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

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

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

What is the primary goal of rehydration in DKA treatment?

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

Why are frequent blood glucose checks necessary during DKA treatment?

<p>All of the above (D)</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) (A)</p> Signup and view all the answers

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

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

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

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

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

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

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

<p>0.9% normal saline (C)</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 (D)</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 (D)</p> Signup and view all the answers

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

<p>Hypokalemia (A)</p> Signup and view all the answers

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

<p>600-1200 mg/dL (B)</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 (C)</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 (A)</p> Signup and view all the answers

What distinguishes HHNS from DKA in clinical diagnosis?

<p>Absence of ketosis (D)</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 (B)</p> Signup and view all the answers

What is the primary goal in treating HHNS?

<p>Rehydrate and restore electrolyte balance (C)</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 (D)</p> Signup and view all the answers

How does dextrose function during the treatment of HHNS?

<p>Prevents hypoglycemia during glucose correction (C)</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 (A)</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 (B)</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 (C)</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 (B)</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 (D)</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 (A)</p> Signup and view all the answers

What is the primary goal of managing hepatic encephalopathy?

<p>Reduce serum ammonia and eliminate precipitating factors (C)</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 (C)</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 (A)</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 (D)</p> Signup and view all the answers

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

<p>Initiate lactulose therapy (C)</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 (C)</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 (D)</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) (A)</p> Signup and view all the answers

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

<p>To detect progression to coma (D)</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 (D)</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 (C)</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) (D)</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 (B)</p> Signup and view all the answers

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

<p>Ventricular fibrillation (C)</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 (A)</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 (D)</p> Signup and view all the answers

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

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

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

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

Flashcards

DKA: effects on the body

Diabetic ketoacidosis (DKA) disrupts the body's glucose regulation, leading to increased blood glucose levels, reduced insulin effectiveness, and the production of ketones.

Target glucose reduction rate in treating DKA

The goal is to lower blood glucose by 50-100 mg/dL per hour during DKA treatment to safely bring it back to normal.

Metabolic Acidosis in DKA - Key Lab Test

Metabolic acidosis in DKA is confirmed by a combination of low pH, high anion gap, and low bicarbonate levels in the blood.

Why is rapid glucose correction dangerous in DKA?

Rapidly lowering blood glucose in DKA can lead to hypoglycemia, cerebral edema (brain swelling), and increased potassium excretion, all posing serious risks.

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DKA treatment: low potassium

If a patient's potassium level drops to 3.0 mEq/L during DKA treatment, the nurse must administer IV potassium to restore normal levels.

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Dietary advice to prevent DKA

Diabetics should maintain constant carbohydrate intake to prevent DKA. Skipping meals or inconsistent carbohydrate intake can lead to dangerously high blood glucose.

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DKA treatment: fluid overload

If a patient in DKA develops fluid overload, the nurse should reduce the fluid infusion rate to manage the excess fluids.

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Frequent blood glucose checks in DKA treatment

Frequent blood glucose checks are crucial during DKA treatment for monitoring treatment effectiveness, adjusting insulin dosage, and preventing hypoglycemia.

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HHNS Blood Sugar Range

Hyperosmolar Hyperglycemic State (HHNS) typically presents with blood glucose levels between 600-1200 mg/dL.

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HHNS Risk Factors

A patient with Type 2 Diabetes, especially if they have a recent infection, is most likely to develop HHNS.

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HHNS Priority Nursing Intervention

Initiating IV fluid therapy is a priority action for a patient with HHNS presenting with confusion and lethargy.

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Difference between HHNS and DKA

HHNS is distinguished from Diabetic Ketoacidosis (DKA) by the absence of ketosis. Both conditions share hyperglycemia and dehydration.

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Neurological Symptoms in HHNS

Hyperosmolality and corresponding fluid shifts in the brain are the primary causes for the neurological symptoms observed in HHNS.

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HHNS Treatment Goal

The primary goal of HHNS treatment is to rehydrate the patient and restore electrolyte balance through IV fluids.

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Lab Finding Consistent with HHNS

An osmolality exceeding 320 mOsm/kg is consistent with HHNS.

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HHNS Recovery Indicator

A clear mental status is a key indication of recovery from HHNS.

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HHNS

Hyperglycemic Hyperosmolar Nonketotic Syndrome is a serious condition caused by high blood sugar levels, leading to dehydration and severe hyperosmolarity. Unlike DKA, it does not involve ketone production.

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Key Difference: HHNS vs. DKA

HHNS is characterized by profound dehydration, unlike DKA, where acetone breath and high blood ketones are the major symptoms.

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Cause of Neurologic Symptoms in HHNS

Cerebral dehydration is the primary culprit behind neurologic symptoms in HHNS. The high blood sugar draws water out of the brain, leading to confusion and other issues.

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Serum Osmolality in HHNS

A serum osmolality of 330 mOsm/kg in a patient with HHNS indicates severe hyperosmolality. It reflects the high concentration of particles in the blood due to dehydration.

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Initial Treatment Priority for HHNS

Fluid replacement is the initial treatment priority in HHNS. It aims to rehydrate the patient and correct hyperosmolality.

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Fluid Type for Initial HHNS Treatment

0.9% normal saline is the first fluid given in HHNS, since it most effectively corrects dehydration.

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Insulin Therapy in HHNS

Insulin therapy in HHNS is used less aggressively compared to DKA because there is no acidosis to correct. The focus is on fluids to reduce hyperosmolality.

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Common Electrolyte Imbalance during HHNS Treatment

Hypokalemia is the most common electrolyte imbalance during HHNS treatment. Due to the high blood sugar, potassium is lost in the urine.

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Lactulose for Hepatic Encephalopathy

Lactulose is a medication used to treat hepatic encephalopathy by reducing ammonia levels in the gut. It works by trapping ammonia and drawing it out of the body through the stool.

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Monitoring Hepatic Encephalopathy

Handwriting and arithmetic assessments are used to monitor the neurological status of patients with hepatic encephalopathy. These simple tests can help identify changes in cognitive function.

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Fetor Hepaticus

Fetor hepaticus is a sweet, musty odor on the breath of patients with hepatic encephalopathy. It's caused by high ammonia levels in the blood.

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Dietary Management of Hepatic Encephalopathy

Patients with hepatic encephalopathy benefit from a low-protein diet to reduce ammonia production in their gut.

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Rifaximin Mechanism

Rifaximin is a medication used to treat hepatic encephalopathy by decreasing the amount of ammonia-producing bacteria in the gut.

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Babinski Reflex in Hepatic Encephalopathy

A positive Babinski reflex (toes fanning upward) in a patient with hepatic encephalopathy indicates severe neurological impairment.

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Managing Hepatic Encephalopathy

The primary goal of managing hepatic encephalopathy is to eliminate factors that trigger the condition and lower the serum ammonia levels.

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Prioritizing Care for Severe Confusion

Patients with severe confusion and agitation caused by hepatic encephalopathy need immediate intervention to ensure their safety and well-being.

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Hepatic Encephalopathy

A brain dysfunction caused by the buildup of toxins in the blood due to liver failure, affecting mental clarity and coordination.

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Branched-Chain Amino Acids (BCAAs) for Hepatic Encephalopathy

BCAAs are a protein alternative for patients with hepatic encephalopathy who can't tolerate regular protein, which helps maintain muscle mass and reduce ammonia production.

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Late-Stage Hepatic Encephalopathy

Disorientation and seizures are signs of late-stage hepatic encephalopathy, indicating severe brain dysfunction.

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Neurologic Assessment in Hepatic Encephalopathy

Regular neurologic checks are crucial to detect the progression of hepatic encephalopathy and identify early signs of coma.

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Dehydration Risk in Hepatic Encephalopathy

Frequent bowel movements due to lactulose therapy can lead to dehydration in patients with hepatic encephalopathy.

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Bleeding Tendencies in Hepatic Encephalopathy

Hepatic encephalopathy can impair blood clotting, leading to bleeding tendencies. The nurse must be vigilant.

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What is the most likely cause of chest pain and dyspnea in a patient with thyroid storm?

Atrial fibrillation, a rapid and irregular heart rhythm, can cause chest pain due to reduced blood flow to the heart and dyspnea due to decreased lung efficiency. It is often seen in patients with thyroid storm.

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Which antithyroid drug acts the fastest in thyroid storm?

Propylthiouracil (PTU) is the most effective antithyroid drug for rapid action in thyroid storm due to its ability to block both thyroid hormone synthesis and the conversion of inactive T4 to active T3.

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How does iodine solution help in thyroid storm?

Iodine solution suppresses the release of stored thyroid hormones from the thyroid gland, which is essential to control the excessive thyroid hormone levels seen in thyroid storm.

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What medication helps manage agitation and fever in thyroid storm?

Hydrocortisone, a corticosteroid, is used to manage agitation and fever in thyroid storm as it helps support adrenal function and reduce the conversion of T4 to T3, contributing to symptom control.

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What is the most alarming cardiovascular symptom in thyroid storm?

Ventricular fibrillation, a life-threatening irregular heart rhythm involving the lower chambers of the heart, is the most alarming cardiovascular symptom in thyroid storm, potentially leading to cardiac arrest.

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Why is an EEG used in a thyroid storm patient with altered neurologic status?

An EEG (Electroencephalogram) is used to assess brain activity and detect any neurological abnormalities that may occur due to thyroid storm, such as seizures or encephalopathy.

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What effect does propranolol have in a thyroid storm patient?

Propranolol is a beta-blocker, which helps control tachycardia and palpitations in thyroid storm by blocking the effects of adrenaline on the heart.

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What increases the risk of thyroid storm in pregnant patients?

Abrupt withdrawal of antithyroid medication during pregnancy can trigger thyroid storm as it allows thyroid hormone levels to rapidly increase, leading to severe hyperthyroidism.

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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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