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Acute Lung Injury Assessment and Management
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Acute Lung Injury Assessment and Management

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Questions and Answers

What occurs during the resolution phase of lung recovery?

  • Type I alveolar epithelial cells decrease in number
  • Hyaline membranes are formed
  • Intra alveolar fluid is transported out of the alveolus (correct)
  • Patients experience severe respiratory failure immediately

    • What symptom indicates the onset of the fibroproliferative phase in patients?

  • Increased PaO2 levels
  • Decreased accessory muscle use
  • Agitation and dyspnea (correct)
  • Improved respiratory rates

    • What is a common respiratory pattern observed during the exudative phase?

  • Tachypnea (correct)
  • Bradycardia
  • Hypoventilation
  • Cyanosis

    • What is the initial state of PaCO2 during hyperventilation?

    <p>It is low due to hyperventilation</p> Signup and view all the answers

    What role do type II alveolar epithelial cells play in lung recovery?

    <p>They multiply and differentiate to type I cells</p> Signup and view all the answers

    What happens to hypoxemia during supplemental oxygen administration?

    <p>It remains high despite administration</p> Signup and view all the answers

    What contributes to the increased usage of accessory muscles in patients during the later stages of lung distress?

    <p>Hyperventilation leading to fatigue</p> Signup and view all the answers

    Which of the following best describes the progression of respiratory failure symptoms?

    <p>It progresses from moderate symptoms to severe agitation</p> Signup and view all the answers

    What is the primary purpose of bronchoscopy in respiratory care?

    <p>For airway surveillance and specimen retrieval</p> Signup and view all the answers

    Which intervention is NOT typically used to improve ventilation?

    <p>Antibiotic therapy</p> Signup and view all the answers

    What is one of the primary goals of nutrition support in patients requiring ventilation?

    <p>To maintain adequate nutrition without overfeeding</p> Signup and view all the answers

    What complication can result from impaired ventilation?

    <p>Respiratory acidosis</p> Signup and view all the answers

    How can sedation assist patients on a ventilator?

    <p>By providing comfort and decreasing work of breathing</p> Signup and view all the answers

    What might happen if a patient does not receive adequate nutrition support?

    <p>They may develop malnutrition</p> Signup and view all the answers

    When is noninvasive ventilation typically initiated for patients with acute lung failure?

    <p>Initially based on the severity of ALF</p> Signup and view all the answers

    Which of the following is a common pharmacological agent used in respiratory care?

    <p>Beta-2 agonists</p> Signup and view all the answers

    Why might neuromuscular paralysis be used in patients on a ventilator?

    <p>To facilitate optimal ventilation</p> Signup and view all the answers

    What imaging techniques are considered for airway evaluation?

    <p>Thoracic CT and chest radiography</p> Signup and view all the answers

    What is a potential consequence of both malnutrition and overfeeding?

    <p>Development of complications affecting pulmonary system performance</p> Signup and view all the answers

    What role do analgesics play in the care of sedated patients?

    <p>To provide pain control</p> Signup and view all the answers

    Which condition may allow respiratory acidosis to correct itself?

    <p>Adequately oxygenated and ventilated patient</p> Signup and view all the answers

    Which of the following statements about thoracic ultrasound is true?

    <p>It provides real-time imaging of thoracic structures.</p> Signup and view all the answers

    What is a significant risk of failing to provide adequate nutrition support?

    <p>Exacerbation of acute lung failure (ALF)</p> Signup and view all the answers

    What might sedation fail to achieve in some patients on a ventilator?

    <p>Adequate spontaneous respiratory efforts</p> Signup and view all the answers

    What is the primary injury to lung units caused by repeated opening and closing of alveoli?

    <p>Atelectrauma</p> Signup and view all the answers

    What complications can arise from excessive pressure during ventilation?

    <p>Volutrauma</p> Signup and view all the answers

    What is the purpose of pressure control ventilation?

    <p>To limit and control pressure in the lungs</p> Signup and view all the answers

    Which pressure level should be targeted to keep pulmonary capillary membrane permeability lower than acceptable limits?

    <p>30 cm H2O</p> Signup and view all the answers

    What is a potential outcome of biotrauma in the lungs?

    <p>Inhibited surfactant production</p> Signup and view all the answers

    How does turning a patient prone affect lung function?

    <p>It improves perfusion to less damaged lung areas.</p> Signup and view all the answers

    What is the recommended duration for applying prone positioning to improve lung function?

    <p>At least 12 hours a day.</p> Signup and view all the answers

    Which condition is NOT mentioned as a comorbidity contributing to the development of CAP?

    <p>Asthma</p> Signup and view all the answers

    What contributes to an increased exposure to pathogens in patients who develop CAP?

    <p>Impaired swallowing and altered mental status.</p> Signup and view all the answers

    Which of the following is NOT a pathogen associated with Hospital-Acquired Pneumonia (HAP)?

    <p>Influenza virus</p> Signup and view all the answers

    What does intrapulmonary shunting refer to?

    <p>Blood flow bypassing ventilated areas of the lungs.</p> Signup and view all the answers

    What effect does early initiation of prone positioning have in patients with ARDS?

    <p>It enhances overall lung recovery.</p> Signup and view all the answers

    Which of the following pathogens is resistant to methicillin?

    <p>Methicillin-resistant Staphylococcus aureus</p> Signup and view all the answers

    Study Notes

    Acute Lung Injury

    • 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
    • Ventilation
      • Methods: Noninvasive, invasive mechanical ventilation
      • Goal: Improve oxygenation, prevent respiratory acidosis
      • 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
    • 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.
    • 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

    • 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

    • 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

    • Complications:
      • ARDS (Acute Respiratory Distress Syndrome)
      • Respiratory failure
      • Multi-organ dysfunction syndrome (MODS)
    • 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

    • Goals:
      • Meet overall nutritional needs
      • Prevent overfeeding and related complications
      • Improve patient outcomes
    • 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)

    • 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.
    • 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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    Related Documents

    NCM118-MIDTERMS.pdf

    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.

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