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Questions and Answers
What occurs during the resolution phase of lung recovery?
What occurs during the resolution phase of lung recovery?
What symptom indicates the onset of the fibroproliferative phase in patients?
What symptom indicates the onset of the fibroproliferative phase in patients?
What is a common respiratory pattern observed during the exudative phase?
What is a common respiratory pattern observed during the exudative phase?
What is the initial state of PaCO2 during hyperventilation?
What is the initial state of PaCO2 during hyperventilation?
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What role do type II alveolar epithelial cells play in lung recovery?
What role do type II alveolar epithelial cells play in lung recovery?
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What happens to hypoxemia during supplemental oxygen administration?
What happens to hypoxemia during supplemental oxygen administration?
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What contributes to the increased usage of accessory muscles in patients during the later stages of lung distress?
What contributes to the increased usage of accessory muscles in patients during the later stages of lung distress?
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Which of the following best describes the progression of respiratory failure symptoms?
Which of the following best describes the progression of respiratory failure symptoms?
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What is the primary purpose of bronchoscopy in respiratory care?
What is the primary purpose of bronchoscopy in respiratory care?
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Which intervention is NOT typically used to improve ventilation?
Which intervention is NOT typically used to improve ventilation?
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What is one of the primary goals of nutrition support in patients requiring ventilation?
What is one of the primary goals of nutrition support in patients requiring ventilation?
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What complication can result from impaired ventilation?
What complication can result from impaired ventilation?
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How can sedation assist patients on a ventilator?
How can sedation assist patients on a ventilator?
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What might happen if a patient does not receive adequate nutrition support?
What might happen if a patient does not receive adequate nutrition support?
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When is noninvasive ventilation typically initiated for patients with acute lung failure?
When is noninvasive ventilation typically initiated for patients with acute lung failure?
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Which of the following is a common pharmacological agent used in respiratory care?
Which of the following is a common pharmacological agent used in respiratory care?
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Why might neuromuscular paralysis be used in patients on a ventilator?
Why might neuromuscular paralysis be used in patients on a ventilator?
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What imaging techniques are considered for airway evaluation?
What imaging techniques are considered for airway evaluation?
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What is a potential consequence of both malnutrition and overfeeding?
What is a potential consequence of both malnutrition and overfeeding?
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What role do analgesics play in the care of sedated patients?
What role do analgesics play in the care of sedated patients?
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Which condition may allow respiratory acidosis to correct itself?
Which condition may allow respiratory acidosis to correct itself?
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Which of the following statements about thoracic ultrasound is true?
Which of the following statements about thoracic ultrasound is true?
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What is a significant risk of failing to provide adequate nutrition support?
What is a significant risk of failing to provide adequate nutrition support?
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What might sedation fail to achieve in some patients on a ventilator?
What might sedation fail to achieve in some patients on a ventilator?
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What is the primary injury to lung units caused by repeated opening and closing of alveoli?
What is the primary injury to lung units caused by repeated opening and closing of alveoli?
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What complications can arise from excessive pressure during ventilation?
What complications can arise from excessive pressure during ventilation?
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What is the purpose of pressure control ventilation?
What is the purpose of pressure control ventilation?
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Which pressure level should be targeted to keep pulmonary capillary membrane permeability lower than acceptable limits?
Which pressure level should be targeted to keep pulmonary capillary membrane permeability lower than acceptable limits?
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What is a potential outcome of biotrauma in the lungs?
What is a potential outcome of biotrauma in the lungs?
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How does turning a patient prone affect lung function?
How does turning a patient prone affect lung function?
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What is the recommended duration for applying prone positioning to improve lung function?
What is the recommended duration for applying prone positioning to improve lung function?
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Which condition is NOT mentioned as a comorbidity contributing to the development of CAP?
Which condition is NOT mentioned as a comorbidity contributing to the development of CAP?
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What contributes to an increased exposure to pathogens in patients who develop CAP?
What contributes to an increased exposure to pathogens in patients who develop CAP?
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Which of the following is NOT a pathogen associated with Hospital-Acquired Pneumonia (HAP)?
Which of the following is NOT a pathogen associated with Hospital-Acquired Pneumonia (HAP)?
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What does intrapulmonary shunting refer to?
What does intrapulmonary shunting refer to?
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What effect does early initiation of prone positioning have in patients with ARDS?
What effect does early initiation of prone positioning have in patients with ARDS?
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Which of the following pathogens is resistant to methicillin?
Which of the following pathogens is resistant to methicillin?
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Study Notes
Acute Lung Injury
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Assessment
- Exudative Phase: Tachypnea, restlessness, apprehension, increased use of accessory muscles
- Fibroproliferative Phase: Agitation, dyspnea, fatigue, excessive use of accessory muscles, fine crackles, respiratory failure
- ABG Analysis: Low PaO2 despite supplemental oxygen (refractory hypoxemia), initially low PaCO2 due to hyperventilation, eventually increases with patient fatigue
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Ventilation
- Methods: Noninvasive, invasive mechanical ventilation
- Goal: Improve oxygenation, prevent respiratory acidosis
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Ventilation Strategies:
- Ventilator: Pressure Control Ventilation limits and controls pressure in lungs, decrease incidence of volutrauma, maintain plateau pressure under 30 cm H2O.
- Tidal Volume: Variable from breath to breath
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Pharmacology
- Bronchodilators: Beta-2 agonists
- Sedation: Assists with maintaining adequate ventilation, comfort, decrease work of breathing, particularly if patient is fighting the ventilator
- Analgesics: Pain control
- Neuromuscular Paralysis: Can be necessary to facilitate optimal ventilation
Resolution Phase
- Recovery Process: Takes several weeks, involves structural and vascular remodeling to reestablish alveolar-capillary membrane.
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Key Changes:
- Hyaline membranes clear
- Intra-alveolar fluid is transported out of alveolus into interstitium
- Type II alveolar epithelial cells multiply and differentiate, facilitating restoration of the alveolus
- Alveolar macrophages remove pathogens
Causes of ALI
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Causes:
- Direct Lung Injury: Aspiration, pneumonia, near-drowning, inhalation of toxic gases, sepsis
- Indirect Lung Injury: Sepsis, trauma, shock, pancreatitis, massive transfusion, multiple organ dysfunction
Pathophysiology
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Processes:
- Initial insult triggers inflammatory response
- Inflammatory mediators cause damage to alveolar-capillary membrane
- Increased permeability leads to fluid leakage into alveoli
- Alveoli collapse, resulting in reduced gas exchange
- Hypoxemia develops
Complications
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Complications:
- ARDS (Acute Respiratory Distress Syndrome)
- Respiratory failure
- Multi-organ dysfunction syndrome (MODS)
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Other Considerations:
- Malnutrition and Overfeeding: Can interfere with pulmonary function
- Patient Positioning: Prone positioning improves ventilation, reduces intrapulmonary shunting, effective when initiated early in ARDS and applied for at least 12 hours a day
Nutrition Support
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Goals:
- Meet overall nutritional needs
- Prevent overfeeding and related complications
- Improve patient outcomes
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Importance:
- Adequate nutrition support prevents malnutrition, which contributes to ventilatory drive decrease and further lung stiffness
- Overfeeding can also interfere with pulmonary function
Hospital-Acquired Pneumonia (HAP)
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Pathogens:
- Common: Escherichia coli, H.influenzae, methicillin-sensitive S.aureus (MSSA), S.pneumoniae, P.aeruginosa, Acinetobacter baumannii, Methicillin-resistant Staphylococcus aureus (MRSA), Klebsiella spp., Enterobacter spp.
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Contributing Factors:
- Decreased immune response
- Hospital environment
- Presence of other infections
- Increased Vulnerability: Patients with chronic obstructive pulmonary disease (COPD), diabetes, malignancy, coronary artery disease
- Risk Factors: Impairments in swallowing, altered mental status leading to increased exposure to pathogens with aspiration of oropharyngeal secretions.
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Description
This quiz focuses on the assessment and management of Acute Lung Injury, covering the key phases of the condition including exudative and fibroproliferative phases. It also explores ventilation methods and pharmacological interventions to improve patient outcomes. Test your understanding of the critical concepts related to this significant respiratory condition.
