as well as to decrease atelectasis
Proning
What is ICU psychosis?
When the patient has been in ICU for a couple of days and is over stimulated and sleep deprived. The patient doesn’t know where they are, what time of day it is they completely lose time and need to be constantly reoriented
Why would we monitor glucose levels of ARDS patient?
It is possible that the patient is on corticosteroids. The levels are also monitored because the patient will probably be receiving TPN which has a lot of glucose
