Ms2 - Exam 1 - Ards

Front 1

What is hypoxemic respiratory failure?

Back 1

PaO2<60 on 60% O2

Oxygenation failure

Front 2

What is hypercapnic respiratory failure?

Back 2

PaCO2>45mm Hg and pH<7.35

Ventilatory filure

Front 3

What is the first step in reversing V/Q mismatch?

Back 3

O2 therapy

Front 4

How is shunt treated?

Back 4

High FiO2 and mechanical ventilation

Front 5

Classic sign of diffusion limitation

Pulmonary fibrosis, interstitial lung disease

Back 5

hypoxia at exercise but not at rest

Front 6

First signs of hypoxia

Back 6

Restlessness, confustion, agitation, combativeness

Front 7

What does hypercapnia produce in the brain?

Back 7

Vasodilation (increased ICP, morning headache)

Front 8

Assessment of orthopnea

Back 8

1, 2, or 3 pillow

Front 9

Assessment of dyspnea

Back 9

speak in sentences, phrases, or words

Front 10

When are crackles heard?

Back 10

Inspiration

Front 11

When are rhonci heard?

Back 11

Expiration (like COPD)

Front 12

When are patients not responsive to O2 therapy?

Back 12

When they have a shunt. They may need positive pressure therapy.

Front 13

What poses a risk for O2 toxicity in intubated patients?

Back 13

O2 at 60% concentration or greater for longer than 48 hours.

Front 14

How do you perform augmented coughing?

Back 14

By placing hands below xiphoid process and moving hands forcefully downward during expiration.

Helps patients too weak to cough on their own.

Front 15

What is huff coughing?

Back 15

Pt says the word "huff" while coughing. Beneficial for COPD patients. Keeps epiglottis from closing during the cough.

Front 16

What is the staged cough?

Back 16

Pt sits upright, breathes 3-4x in and out through mouth, coughs while bending forward and pressing a pillow inward against the diaphragm.

Front 17

When do you position a pt with the good lung down? (Side lying lateral)

Back 17

When lung disease only affects one lung - assist in ventilation and perfusion in good lung and mobilizes secretions in affected lung as with pneumonia.

Front 18

What do you do if a pt produces >30ml of sputum/day?

Back 18

Chest physiotherapy, percussion, vibration to affected lung segments

Front 19

When is CPAP and biPAP inappropriate?

Back 19

Pt has absent respirations, excessive secretions, decreased LOC, high O2 requirements, facial trauma, hemodynamic instability

Front 20

How often do you give bronchodilators in acute bronchospasm?

Back 20

q 15-30 min

Front 21

What kind of corticosteroids have an IMMEDIATE effect on airway inflammation?

Back 21

IV

Front 22

What electrolyte do you monitor with corticosteroids?

Back 22

Potassium - hypokalemia

Front 23

How long do inhaled corticosteroids take to work?

Back 23

4-5 days

Front 24

Neuromuscular blockade indication, drugs, and interventions

Back 24

vecuronium (Norcuron) and cisatracurium (Nimbex)

Provide sedation and analgesia to the point of unconsciousness so pt isn't paralyzed and in pain.

Paralyzes pt when they remain asynchronous with mechanical ventilation despite aggressive sedative and analgesic dosing.

Use non-invasive ECG to monitor level of sedation.

Front 25

What mean arterial pressure should be maintained to provide adequate perfusion to vital organs?

Back 25

>60mmHg

Front 26

What kind of diet is avoided in pts with retained CO2?

Back 26

High carb b/c carbs metabolize in to CO2

Front 27

Gerontologic considerations for mechanical ventilation

Back 27

BP and HR are increased normally

Delirium increases O2 consumptions, increases risk for unplanned extubation

Front 28

What are the 3 stages of ARDS?

Back 28

Injury/Exudative Phase where there is alveolar edema and atela=ectasis. Reduced lung compliance. First 24-48 hours.

Reparative phase 1-2 weeks after lung injury. Lung fibrosis

Fibrotic phase 2-3 weeks after injury. Pulmonary HTN and fibrosis

Front 29

ARDS is

Back 29

diffuse pulmonary edema without cardiac failure, fluid overload, chest infection, or chronic lung disease

Front 30

ARDS is usually caused by...

Back 30

sepsis.

Immune system attacks the alveolar lining as well as bacteria.

Front 31

How can ventilator associated pneumonia be prevented?

Back 31

Strict hand washing, sterile technique during suctioning, frequent mouth care and oral hygiene and ventilator bundle protocol

Front 32

What is the ventilator bundle protocol?

Back 32

Elevation of HOB 30-45 degrees.
Daily "sedation vactions" and assessment of readiness to extubate.
Peptic ulcer disease prophylaxis.
Venous thromboembolism prophylaxis.

Front 33

When is permissive hypercapnia used?

Back 33

With ARDS, on ventilator to prevent barotrauma.

Do it slowly, and keep pH of blood >7.2.

Front 34

Nursing Dx for ARDS

Back 34

Impaired CO r/t decreased circulation in pulmonary capillaries from PEEP.

Impaired gas exchange r/t pulmonary edema

Ineffective airway clearance r/t secretions

Ineffective breathing pattern

Risk for imbalanced fluid volume r/t Na and H2O retention

Front 35

Symptoms of hypoxemic respiratory failure

Back 35

Cyanosis, tachypnea, paradoxic breathing

Front 36

Symptoms of hypercapnic respiratory failure

Back 36

Morning headache and use of pursed-lip breathing

Front 37

The O2 delivery system chosen for the pt in acute respiratory failure should..

Back 37

maintain the PaO2 at >60mmHg at the lowest O2 concentration possible.