Ch. 28 ARDS RCP 140 Question and answers verified to pass, Exams of Nursing

Download Ch. 28 ARDS RCP 140 Question and answers verified to pass and more Exams Nursing in PDF only on Docsity! Ch. 28 ARDS RCP 140 What are the anatomic alterations of the lungs with ARDS? - interstitial and interalveolar edema and hemorrhage - alveolar consolidation - interalveolar hyaline membrane - pulmonary surfactant deficiency or abnormality - atelectasis - membranes will contain fibrin and cellular debris What is the number one cause of ARDS? sepsis ARDS can be: - direct - indirect What is considered direct: - pneumonia (bacterial, viral, fungal) - aspiration of gastric contents - smoke inhalation - near drowning What is considered indirect: - sepsis (#1) - long bone fracture - pancreatitis - blood transfusion - drug abuse (heroin and morphine) What may cause ARDS within 12-48 hours? fat embolism from a long bone fracture What does type two cells produce? surfactant What are type ones involved in? gas exchange (they create the blood air barrier between the capillaries and alveoli) What does a decrease in surfactant call? atelectasis (bacteria comes in and attacks type 1 and 2 cells which messes with gas exchange and surfactant production) What types of cells live in the alveoli? macrophages Radiologic findings: - increased opacity diffused throughout the lungs - ground-glass appearance With patients in acute ventilatory failure caused by ARDS rather than doing an initial trial of noninvasive positive pressure ventilation what is recommended? immediate mechanical ventilation Rather than a partially supported mode of ventilation what is recommended? full support mode of mechanical ventilation What modes of ventilation are accepted? volume-limited or pressure-limited What is the recommended ventilatory strategy for ARDS? low-tidal volumes ventilation and high RR What is the recommended tidal volume and RR for ventilation? 4-6 mL/kg Vt and 20-25 breaths per minute What should the plateau be maintained between to decrease barotrauma? 25-30 cmH2O What is the most common protocol if the Pplat drops below 25 cm H2O? increase the tidal volume With ARDS, a strategy of high PEEP is recommended when the: PaO2/FiO2 is less than 200 mm Hg What is plateau pressure? the pressure within the lung (small airways and alveoli) at end inspiration to keep it open during mechanical ventilation (.5-1 sec breath hold on vent) (distending pressure) more pressure = less compliant less pressure = more compliant Ventilation rates as high as ______ may be needed to maintain adequate minute volume. 35 breaths/ minute Mild ARDS is classified as: PaO2/FiO2 greater than 200 but less than or equal to 300 on a vent setting that include PEEP or CPAP of greater than or equal to 5 cm H2O or greater Moderate ARDS is classified as: PaO2 /FiOP2 greater than 100 mm Hg but less than or equal to 200 mm Hg on vent settings that include PEEP of 5 cm H2O Severe ARDS is classified as: PaO2/FiO2 less than or equal to 100 mm Hg on vent settings that include PEEP of 5 or greater The patients PaCO2 (permissive hypercapnia) is often allowed to increase as a: tradeoff to protect the lungs from high airway pressures When should you cut off permissive hypercapnia? A PH below 7.2 Ventilation therapeutic goals for ARDS: - maintain plateau - reduce overdistention of the lungs - decrease barotrauma - adequately oxygenate the patient What is proning and how does it help? laying on the stomach (to improve V/Q), it increases FRC (opens your lungs)