ARDS Flashcards

Questions and Answers

Which assessment finding by the nurse is most important to report to the health care provider for a patient with COPD?

The patient is sitting in the tripod position.

The patient's respirations have dropped to 10 breaths/minute. (correct)

The patient's pulse oximetry indicates a 91% O2 saturation.

The patient has bibasilar lung crackles.

During the Acute Exudate Phase of ARDS, __________.

Fluids shift into the alveoli, the alveoli and bronchii collapse, and lose lung compliance.

When assessing a patient with COPD, which action should the nurse take first if there is a new onset of agitation and confusion?

Notify the health care provider.

Assess oxygenation using pulse oximetry. (correct)

Attempt to calm and reorient the patient.

Observe for facial symmetry.

Which of the following are advanced signs and symptoms of ARDS? (Select all that apply)

Pallor or cyanosis Signup and view all the answers

Which assessment finding requires the most rapid action for a patient with acute respiratory distress?

The patient's PaO2 is 45 mm Hg. Signup and view all the answers

Which assessment information is most important to communicate for a patient hospitalized with community-acquired pneumonia?

Oxygen saturation 90% on 100% O2 by non-rebreather mask. Signup and view all the answers

Which assessment finding is most important for the nurse to report for a patient with ARDS on mechanical ventilation?

O2 saturation of 99%. Signup and view all the answers

Which information about a patient receiving cisatracurium (Nimbex) requires action by the nurse?

No sedative has been ordered for the patient. Signup and view all the answers

Which action should the nurse take first for a patient with aspiration pneumonia who has become increasingly agitated?

Use pulse oximetry to check the oxygen saturation. Signup and view all the answers

Which actions should the nurse take to reduce the risk for ventilator-associated pneumonia (VAP)? (Select all that apply)

Give prescribed pantoprazole (Protonix). Signup and view all the answers

Which drug should the nurse discuss with the health care provider before giving?

Gentamicin 60 mg IV Signup and view all the answers

Which diagnostic test will provide the nurse with the most specific information to evaluate the effectiveness of interventions for a patient with ventilatory failure?

Arterial blood gas analysis Signup and view all the answers

To determine whether the patient has acute respiratory distress syndrome (ARDS) or pulmonary edema caused by heart failure, the nurse will plan to assist with:

Insertion of a pulmonary artery catheter Signup and view all the answers

Which action should the nurse take when a patient with a pulmonary embolism notes a change in oxygen saturation from 94% to 88%?

Increase the prescribed O2 flow rate Signup and view all the answers

Which collaborative action will the nurse anticipate next for a patient with ARDS who is intubated and develops a right pneumothorax?

Lower the positive end-expiratory pressure (PEEP) Signup and view all the answers

Which intervention will the nurse anticipate for a patient with a respiratory rate of 6 breaths/min and an oxygen saturation of 88%?

Endotracheal intubation and positive pressure ventilation Signup and view all the answers

Which nursing interventions can the RN delegate to an experienced LPN/LVN in the intensive care unit?

Insert an indwelling urinary catheter Signup and view all the answers

What action should the nurse take next for a patient with left lower lobe pneumonia and an oxygen saturation of 90%?

Assist the patient with staged coughing Signup and view all the answers

Which finding is most important to report to the health care provider for a patient intubated and receiving mechanical ventilation?

Red-brown drainage from nasogastric tube Signup and view all the answers

Which position will be best to improve gas exchange for an obese patient with right lower lobe pneumonia?

On the left side Signup and view all the answers

Which condition triggers the high-pressure alarm on the mechanical ventilator?

Kinking of the ventilator tubing Signup and view all the answers

What assessment information should be immediately reported for a patient with possible respiratory failure?

The patient is very somnolent Signup and view all the answers

What condition has a firefighter likely developed after severe hypoxia from smoke inhalation?

Acute respiratory distress syndrome (ARDS) Signup and view all the answers

When checking a client with chest trauma after vehicle accident, which condition should the nurse assess for when the high-pressure alarm sounds?

Right pneumothorax Signup and view all the answers

What does a pulmonary capillary wedge pressure reading of 12 mm Hg indicate?

Normal and expected Signup and view all the answers

Which assessment finding may indicate that PEEP needs to be reduced?

The patient has subcutaneous emphysema on the upper thorax Signup and view all the answers

Which of the following are early signs and symptoms of ARDS? (Select all that apply)

Dyspneic Signup and view all the answers

To decrease the risk for ventilator-associated pneumonia in a mechanically ventilated patient, which action should the nurse include in the plan of care?

Elevate the head of bed to 30 to 45 degrees Signup and view all the answers

During the Fibrotic Phase of ARDS, ____________________.

Fibrous tissue forms and lungs don't expand well; the effort to breathe increases O2 demand which causes more effort to breathe. Signup and view all the answers

Acute Respiratory Distress Syndrome (ARDS) can be defined as:

Non-cardiac pulmonary edema with increasing hypoxemia despite treatment with O2. Signup and view all the answers

Which of the following are the 5 characteristics of ARDS? (Select all that apply)

Dyspnea Signup and view all the answers

After receiving change-of-shift report on a medical unit, which patient should the nurse assess first?

A patient with septicemia who has intercostal and suprasternal retractions Signup and view all the answers

It will be most important for the nurse to check pulse oximetry for which of these patients?

A patient with pneumonia who has just been admitted to the unit Signup and view all the answers

The nurse will monitor for clinical manifestations of hypercapnia when a patient in the emergency department has?

Chest trauma and multiple rib fractures Signup and view all the answers

When a patient is diagnosed with pulmonary fibrosis, the nurse will teach the patient about the risk for poor oxygenation because of?

Decreased transfer of oxygen into the blood because of thickening of the alveoli Signup and view all the answers

A patient is diagnosed with a large pulmonary embolism. When explaining to the patient what has happened to cause respiratory failure, which information will the nurse include?

Blood flow through some areas of your lungs is decreased even though you are taking adequate breaths Signup and view all the answers

A patient is brought to the emergency department unconscious following a barbiturate overdose. Which potential complication will the nurse include when developing the plan of care?

Hypercapnic respiratory failure related to decreased ventilatory effort Signup and view all the answers

When assessing a patient with chronic lung disease, the nurse finds a sudden onset of agitation and confusion. Which action should the nurse take first?

Assess vital signs and pulse oximetry Signup and view all the answers

To evaluate both oxygenation and ventilation in a patient with acute respiratory failure, the nurse uses the findings revealed with?

Arterial blood gas (ABG) analysis Signup and view all the answers

A finding indicating to the nurse that a 22-year-old patient with respiratory distress is in acute respiratory failure includes?

Partial pressure of arterial oxygen (PaO2) of 45 mm Hg Signup and view all the answers

While caring for a patient who has been admitted with a pulmonary embolism, the nurse notes a change in the patient's arterial oxyhemoglobin saturation (SpO2) from 94% to 88%. The nurse will?

Increase the oxygen flow rate Signup and view all the answers

A patient with hypercapnic respiratory failure has a respiratory rate of 8 and an SpO2 of 89%. The patient is increasingly lethargic. Which collaborative intervention will the nurse anticipate?

Endotracheal intubation and positive pressure ventilation Signup and view all the answers

A patient in acute respiratory failure as a complication of COPD has a PaCO2 of 65 mm Hg, rhonchi audible in the right lung, and marked fatigue with a weak cough. The nurse will plan to?

Assist the patient with augmented coughing to remove respiratory secretions Signup and view all the answers

When the nurse is caring for an obese patient with left lower-lobe pneumonia, gas exchange will be best when the patient is positioned?

On the right side Signup and view all the answers

The nurse is caring for a patient who was hospitalized 2 days earlier with aspiration pneumonia. Which assessment information is most important to communicate to the health care provider?

The patient's SpO2 has dropped to 90%, although the O2 flow rate has been increased Signup and view all the answers

When caring for a patient who developed acute respiratory distress syndrome (ARDS) as a result of a urinary tract infection (UTI), the nurse is asked by the patient's family how a UTI could cause lung damage. Which response by the nurse is appropriate?

The infection caused generalized inflammation that damaged the lungs Signup and view all the answers

Which information obtained by the nurse when assessing a patient with acute respiratory distress syndrome (ARDS) who is being treated with mechanical ventilation and high levels of positive end-expiratory pressure (PEEP) indicates a complication of ventilator therapy is occurring?

The patient has subcutaneous emphysema Signup and view all the answers

Which statement by the nurse when explaining the purpose of positive end-expiratory pressure (PEEP) to the family members of a patient with ARDS is correct?

PEEP prevents the lung air sacs from collapsing during exhalation Signup and view all the answers

When prone positioning is used for a patient with acute respiratory distress syndrome (ARDS), which information obtained by the nurse indicates that the positioning is effective?

The patient's PaO2 is 89 mm Hg, and the SaO2 is 91% Signup and view all the answers

A patient with acute respiratory distress syndrome (ARDS) has progressed to the fibrotic phase. The patient's family members are anxious about the patient's condition and are continuously present at the hospital. In addressing the family's concerns, it is important for the nurse to?

Support the family and help them understand the realistic expectation that the patient's chance for survival is poor Signup and view all the answers

The nurse assesses vital signs for a patient admitted 2 days ago with gram-negative sepsis: temperature of 101.2°F, blood pressure of 90/56 mm Hg, pulse of 92 beats/min, and respirations of 34 breaths/min. Which action should the nurse take next?

Obtain oxygen saturation using pulse oximetry Signup and view all the answers

Which of these nursing actions included in the care of a mechanically ventilated patient with acute respiratory distress syndrome (ARDS) is most appropriate for the RN to delegate to an experienced LPN/LVN working in the intensive care unit?

Administration of enteral tube feedings Signup and view all the answers

Study Notes

Key Patient Assessments and Interventions

Monitor pulse oximetry for patients at risk of hypoxemia, especially those with pneumonia.
Hypercapnia often arises from poor ventilatory efforts, commonly seen in chest trauma cases with rib fractures.
In pulmonary fibrosis, the risk of poor oxygenation is due to thickening of the alveolar-capillary interface, which slows gas diffusion.
In cases of large pulmonary embolism, a ventilation-perfusion mismatch occurs, indicating areas of good blood flow without adequate air.

Respiratory Failure and Its Causes

Hypercapnic respiratory failure can occur after opioid overdose due to decreased respiratory effort.
Sudden changes in patient neuro status, like agitation, necessitate immediate vital signs and pulse oximetry assessment.
Arterial blood gas (ABG) analysis is critical to evaluate both oxygenation and ventilation in acute respiratory failure.

Key Indicators of Respiratory Distress

A partial pressure of arterial oxygen (PaO2) below 60 mm Hg is severe hypoxemia requiring urgent action.
SpO2 dropping despite increased oxygen flow rates can indicate complications, such as progression to ARDS.

Specific Nursing Considerations

Increasing oxygen flow rates can alleviate hypoxemia due to ventilation-perfusion mismatch.
Patients with hypercapnia who exhibit lethargy and low respiratory rates may require mechanical ventilation.
Enhanced coughing techniques may help clear respiratory secretions in patients with poor cough strength.

Positioning and Management Strategies

Positioning patients, especially those with pneumonia, lung function can be improved by having them lie on the unaffected side.
Prone positioning in ARDS patients should be evaluated for efficacy through improved oxygenation metrics.

Family Communication and Care Coordination

When informing families of patients progressing to the fibrotic stage of ARDS, appropriately set expectations regarding survival chances.
Discuss potential nephrotoxic medications with healthcare providers when patients with ARDS also experience acute kidney injury.

Diagnostic Tests and Their Utilities

Arterial blood gas analysis is the most specific test for evaluating respiratory failure, as it indicates CO2 retention and pH balance.
Routine vital sign assessment, particularly temperature and blood pressure, can hint at developing ARDS in critically ill patients.

Patient Management Goals

In mechanically ventilated patients with ARDS, certain tasks, like enteral feed administration, can be delegated to experienced LPNs/LVNs.
Continuous assessment and adjustment to therapeutic interventions are essential to manage complications and improve patient outcomes.### Acute Respiratory Distress Syndrome (ARDS) and Related Conditions
ARDS is characterized by non-cardiac pulmonary edema and worsening hypoxemia despite oxygen treatment.
Pulmonary artery wedge pressures remain normal in ARDS, distinguishing it from cardiogenic pulmonary edema.
Common assessments include arterial blood gases and chest X-rays; specific measurements help differentiate causes of respiratory distress.

Interventions and Nursing Actions

In cases of pulmonary embolism, increasing oxygen flow rates is essential to improve oxygen saturation due to ventilation-perfusion mismatch.
For patients with ARDS on mechanical ventilation, reducing positive end-expiratory pressure (PEEP) may be necessary in the presence of pneumothorax or barotrauma.
Endotracheal intubation is indicated for patients with lethargy, low respiratory rates, and low oxygen saturation.
Routine suctioning and assessment of lung sound changes are crucial, but advanced assessment skills should remain with the registered nurse (RN).

Symptoms and Signs of ARDS

Early signs include dyspnea, non-productive cough, restlessness, and chest X-ray results may show clear lungs initially.
Advanced symptoms involve accessory muscle use, pallor/cyanosis, and changes in chest X-ray indicating pulmonary infiltrates.
Patients may demonstrate signs of respiratory alkalosis at early stages and progress to respiratory acidosis if condition worsens.

Care Strategies

Elevating the head of the bed can reduce the risk of ventilator-associated pneumonia.
Increased oral fluid intake is crucial to managing thick secretions in patients with ineffective airway clearance.
In the acute exudative phase of ARDS, fluids shift into the alveoli, decreasing lung compliance and gas exchange efficiency.

Conditions Triggering Alarms

High-pressure alarms on mechanical ventilators often indicate kinking of ventilator tubing, while disconnected tubes trigger low-pressure alarms.
The presence of agitation and confusion in COPD patients should prompt immediate oxygenation assessments due to potential hypoxemia.

Collaboration and Communication

Persistent coughing of blood-tinged sputum and low oxygen saturations should be prioritized in communication with healthcare providers as they may indicate critical deterioration.
Continuous monitoring and adjusting treatment plans based on assessment findings are vital components of care for patients with respiratory failure.### Acute Respiratory Distress Syndrome (ARDS)
Low SpO2 despite high fraction of inspired oxygen (FIO2) suggests ARDS.
Blood-tinged sputum and scattered crackles can be seen in pneumonia, requiring monitoring.
Elevated temperature may indicate a need for antibiotic adjustment but is less urgent than hypoxemia progression.

Mechanical Ventilation in ARDS

Synchronized Intermittent Mandatory Ventilation (SIMV) settings: FIO2 80%, tidal volume 450, rate 16/min, PEEP 5 cm.
Important assessment finding to report: O2 saturation of 99%, indicating need to reduce FIO2 to prevent oxygen toxicity.
Other signs, like increased heart rate, crackles, and slightly elevated respiratory rate, are typical for ARDS.

Neuromuscular Blockade

Patients on cisatracurium (Nimbex) require concurrent sedation due to anxiety caused by neuromuscular blockade.
Expected responses include no reaction to verbal stimulation and absence of cough/gag reflex.
Oxygen saturation between 90-93% is considered adequate.

Agitation in Respiratory Patients

Increased agitation in patients with aspiration pneumonia could signal hypoxemia.
First action should be to check oxygen saturation using pulse oximetry before administering sedatives or reassurance.

Preventing Ventilator-Associated Pneumonia (VAP)

Key actions include:
- Providing daily "sedation holidays" to assess the patient's need for sedation.
- Administering prescribed pantoprazole (Protonix) to reduce gastrointestinal complications.
- Keeping the head of the bed elevated to at least 30° to prevent aspiration.
- Daily oral care with chlorhexidine (0.12%) solution to maintain oral hygiene.
Daily arterial blood gases may not be necessary for VAP prevention.

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Description

Test your knowledge on ARF/ARDS with these flashcards. Each card presents a scenario for nurses to evaluate the importance of monitoring pulse oximetry in various patient situations. Perfect for nursing students and professionals preparing for clinical practice.