Chapter 28 (ARDS) Question and answers correctly solved, Exams of Nursing

Download Chapter 28 (ARDS) Question and answers correctly solved and more Exams Nursing in PDF only on Docsity! Chapter 28 (ARDS) Approximately 200,000 Americans annually develop ARDS, what is the mortality rate? - correct answer Average around 50% What does the survivability depend on for ARDS patients? - correct answer -Severity of illness -Age -Comorbidities -Underlying pulmonary injury What is the diagnostic criteria for ARDS? - correct answer -Respiratory symptoms within 1 week of known clinical even or new or worsening symptoms over the past 7 days -Bilateral opacities on CXR or CT scan (cannot be from effusion, lung collapse, or pulmonary nodules) -Patients respiratory failure that cannot be explained by heart failure or fluid overload -Moderate to severe impairment in oxygenation, measured by the PaO2/FiO2 How do you define mild ARDS? - correct answer P/F ratio >200 but <300 mmHg, on ventilator settings that include PEEP or CPAP >5 cmH2O How do you define moderate ARDS? - correct answer P/F ratio >100 but <200 mmHg, on ventilator settings that include peep >5 cmH2O How do you define severe ARDS? - correct answer P/F ratio <100 mmHg, on ventilator settings that include PEEP >5 cmH2O ARDS is not really a disease, what is it? - correct answer A syndrome that encompasses a wide array of signs and symptoms. It is a medial emergency that causes direct and indirect lung injury (pulmonary vs. nonpulmonary) What are the most common causes of ARDS? - correct answer -Sepsis -Aspiration -Pneumonia (community acquired) -Severe trauma -Massive blood transfusion and stem cell transplantation -Drug abuse what are the less common causes of ARDS? - correct answer -CNS disease -Cardiopulmonary bypass -Disseminated intravascular coagulation -Inhalation of toxins and irritants -Immunologic reactions -Oxygen toxicity The primary abnormality in ARDS is the disruption of the alveolar-capillary membrane, which results in increased permeability between the capillaries and alveolus. What are some other abnormalities associated with ARDS? - correct answer -Neutrophils and macrophages go to the AC epithelium -Cellular damage and alveolar flooding -Deactivation of pulmonary surfactant -Intra-alveolar walls become lined with thick, ripped hyaline membrane, which contains fibrin and cellular debris -Alveolar collapse, shunting, decreased lung compliance, severe hypoxemia, increased WOB What are the major pathologic or structural changes associated with ARDS? - correct answer -Interstitial and intra-alveolar edema and hemorrhage -Alveolar consolidation -Intra-alveolar hyaline membrane -Pulmonary surfactant deficiency or abnormality -Atelectasis Ideally, the plateau pressure should be maintained between 25 to 30 cmH2O, what is the most common protocol if the pressure drops below 25 cmH2O? - correct answer Increase the tidal volume Ventilatory rates as high as what may be needed to maintain adequate minute volume? - correct answer 35 breaths/minute When is a strategy of high PEEP recommended (between 15-20cmH2O)? - correct answer When the PaO2/FiO2 ratio is less than 200mmHg The patients PaCO2 is often allowed to increase (permissive hypercapnia) as a tradeoff to what? - correct answer Protect the lungs from high airway pressures, however pH should be maintained at or above 7.20 In most cases, what can help offset the decreased tidal volume used in the management of ARDS? - correct answer Increased respiratory rates What are the therapeutic goals of the ventilatory strategy for ARDS? - correct answer -Maintain plateau pressure between 25-30 cmH2O -Reduce overdistention of the lungs -Decrease barotrauma -Adequately oxygenate the patient What are some other strategies used for ARDS patients? - correct answer -Prone positioning, to allow perfusion to meet ventilation -Inverse ratio ventilation, to allow for better gas exchange -Nitric oxide, to improve oxygenation when a severe V/Q mismatch is present What are some possible medications and procedures commonly prescribed by the physician for an ARDS patient? - correct answer -Antibiotics, if bacterial infection is present -Diuretics, for fluid management -Corticosteriods, to reduce any inflammation -Surfactant replacement, to help keep lungs open -ECMO, to replace CO2 with O2