wk 3 respiratory ppt/2

Question 1

ARDS - proning is typically reserved for

Answer 1

refractory hypoxemia not responding to other therapies

Question 2

rupture of overdistended alveoli during mechanical ventilation

Answer 2

barotrauma

Question 3

ARDS early s/s

5

Answer 3

1. dyspnea
2. tachypnea
3. cough
4. restlessness
5. chest auscultation normal or fine, scattered crackles

Question 4

ARDS etiology

Answer 4

develops from a variety of direct and indirect lung injuries; sepsis is most common cause

Question 5

occurs when large tidal volumes used to ventilate noncompliant lungs

Answer 5

volutrauma

Question 6

ARDS early chest x ray

Answer 6

may be normal or may show minimal scattered interstitial infiltrates

Question 7

ARDS mgmt - mechanical ventilation

3

Answer 7

1. PEEP opens collapsed alveoli
2. higher levels of PEEP are often needed to maintain PaO2 >60
3. high levels of PEEP can compromise venous return

Question 8

how to prevent VAP

Answer 8

oral hygiene

Question 9

high pressure alarm - do what?

2

Answer 9

suction or they could be fighting the vent (increased sedation)

Question 10

ARDS late chest x ray

Answer 10

diffuse and extensive bilateral interstitial and alveolar infiltrates “white out”

Question 11

can a PICC be used for TPN

Answer 11

yes

Question 12

barotrauma

Answer 12

rupture of overdistended alveoli during mechanical ventilation

Question 13

if on oxygen 60% for > 24 hours

3

Answer 13

1. increase in pulmonary capillary pressure
2. fibrotic changes in alveoli
3. decreased surfactant

Question 14

ARDS early ABGs

Answer 14

mild hypoxemia and respiratory alkalosis caused by hyperventilation

Question 15

RF drug therapy

5

Answer 15

1. bronchodilators
2. steroids - inflammation
3. diuretics - reduce pulmonary congestion
4. antibiotics - pulmonary infection
5. benzos, narcotics - reduce anxiety and pain

Question 16

ARDS oxygen therapy

2

Answer 16

1. give lowest concentration that results in PaO2 >60

2. common to intubate with mechanical ventilation because PaO2 cannot be maintained

Question 17

volutrauma

Answer 17

occurs when large tidal volumes used to ventilate noncompliant lungs

Question 18

what are two s/s that a patient needs to be intubated soon

Answer 18

1. retractions

2. elevated lactic acid levels

Question 19

ARDS late - s/s worsen with

Answer 19

progression of fluid accumulation and decreased lung compliance

Question 20

patho changes of ARDS thought to be due to

Answer 20

stimulation of inflammatory and immune systems

Question 21

sudden progressive form of acute RF

Answer 21

ARDS

Question 22

ARDS late s/s

6

Answer 22

1. suprasternal retractions
2. tachycardia
3. diaphoresis
4. changes in sensorium with decreased mentation
5. cyanosis
6. pallor

Question 23

septic pts are at high risk for developing what

Answer 23

ARDS

Question 24

ARDS - complications of treatment

5

Answer 24

1. ventilator associated pneumonia
2. barotrauma
3. volutrauma
4. high risk for stress ulcers
5. renal failure

Question 25

ARDS results in | 5

Answer 25

1. severe dyspnea 2. hypoxia 3. decreased lung compliance 4. diffuse pulmonary infiltrates 5. loss of recoil from scarring

Question 26

ARDS late ABGs

Answer 26

hypoxemia and a PaO2/FiO2 ratio < 200 despite increased FiO2

Question 27

ARDS - alveoli

Answer 27

alveolar capillary membrane becomes damaged and more permeable to intravascular fluid; alveoli fill with fluid

Question 28

drug for pulmonary congestion if HF is present

Answer 28

nitrates

Question 29

ARDS late - pulmonary function tests reveal

Answer 29

decreased compliance and lung volume

Question 30

``` ARDS positioning strategies 4 - turn -mediastinal -fluid -don't ```

Answer 30

1. turn from supine to prone position - may be sufficient to reduce inspired oxygen or PEEP 2. mediastinal and heart contents place more pressure on lungs with supine 3. fluid pools in dependent regions of lungs 4. don't lay them on their good side