Acute Respiratory Distress Syndrome Overview
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Questions and Answers

Which of the following findings indicates metabolic acidosis in DKA?

  • Elevated anion gap
  • Low pH
  • Both A and B (correct)
  • Low serum bicarbonate

    • What is the target glucose reduction rate during the treatment of DKA?

  • 20-50 mg/dL per hour
  • No specific target
  • 50-100 mg/dL per hour (correct)
  • 100-200 mg/dL per hour

    • What dietary advice is essential in preventing DKA for diabetics?

  • Increase protein consumption
  • Skip meals when not hungry
  • Avoid high-fat foods
  • Maintain consistent carbohydrate intake (correct)

    • Why is it critical to avoid rapid correction of blood glucose in DKA?

    <p>It can lead to cerebral edema</p> Signup and view all the answers

    What action should the nurse take if a patient's potassium level drops to 3.0 mEq/L during DKA treatment?

    <p>Administer IV potassium</p> Signup and view all the answers

    Which of the following is NOT a common cause of DKA?

    <p>Low carbohydrate intake</p> Signup and view all the answers

    What is the primary goal of rehydration in DKA treatment?

    <p>To restore vascular volume</p> Signup and view all the answers

    Why are frequent blood glucose checks necessary during DKA treatment?

    <p>All of the above</p> Signup and view all the answers

    Which condition is characterized by severe hyperosmolarity and no significant ketone production?

    <p>Hyperglycemia Hyperosmolar Nonketotic Syndrome (HHNS)</p> Signup and view all the answers

    What is the primary indicator of neurologic symptoms in Hyperglycemic Hyperosmolar Nonketotic Syndrome?

    <p>Cerebral dehydration</p> Signup and view all the answers

    A serum osmolality of 330 mOsm/kg in a patient indicates what condition?

    <p>Severe hyperosmolality</p> Signup and view all the answers

    What is the initial treatment priority for a patient presenting with HHNS?

    <p>Fluid replacement</p> Signup and view all the answers

    In the management of HHNS, what fluid is typically administered first?

    <p>0.9% normal saline</p> Signup and view all the answers

    When monitoring a patient with HHNS who is receiving IV fluids, at what glucose level should dextrose be added to the fluid regimen?

    <p>300 mg/dL</p> Signup and view all the answers

    Why is insulin therapy used less aggressively for HHNS compared to DKA?

    <p>There is no acidosis to treat</p> Signup and view all the answers

    What electrolyte imbalance is most frequently encountered during the treatment of HHNS?

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

    What is the range of osmolality that is consistent with HHNS?

    <p>600-1200 mg/dL</p> Signup and view all the answers

    Which patient is most likely to present with HHNS?

    <p>A 60-year-old with Type 2 Diabetes and recent infection</p> Signup and view all the answers

    What is the primary nursing intervention when a patient with HHNS is lethargic?

    <p>Start IV fluid therapy</p> Signup and view all the answers

    What distinguishes HHNS from DKA in clinical diagnosis?

    <p>Absence of ketosis</p> Signup and view all the answers

    What physiologic mechanism explains neurologic symptoms in patients with HHNS?

    <p>Hyperosmolality and fluid shifts in the brain</p> Signup and view all the answers

    What is the primary goal in treating HHNS?

    <p>Rehydrate and restore electrolyte balance</p> Signup and view all the answers

    A patient with HHNS has a potassium level of 3.2 mEq/L. What should the nurse do?

    <p>Administer potassium supplementation</p> Signup and view all the answers

    How does dextrose function during the treatment of HHNS?

    <p>Prevents hypoglycemia during glucose correction</p> Signup and view all the answers

    What is the recommended adjustment to lactulose dosage for a patient with hepatic encephalopathy experiencing diarrhea?

    <p>Reduce the lactulose dosage</p> Signup and view all the answers

    Which method is most effective in monitoring neurologic status over time for a patient with hepatic encephalopathy?

    <p>Daily handwriting and arithmetic assessments</p> Signup and view all the answers

    What does the presence of a sweet fecal odor (fetor hepaticus) in a patient with hepatic encephalopathy indicate?

    <p>High ammonia levels in the blood</p> Signup and view all the answers

    For a patient with hepatic encephalopathy, which dietary recommendation is the most appropriate?

    <p>Low protein intake to minimize ammonia production</p> Signup and view all the answers

    What is the mechanism of action of rifaximin in treating hepatic encephalopathy?

    <p>Reduces intestinal ammonia-producing bacteria</p> Signup and view all the answers

    The presence of a positive Babinski reflex in a patient with hepatic encephalopathy indicates what?

    <p>Severe neurologic impairment</p> Signup and view all the answers

    What is the primary goal of managing hepatic encephalopathy?

    <p>Reduce serum ammonia and eliminate precipitating factors</p> Signup and view all the answers

    In a patient with hepatic encephalopathy displaying severe confusion and agitation, what intervention should be prioritized?

    <p>Provide reassurance and calm the patient</p> Signup and view all the answers

    What is a critical assessment finding in a patient with hepatic encephalopathy that indicates advanced severity?

    <p>Disorientation and seizures</p> Signup and view all the answers

    What is the primary reason for administering lactulose in patients with hepatic encephalopathy?

    <p>To expel ammonia through feces</p> Signup and view all the answers

    Which nursing action is appropriate for a patient with elevated serum ammonia levels?

    <p>Initiate lactulose therapy</p> Signup and view all the answers

    What alternative source of nitrogen can be provided to a patient with hepatic encephalopathy who has protein intolerance?

    <p>Branched-chain amino acid supplements</p> Signup and view all the answers

    What assessment finding should a nurse recognize as a complication in a patient with hepatic encephalopathy experiencing frequent bowel movements?

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

    Which diagnostic test is expected to show slowing of brain waves in patients with hepatic encephalopathy?

    <p>Electroencephalogram (EEG)</p> Signup and view all the answers

    Why is monitoring neurological status crucial in patients with hepatic encephalopathy?

    <p>To detect progression to coma</p> Signup and view all the answers

    What should patients with hepatic encephalopathy avoid in order to prevent muscle mass loss?

    <p>Total protein restriction</p> Signup and view all the answers

    What should a nurse suspect in a patient with thyroid storm who complains of chest pain and dyspnea?

    <p>Atrial fibrillation</p> Signup and view all the answers

    Which antithyroid drug is known for its rapid onset of action during a thyroid storm?

    <p>Propylthiouracil (PTU)</p> Signup and view all the answers

    What is the mechanism by which iodine solution aids a patient in thyroid storm?

    <p>Suppresses release of stored thyroid hormones</p> Signup and view all the answers

    What cardiovascular symptom is considered most alarming in a thyroid storm patient?

    <p>Ventricular fibrillation</p> Signup and view all the answers

    Which diagnostic tool is most suitable for assessing altered neurologic status in a patient experiencing thyroid storm?

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

    What expected outcome should a nurse monitor for after administering propranolol to a thyroid storm patient?

    <p>Controlled tachycardia and palpitations</p> Signup and view all the answers

    What condition heightens the risk of thyroid storm in pregnant patients?

    <p>Abrupt withdrawal of antithyroid medication</p> Signup and view all the answers

    Why should cooling therapy be used with caution in thyroid storm patients?

    <p>To avoid rebound hyperthermia</p> Signup and view all the answers

    Study Notes

    Acute Respiratory Distress Syndrome (ARDS)

    • A 45-year-old patient presenting with severe shortness of breath, rapid breathing, and bluish discoloration is likely experiencing ARDS.
    • ARDS is diagnosed with bilateral infiltrates on a chest X-ray, not clear lung fields, pleural effusion, or lung hyperinflation.
    • To improve oxygenation in ARDS patients with persistent hypoxemia despite oxygen support, positive end-expiratory pressure (PEEP) is the recommended intervention.
    • If a patient with ARDS on mechanical ventilation has an arterial blood gas (ABG) reading of PaO2 of 55 mmHg and FiO2 of 80%, the next step is to increase the PEEP.
    • Decreased urine output and edema in an ARDS patient is most likely due to fluid overload, not hypovolemia, electrolyte imbalance, or kidney infection.
    • Crackles on auscultation and intercostal muscle retractions in an ARDS patient support the expectation of cyanosis and decreased blood pressure.
    • Positive end-expiratory pressure (PEEP) in mechanical ventilation for ARDS prevents alveolar collapse and supports oxygenation without increasing oxygen consumption excessively.
    • A priority nursing diagnosis for an ARDS patient is impaired gas exchange. Risk for infection, acute pain, and deficient fluid volume are also possible considerations.
    • Nutritional support is essential for ARDS patients to foster recovery and to prevent tissue breakdown.

    Acute Respiratory Distress Syndrome (ARDS) - Additional Points

    • Maintaining oxygen saturation above 85% is a critically important goal of oxygen therapy in ARDS patients.
    • Propofol is a sedative frequently used in ARDS patients who require mechanical ventilation.
    • Bilateral crackles are a common physical assessment finding in patients with ARDS.
    • Worsening conditions in ARDS patients manifest as persistent hypoxemia.
    • A PaO2/FiO2 ratio of 100 indicates mild ARDS severity.

    Diabetic Ketoacidosis (DKA)

    • A 25-year-old with type 1 diabetes exhibiting nausea, vomiting, abdominal pain, and a blood glucose of 450mg/dL likely has diabetic ketoacidosis (DKA).
    • DKA is differentiated from HHNS by the presence of ketosis.
    • The primary treatment goal for DKA is correcting hyperglycemia, dehydration, and acidosis.
    • Initial fluid replacement for DKA involves 0.9% normal saline, not dextrose 5% in water, lactated ringers or 0.45% saline.
    • The critical electrolyte imbalance to monitor closely in DKA patients undergoing treatment is potassium.
    • Frequent blood glucose monitoring is vital during DKA treatment to adjust insulin therapy effectively and prevent potential hypoglycemia.
    • The typical ABG finding for DKA patients is a decreased pH and bicarbonate.
    • Avoiding rapid correction of blood glucose in DKA to prevent cerebral edema is essential.

    Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)

    • HHNS is suspected in a 70-year-old with type 2 diabetes who presents with confusion, profound dehydration, and a blood glucose level of 750mg/dL.
    • HHNS differs from DKA in the absence of significant ketosis.
    • Profound dehydration is a prominent feature, often causing neurologic symptoms.
    • Serum osmolality above 320 mosm/kg indicates severe hyperosmolality in HHNS and requires swift fluid replacement.
    • Prompt fluid therapy is the first priority in HHNS treatment, followed by adjusting insulin therapy, then addressing potassium levels.

    Hepatic Encephalopathy

    • Hepatic encephalopathy is suspected in a 55-year-old patient with chronic liver disease who presents with confusion, sleep disturbances, and asterixis.
    • Elevated serum ammonia levels are a key diagnostic indicator.
    • Lactulose is frequently prescribed to reduce serum ammonia levels in hepatic encephalopathy to improve function and cognitive function.
    • Neurologic assessments are essential to monitor the condition and promptly address any worsening symptoms, such as disorientation or seizures.
    • Protein restriction in the diet is crucial to reduce the workload on the liver and prevent further complications in hepatic encephalopathy.
    • A sweet fecal odor (fetor hepaticus) in a patient with hepatic encephalopathy indicates high ammonia levels.

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    Description

    This quiz assesses your understanding of Acute Respiratory Distress Syndrome (ARDS), including its symptoms, diagnosis, and management. Test your knowledge on key interventions like positive end-expiratory pressure (PEEP) and identify signs of fluid overload. Prepare to dive into crucial details that impact patient care in ARDS.

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