Med Surg ARDS Question and answers verified to pass, Exams of Nursing

Download Med Surg ARDS Question and answers verified to pass and more Exams Nursing in PDF only on Docsity! Med/Surg: ARDS ARDS - correct answer sudden, progressive form of acute respiratory failure Most common precipitating injuries of ARDS - correct answer sepsis, gastric aspiration, severe massive trauma What happens to the alveoli in ARDS - correct answer Alveolar capillary membrane becomes damaged and more permeable to intravascular fluid, capillary membrane that surrounds the alveolar sac starts to leak fluid, leads to gas exchange where it shouldn't be occurring, leads to hypoxemia How to assess the degree of ARDS - correct answer P/F ratio Normal is 400 3 stages of edema formation in ARDS - correct answer 1. Normal alveoli and pulmonary capillary 2. Interstital edema occurs with increased flow of fluid into the interstital space 3. Alveolar edema occurs when fluid crosses the blood gas barrier Results of ARDS - correct answer -severe dyspnea -hypoxia -decreased lung compliance -decreased pulmonary infiltrates Direct lung injury - correct answer -Aspiration -Near drowning -Pneumonia -Fat emboli - something inside/within the lungs that causes ARDS Indirect lung injury - correct answer -Sepsis -Shock states -Cardiopulmonary bypass -Acute pancreatitis -Burns -Drug overdose Three phases of ARDS - correct answer -Injury/Exudative phase -Reparative/ Proliferative phase -Fibrotic or chronic/late phase Injury/Exudative phase ARDS - correct answer -24 hours after injury - Fluid in sac, decreased surfactant, and a hyaline membrane forming which causes sac to collapse, decreased lung compliance, and a V/Q mismatch - This is why we get the hallmark sign of ARDS: refractory hypoxemia (O2 goes down no matter how much you are giving to them Lung sounds in injury/exudative phase of ARDS - correct answer normal, maybe diminished once fluid starts to lead into sac, patient has pulmonary edema and you would hear crackles Reparative/proliferative phase ARDS - correct answer ~14 days after injury -body is trying to repair, trying to reabsorb fluid. Lung tissue becomes more dense and fibrous -Lung compliance decreases due to interstitial fibrosis = worsening hypoxemia Fibrotic/Chronic/Late phase ARDS - correct answer PROGNOSIS IS VERY POOR ; occurs three weeks after initial injury -fibrosis of lung tissues causes dead space in the lungs -lung is completely remodeled by collagenous and fibrous tissues -decrease in lung compliance, decrease in area for gas exchange, hypoxemia continues -pulmonary hypertension results from pulmonary vascular destruction and fibrosis Pressure support ventilation - correct answer each breath supported during inhalation, but patient regulates own rate and tidal volume, used for weaning Prone position in ARDS - correct answer increases oxygen level without having to give them more oxygen Less pressure on the lungs Continuous lateral rotation therapy - correct answer continuous, slow side to side turning <40 degrees every 18-24 hours Inotropic drugs - correct answer drugs that influence the force of muscular contractions Dobutamine and Dopamine Dobutamine (Dobutrex) - correct answer -IV -Monitor BP, EKG, HR, MAP, glucose, renal function, urine output -Onset 1-10 minutes -initial dose 0.5, maintenance dose 2-20, lower doses for HF patients Dopamine (intropin) - correct answer IV, dose 2-20, onset 5 minutes, duration <10 minutes -Monitor BP, EKG, HR, MAP, glucose, renal function, urine output Dopamine Extravasation - correct answer Infiltration of dopamine that will cause tissue necrosis and sloughing Phentolamine is antidote To avoid this: use central line instead of peripheral line to administer Ventilation associated pneumonia prevention - correct answer -Strict infection control measures -Eleate HOB to 30-45 degrees -Daily sedation holida -VTE prophylaxis - Daily oral care with chlorhexidine Ventilation associated pneumonia clinical manifestations - correct answer fever, elevated WBC count Purulent of odorous sputum Barotrauma - correct answer rupture of over distended alveoli during mechanical ventilation -air can escape into pleural space from alveoli or interstitium, accumulate, and become trapped -Lung collapse-pneumothorax -Patients with COPD/ARDS at higher risk -Chest tube Volutrauma - correct answer The VOLUME of the air is more than the lungs can handle and physical damage to the lungs occurs. results in alveolar fractures and movement of fluids and proteins into alveolar spaces Stress ulcer risk on ventilator - correct answer -bleeding from stress ulcers occurs in 30% of patients who are on mechanical ventilation -correct predisposing conditions, proton pump inhibitors as prophylaxis, early initiation of enteral nutrition Renal failure - correct answer decreased renal perfusion and subsequent decreased delivery of O2 to kidneys -occurs from hypotension, hypoxemia, hypercapnia -may be caused by nephrotoxoid drugs used to treat ARDS related infections organs at highest risk of injury on ventilator - correct answer kidneys, liver, heart Pantoprazoel (protonix) - correct answer -IV/PO -Usual dose is 20-40 mg -PO: give 30-60 minutes before a meal -Onset PO: 2.5 hours, IV 15-30 minutes -Peak Iv 2 hours -Duration 24 hours -Proton pump inhibitor What is the rationale for applying PEEP - correct answer prevent alveolar collapse and open up collapsed alveoli A patient with PEEP is experiencing negative effects of PEEP when ... - correct answer decreasing blood pressure is observed