Week 2 ARDS Flashcards
The nurse is caring for a client who developed ARDS due to sepsis from streptococcus pneumoniae infection. An assessment reveals that the client is tolerating mechanical ventilation with positive end-expiratory pressure (PEEP) without distress. Which prescription should the nurse prioritize for the client?
Ceftriaxone 1 gm intravenously every 12 hours
Acetaminophen 650 mg PR q4-6hr PRN. Not to exceed 4 g/day
Vecuronium 0.08 mg/kg intravenously as needed
Lorazepam 0.05 mg/kg intravenously q2-6hr PRN
Ceftriaxone 1 gm intravenously every 12 hours
The nurse is caring for a client with suspected acute respiratory distress syndrome (ARDS). For which diagnostic testing should the nurse prepare the client?
Exhaled nitric oxide test
Bronchoscopy
Chest x-ray
Gas diffusion test
Chest x-ray
The nurse has described the physiology of gas exchange in the respiratory system to a nursing student. Which response indicates the student understands the teaching?
“Carbon dioxide is transferred from the blood into the alveolar sacs to be exhaled.”
“The vast majority of alveolar epithelial cells produce surfactant.”
“Oxygen and carbon dioxide pass through type Il pneumocytes.”
“Surfactants produced by type I pneumocytes prevent the alveoli from collapsing.”
“Carbon dioxide is transferred from the blood into the alveolar sacs to be exhaled.”
The nurse is preparing to provide education about respiratory distress syndrome (ARDS) to a client. Which statement should the nurse use to describe the condition?
“ARDS is a respiratory condition characterized by severe lung collapse.”
“ARDS is a respiratory condition characterized by overinflation of the lungs.”
“ARDS is a type of lung carcinoma characterized by lung infiltrates.”
“ARDS is a respiratory condition characterized by lung inflammation.”
“ARDS is a respiratory condition characterized by lung inflammation.”
The nurse is preparing to assess a client with acute respiratory distress syndrome (ARDS). Which signs and symptoms should the nurse anticipate? Select all that apply.
A. Inspiratory intercostal retraction
B. Dyspnea
C. Cyanosis
D. Inspiratory crackles
E. Hypertension
F. Bradycardia
A. Inspiratory intercostal retraction
B. Dyspnea
C. Cyanosis
D. Inspiratory crackles
The nurse is caring for a client experiencing shortness of breath who is diagnosed with acute respiratory distress syndrome (ARDS). Which effect(s) of ARDS on the body is/are causing the client’s shortness of breath? Select all that apply.
A. Blood cannot become oxygenated due to alveolar collapse
B. Refractory hypoxemia
C. Ventilation perfusion mismatch
D. Damaged type l pneumocytes
E. Fluid from the capillaries leaks into the alveoli
A. Blood cannot become oxygenated due to alveolar collapse
B. Refractory hypoxemia
C. Ventilation perfusion mismatch
E. Fluid from the capillaries leaks into the alveoli
The nurse has provided education to a client recovering from acute respiratory distress syndrome (ARDS). Which statement made by the client indicates further teaching is required?
“If my condition worsens, I will need pulmonary rehabilitation.”
“If I feel anxious or have difficulty concentrating, I will contact my healthcare provider.”
“ARDS prevents the air sacs in my lungs from working well.”
“I may experience chest pain and shortness of breath with exertion.”
“If my condition worsens, I will need pulmonary rehabilitation.”
The nurse caring for a 65-year-old patient with acute respiratory distress syndrome (ARDS) with a priority hypothesis of impaired gas exchange. Which finding supports this hypothesis?
Patient’s blood pressure is 94/60
Patient’s heart rate is 123/minute
Chest X-ray shows bilateral opacities
Patient is on 4L nasal cannula
Chest X-ray shows bilateral opacities
The nurse is caring for a 76-year-old patient with acute respiratory distress syndrome (ARDS) in the critical care unit who is on mechanical ventilation and sedation. Which outcome is most important when prioritizing the hypothesis of impaired gas exchange?
The patient’s blood pressure will be within the normal range by the end of the shift
The patient will remain comfortably sedated during the shift
The patient’s oxygen saturation will remain above 95% during the shift
The nurse will administer intravenous (IV) antibiotics as scheduled
The patient’s oxygen saturation will remain above 95% during the shift
The nurse in the intensive care unit is caring for a patient who is suspected of having acute respiratory distress syndrome (ARDS). Which clinical finding(s) support this diagnosis? Select all that apply.
A. Diffuse crackles
B. Heart rate 56/min
C. Blood pressure 184/92 mmHg
D. Oxygen saturation 95% on 10L high-flow nasal cannula
E. Respiratory rate 36/min
F. Substernal retractions
A. Diffuse crackles
E. Respiratory rate 36/min
F. Substernal retractions
The nurse is caring for a client with a PaO2 of 76 mmHg who is receiving high flow oxygen therapy. Which repeat PaO2 value drawn minutes later would be consistent with refractory hypoxemia?
PaO2 of 74 mm Hg
Pa02 of 78 mmHg
PaO2 of 84 mmHg
PaO2 of 90 mm Hg
PaO2 of 74 mm Hg
This answer choice is correct because the PaO2 value of 74 mm Hg is lower than the initial PaO2 value of 76 mm Hg even though high flow oxygen has been administered. Refractory hypoxemia is the term used to describe a low PaO2 despite oxygen delivery. Refractory hypoxemia is a key sign in acute respiratory distress syndrome (ARDS).
Which condition increases a client’s risk for developing acute respiratory distress syndrome (ARDS)?
Acute glomerulonephritis
Acute pancreatitis
Chronic atrial fibrillation
Gouty arthritis
Acute pancreatitis
This answer is correct because acute pancreatitis occurs when an inflamed and irritated pancreas releases active digestive enzymes and cytokines. These enzymes can travel to the lungs and cause severe inflammation of the alveoli. This alveolar inflammation significantly increases a client’s risk for developing ARDS.
The nurse is caring for a client with severe burns. Which manifestation(s) could indicate that the client may be developing acute respiratory distress syndrome? Select all that apply.
Respiratory rate of 26 breaths/minute
Heart rate of 58 beats/minute
Restlessness and agitation
Nausea with projectile vomiting
Blood pressure of 88/56
Respiratory rate of 26 breaths/minute
Restlessness and agitation
Blood pressure of 88/56
This answer is correct because a blood pressure of 88/56 is consistent with hypotension. Cardiac manifestations that occur in ARDS include hypotension and tachycardia, as the body works to compensate for the impaired gas exchange and decreased perfusion. Other manifestations of ARDS include shortness of breath, increased rate and work of breathing, fatigue, and changes in mental status (restlessness, agitation, confusion)
Which components of arterial blood gas (ABG) values are consistent with a client in acute hypercapneic respiratory failure?
PaO2 of 88 mmHg and PaCO2 of 42 mmHg
PaO2 of 94 mmHg and PaCO2 of 48 mmHg
PaO2 of 66 mmHg and PaCO2 of 54 mmHg
PaO2 of 74 mmHg and PaCO2 of 38 mmHg
PaO2 of 66 mmHg and PaCO2 of 54 mmHg
This answer is correct because PaO2 of 66 mmHg and PaCO2 of 54 mmHg are values of an arterial blood gas consistent with acute hypercapnic respiratory failure, because a PaCO2 level of 54 demonstrates that the client is either unable to eliminate carbon dioxide or is producing too much. Carbon dioxide can be thought of as acid in the body, which would lead to a decreased (more acidic) pH. The PaO2 of 66 is significantly low, which indicates that the client is also becoming hypoxemic.
What is the pathophysiology of acute respiratory distress syndrome (ARDS)?
- Infection and inflammation that leads to fluid-filled alveoli and atelectasis.
- Irritation of the mucus producing goblet cells within the bronchi.
- Complete separation of the alveolar-capillary membrane which prevents gas exchange.
- Hyperactivity of the bronchi due to an exposure to an external allergen.
- Complete separation of the alveolar-capillary membrane which prevents gas exchange.
This answer is correct because the underlying patho of ARDS is a separation of the alveolar bed from the underlying capillary bed thus preventing adequate gas exchange.
The hallmark manifestation of ARDS is refractory hypoxemia, or hypoxemia that does not respond to large amounts of FiO2. The reason for this is that the alveolar membrane and underlying capillary bed have lost contact therefore preventing gas exchange to occur. The treatment for ARDS consists of large amounts of positive pressure in order to expand the alveoli and promote gas exchange.
