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Questions and Answers
Which assessment finding by the nurse is most important to report to the health care provider for a patient with COPD?
Which assessment finding by the nurse is most important to report to the health care provider for a patient with COPD?
During the Acute Exudate Phase of ARDS, __________.
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?
When assessing a patient with COPD, which action should the nurse take first if there is a new onset of agitation and confusion?
Which of the following are advanced signs and symptoms of ARDS? (Select all that apply)
Which of the following are advanced signs and symptoms of ARDS? (Select all that apply)
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Which assessment finding requires the most rapid action for a patient with acute respiratory distress?
Which assessment finding requires the most rapid action for a patient with acute respiratory distress?
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Which assessment information is most important to communicate for a patient hospitalized with community-acquired pneumonia?
Which assessment information is most important to communicate for a patient hospitalized with community-acquired pneumonia?
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Which assessment finding is most important for the nurse to report for a patient with ARDS on mechanical ventilation?
Which assessment finding is most important for the nurse to report for a patient with ARDS on mechanical ventilation?
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Which information about a patient receiving cisatracurium (Nimbex) requires action by the nurse?
Which information about a patient receiving cisatracurium (Nimbex) requires action by the nurse?
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Which action should the nurse take first for a patient with aspiration pneumonia who has become increasingly agitated?
Which action should the nurse take first for a patient with aspiration pneumonia who has become increasingly agitated?
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Which actions should the nurse take to reduce the risk for ventilator-associated pneumonia (VAP)? (Select all that apply)
Which actions should the nurse take to reduce the risk for ventilator-associated pneumonia (VAP)? (Select all that apply)
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Which drug should the nurse discuss with the health care provider before giving?
Which drug should the nurse discuss with the health care provider before giving?
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Which diagnostic test will provide the nurse with the most specific information to evaluate the effectiveness of interventions for a patient with ventilatory failure?
Which diagnostic test will provide the nurse with the most specific information to evaluate the effectiveness of interventions for a patient with ventilatory failure?
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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:
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:
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Which action should the nurse take when a patient with a pulmonary embolism notes a change in oxygen saturation from 94% to 88%?
Which action should the nurse take when a patient with a pulmonary embolism notes a change in oxygen saturation from 94% to 88%?
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Which collaborative action will the nurse anticipate next for a patient with ARDS who is intubated and develops a right pneumothorax?
Which collaborative action will the nurse anticipate next for a patient with ARDS who is intubated and develops a right pneumothorax?
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Which intervention will the nurse anticipate for a patient with a respiratory rate of 6 breaths/min and an oxygen saturation of 88%?
Which intervention will the nurse anticipate for a patient with a respiratory rate of 6 breaths/min and an oxygen saturation of 88%?
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Which nursing interventions can the RN delegate to an experienced LPN/LVN in the intensive care unit?
Which nursing interventions can the RN delegate to an experienced LPN/LVN in the intensive care unit?
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What action should the nurse take next for a patient with left lower lobe pneumonia and an oxygen saturation of 90%?
What action should the nurse take next for a patient with left lower lobe pneumonia and an oxygen saturation of 90%?
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Which finding is most important to report to the health care provider for a patient intubated and receiving mechanical ventilation?
Which finding is most important to report to the health care provider for a patient intubated and receiving mechanical ventilation?
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Which position will be best to improve gas exchange for an obese patient with right lower lobe pneumonia?
Which position will be best to improve gas exchange for an obese patient with right lower lobe pneumonia?
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Which condition triggers the high-pressure alarm on the mechanical ventilator?
Which condition triggers the high-pressure alarm on the mechanical ventilator?
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What assessment information should be immediately reported for a patient with possible respiratory failure?
What assessment information should be immediately reported for a patient with possible respiratory failure?
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What condition has a firefighter likely developed after severe hypoxia from smoke inhalation?
What condition has a firefighter likely developed after severe hypoxia from smoke inhalation?
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When checking a client with chest trauma after vehicle accident, which condition should the nurse assess for when the high-pressure alarm sounds?
When checking a client with chest trauma after vehicle accident, which condition should the nurse assess for when the high-pressure alarm sounds?
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What does a pulmonary capillary wedge pressure reading of 12 mm Hg indicate?
What does a pulmonary capillary wedge pressure reading of 12 mm Hg indicate?
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Which assessment finding may indicate that PEEP needs to be reduced?
Which assessment finding may indicate that PEEP needs to be reduced?
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Which of the following are early signs and symptoms of ARDS? (Select all that apply)
Which of the following are early signs and symptoms of ARDS? (Select all that apply)
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To decrease the risk for ventilator-associated pneumonia in a mechanically ventilated patient, which action should the nurse include in the plan of care?
To decrease the risk for ventilator-associated pneumonia in a mechanically ventilated patient, which action should the nurse include in the plan of care?
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During the Fibrotic Phase of ARDS, ____________________.
During the Fibrotic Phase of ARDS, ____________________.
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Acute Respiratory Distress Syndrome (ARDS) can be defined as:
Acute Respiratory Distress Syndrome (ARDS) can be defined as:
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Which of the following are the 5 characteristics of ARDS? (Select all that apply)
Which of the following are the 5 characteristics of ARDS? (Select all that apply)
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After receiving change-of-shift report on a medical unit, which patient should the nurse assess first?
After receiving change-of-shift report on a medical unit, which patient should the nurse assess first?
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It will be most important for the nurse to check pulse oximetry for which of these patients?
It will be most important for the nurse to check pulse oximetry for which of these patients?
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The nurse will monitor for clinical manifestations of hypercapnia when a patient in the emergency department has?
The nurse will monitor for clinical manifestations of hypercapnia when a patient in the emergency department has?
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When a patient is diagnosed with pulmonary fibrosis, the nurse will teach the patient about the risk for poor oxygenation because of?
When a patient is diagnosed with pulmonary fibrosis, the nurse will teach the patient about the risk for poor oxygenation because of?
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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?
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?
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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?
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?
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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?
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?
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To evaluate both oxygenation and ventilation in a patient with acute respiratory failure, the nurse uses the findings revealed with?
To evaluate both oxygenation and ventilation in a patient with acute respiratory failure, the nurse uses the findings revealed with?
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A finding indicating to the nurse that a 22-year-old patient with respiratory distress is in acute respiratory failure includes?
A finding indicating to the nurse that a 22-year-old patient with respiratory distress is in acute respiratory failure includes?
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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?
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?
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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?
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?
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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?
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?
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When the nurse is caring for an obese patient with left lower-lobe pneumonia, gas exchange will be best when the patient is positioned?
When the nurse is caring for an obese patient with left lower-lobe pneumonia, gas exchange will be best when the patient is positioned?
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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 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?
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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?
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?
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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?
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?
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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?
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?
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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?
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?
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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?
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?
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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?
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?
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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?
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?
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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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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.
