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Questions and Answers
A 68-year-old patient presents to the ED with dyspnea, anxiety, diaphoresis, and accessory muscle use. Their spouse reports recent travel to Florida and concerns about COVID-19. Which of these initial interventions is MOST critical?
A 68-year-old patient presents to the ED with dyspnea, anxiety, diaphoresis, and accessory muscle use. Their spouse reports recent travel to Florida and concerns about COVID-19. Which of these initial interventions is MOST critical?
- Assessing oxygen saturation and providing supplemental oxygen. (correct)
- Administering a rapid COVID-19 test to confirm or rule out infection
- Obtaining a detailed travel history to identify potential exposures.
- Initiating intravenous fluids to address potential dehydration.
A patient is experiencing partially compensated respiratory acidosis. Which arterial blood gas (ABG) result BEST represents this condition?
A patient is experiencing partially compensated respiratory acidosis. Which arterial blood gas (ABG) result BEST represents this condition?
- pH 7.45, PaCO2 59 mm Hg, HCO3 25 mEq/L
- pH 7.31, PaCO2 65 mm Hg, HCO3 19 mEq/L (correct)
- pH 7.35, PaCO2 45 mm Hg, HCO3 29 mEq/L
- pH 7.38, PaCO2 40 mm Hg, HCO3 24 mEq/L
A patient with a history of COPD is admitted for respiratory distress. Which of the following findings would be MOST indicative of respiratory dysfunction, warranting immediate attention?
A patient with a history of COPD is admitted for respiratory distress. Which of the following findings would be MOST indicative of respiratory dysfunction, warranting immediate attention?
- Temperature of 101.2°F (38.4°C) with chills.
- Productive cough with purulent sputum.
- New onset of altered mental status and decreased oxygen saturation. (correct)
- Reports of chest pain that worsens with coughing.
A patient diagnosed with community-acquired pneumonia exhibits improved oxygenation but continues to use accessory muscles and reports exhaustion. The physician decides to intubate. Which nursing action is MOST important to perform immediately?
A patient diagnosed with community-acquired pneumonia exhibits improved oxygenation but continues to use accessory muscles and reports exhaustion. The physician decides to intubate. Which nursing action is MOST important to perform immediately?
During a ventilator weaning trial, which assessment finding would MOST strongly indicate the need to resume mechanical ventilation?
During a ventilator weaning trial, which assessment finding would MOST strongly indicate the need to resume mechanical ventilation?
A 42-year-old female is admitted after a motor vehicle crash. She has significant chest pain, visible bruising from the seatbelt, a respiratory rate of 28, and O2 saturation of 93%. Which assessment should be prioritized to evaluate the significance of her clinical presentation?
A 42-year-old female is admitted after a motor vehicle crash. She has significant chest pain, visible bruising from the seatbelt, a respiratory rate of 28, and O2 saturation of 93%. Which assessment should be prioritized to evaluate the significance of her clinical presentation?
A patient with multiple rib fractures and pulmonary contusions is being monitored for respiratory compromise. Which finding would be MOST indicative of an urgent need for intervention?
A patient with multiple rib fractures and pulmonary contusions is being monitored for respiratory compromise. Which finding would be MOST indicative of an urgent need for intervention?
Following a motor vehicle accident, a patient's ABG results are pH 7.49, PaCO2 34, PaO2 52, and HCO3 24. What is the MOST appropriate interpretation of these values?
Following a motor vehicle accident, a patient's ABG results are pH 7.49, PaCO2 34, PaO2 52, and HCO3 24. What is the MOST appropriate interpretation of these values?
A patient has PaO2/FiO2 ratio is 130. Based on this result, how would you describe their condition, and what is their risk for ARDS (Acute Respiratory Distress Syndrome)?
A patient has PaO2/FiO2 ratio is 130. Based on this result, how would you describe their condition, and what is their risk for ARDS (Acute Respiratory Distress Syndrome)?
A patient in respiratory distress has a markedly elevated A-a gradient. What does this finding indicate?
A patient in respiratory distress has a markedly elevated A-a gradient. What does this finding indicate?
A patient is intubated, and a chest tube is inserted. Despite these interventions, the PaO2 remains in the low 70s with an O2 saturation of 88% despite FiO2 100%. What is the priority nursing action?
A patient is intubated, and a chest tube is inserted. Despite these interventions, the PaO2 remains in the low 70s with an O2 saturation of 88% despite FiO2 100%. What is the priority nursing action?
A patient on a mechanical ventilator has ABG results of pH 7.25, PaCO2 60, PaO2 52, and HCO3 16. What is the correct interpretation of these ABG values?
A patient on a mechanical ventilator has ABG results of pH 7.25, PaCO2 60, PaO2 52, and HCO3 16. What is the correct interpretation of these ABG values?
A patient with ARDS is on a mechanical ventilator. What combination of ventilator settings and strategies is MOST appropriate to implement?
A patient with ARDS is on a mechanical ventilator. What combination of ventilator settings and strategies is MOST appropriate to implement?
A patient with ARDS is being considered for weaning from mechanical ventilation. Which of the following parameters is MOST indicative that the patient is ready to wean?
A patient with ARDS is being considered for weaning from mechanical ventilation. Which of the following parameters is MOST indicative that the patient is ready to wean?
A patient is deemed ready to wean from the ventilator. The healthcare team performs a spontaneous breathing trial with the ventilator set to CPAP, FiO2 40%, and Pressure support 15 cm. The baseline is BP 130/65 mm Hg, Heart rate, 88 beats/min, Sinus rhythm, Spontaneous respiratory rate, 22 breaths/min, Temp 98.6. Which of the following disciplines are important in that patients care?
A patient is deemed ready to wean from the ventilator. The healthcare team performs a spontaneous breathing trial with the ventilator set to CPAP, FiO2 40%, and Pressure support 15 cm. The baseline is BP 130/65 mm Hg, Heart rate, 88 beats/min, Sinus rhythm, Spontaneous respiratory rate, 22 breaths/min, Temp 98.6. Which of the following disciplines are important in that patients care?
Which statement best reflects the overall purpose of incorporating active learning guides into a module of study?
Which statement best reflects the overall purpose of incorporating active learning guides into a module of study?
A patient is admitted to the emergency department reporting severe shortness of breath. Initial assessment reveals anxiety, diaphoresis, and the use of accessory muscles. Considering the need for immediate intervention, what is the MOST crucial piece of information to gather initially?
A patient is admitted to the emergency department reporting severe shortness of breath. Initial assessment reveals anxiety, diaphoresis, and the use of accessory muscles. Considering the need for immediate intervention, what is the MOST crucial piece of information to gather initially?
After the patient is diagnosed with community-acquired pneumonia, which intervention BEST ensures adherence to the prescribed treatment plan?
After the patient is diagnosed with community-acquired pneumonia, which intervention BEST ensures adherence to the prescribed treatment plan?
A patient with a history of COPD presents with increased dyspnea and a productive cough. The nurse obtains an arterial blood gas (ABG). Which of the following ABG results would MOST strongly suggest the presence of acute respiratory failure?
A patient with a history of COPD presents with increased dyspnea and a productive cough. The nurse obtains an arterial blood gas (ABG). Which of the following ABG results would MOST strongly suggest the presence of acute respiratory failure?
The healthcare provider prescribes VTE prophylaxis for an immobilized patient. Which intervention will MOST effectively prevent venous thromboembolism in this patient?
The healthcare provider prescribes VTE prophylaxis for an immobilized patient. Which intervention will MOST effectively prevent venous thromboembolism in this patient?
A patient is diagnosed with ARDS and is on a mechanical ventilator. To optimize oxygenation and ventilation, the nurse should prioritize which action?
A patient is diagnosed with ARDS and is on a mechanical ventilator. To optimize oxygenation and ventilation, the nurse should prioritize which action?
What is the BEST approach to address the anxiety and potential fear of intubation for a patient diagnosed with community-acquired pneumonia?
What is the BEST approach to address the anxiety and potential fear of intubation for a patient diagnosed with community-acquired pneumonia?
The healthcare team is evaluating the patient for extubation. Which assessment BEST indicates readiness?
The healthcare team is evaluating the patient for extubation. Which assessment BEST indicates readiness?
A trauma patient with multiple rib fractures is at high risk for developing pneumonia secondary to inadequate cough and secretion clearance. What intervention should the nurse prioritize to prevent this complication?
A trauma patient with multiple rib fractures is at high risk for developing pneumonia secondary to inadequate cough and secretion clearance. What intervention should the nurse prioritize to prevent this complication?
Which intervention is MOST important to implement in patients with impaired gas exchange to optimize oxygen delivery to tissues?
Which intervention is MOST important to implement in patients with impaired gas exchange to optimize oxygen delivery to tissues?
During the care of a patient with ARDS, the nurse recognizes the importance of monitoring for potential complications related to mechanical ventilation. Which assessment finding necessitates immediate intervention?
During the care of a patient with ARDS, the nurse recognizes the importance of monitoring for potential complications related to mechanical ventilation. Which assessment finding necessitates immediate intervention?
In the management of ARDS, prone positioning is often employed to improve oxygenation. Which statement accurately reflects the physiological rationale behind this intervention?
In the management of ARDS, prone positioning is often employed to improve oxygenation. Which statement accurately reflects the physiological rationale behind this intervention?
What is the MOST important nursing intervention for a patient undergoing mechanical ventilation to prevent ventilator-associated pneumonia (VAP)?
What is the MOST important nursing intervention for a patient undergoing mechanical ventilation to prevent ventilator-associated pneumonia (VAP)?
A patient with ARDS is receiving neuromuscular blockade to optimize ventilation. What nursing intervention is MOST critical to include in the plan of care?
A patient with ARDS is receiving neuromuscular blockade to optimize ventilation. What nursing intervention is MOST critical to include in the plan of care?
During the weaning process from mechanical ventilation, a patient demonstrates increased anxiety, diaphoresis, and a respiratory rate of 32. What should the nurse do FIRST?
During the weaning process from mechanical ventilation, a patient demonstrates increased anxiety, diaphoresis, and a respiratory rate of 32. What should the nurse do FIRST?
When caring for a patient with a chest tube, what assessment finding requires immediate notification of the healthcare provider?
When caring for a patient with a chest tube, what assessment finding requires immediate notification of the healthcare provider?
A patient is being prepared for chest tube removal. What action reduces the risk of pneumothorax during removal?
A patient is being prepared for chest tube removal. What action reduces the risk of pneumothorax during removal?
What is the BEST method for evaluating the effectiveness of interventions aimed at improving oxygenation in a patient with respiratory failure?
What is the BEST method for evaluating the effectiveness of interventions aimed at improving oxygenation in a patient with respiratory failure?
A patient in the ICU on a mechanical ventilator suddenly develops acute agitation and combativeness. What should the nurse do FIRST?
A patient in the ICU on a mechanical ventilator suddenly develops acute agitation and combativeness. What should the nurse do FIRST?
Which intervention is MOST important to include in the plan of care for a patient with a pulmonary contusion?
Which intervention is MOST important to include in the plan of care for a patient with a pulmonary contusion?
A patient develops a pneumothorax following central line insertion. What physical assessment finding would the nurse expect to observe?
A patient develops a pneumothorax following central line insertion. What physical assessment finding would the nurse expect to observe?
Which collaborative treatment is MOST appropriate for a patient with a newly diagnosed tension pneumothorax?
Which collaborative treatment is MOST appropriate for a patient with a newly diagnosed tension pneumothorax?
What factor is MOST important to assess when deciding to extubate a patient?
What factor is MOST important to assess when deciding to extubate a patient?
A patient with a history of asthma and pneumonia is admitted with acute respiratory distress. What initial intervention should the nurse prioritize?
A patient with a history of asthma and pneumonia is admitted with acute respiratory distress. What initial intervention should the nurse prioritize?
Which laboratory value is MOST reliable in monitoring the effectiveness of interventions aimed at improving oxygenation in a patient with ARDS?
Which laboratory value is MOST reliable in monitoring the effectiveness of interventions aimed at improving oxygenation in a patient with ARDS?
A patient with ARDS is ordered to have neuromuscular blockade medication. The nurse should keep what in mind while administering the medication?
A patient with ARDS is ordered to have neuromuscular blockade medication. The nurse should keep what in mind while administering the medication?
Flashcards
Impaired Gas Exchange signs?
Impaired Gas Exchange signs?
Difficulty breathing, use of accessory muscles, hypoxia, anxiety, and diaphoresis.
Ineffective Airway Clearance signs?
Ineffective Airway Clearance signs?
Increased mucus, inflammation, infection, bronchoconstriction, dyspnea distress, decreased oxygen saturation.
Ineffective Breathing Pattern signs?
Ineffective Breathing Pattern signs?
Pulmonary dysfunction, anxiety, increased respiratory effort, use of accessory muscles, tachypnea, dyspnea, reporting difficulty breathing.
Partially compensated respiratory acidosis?
Partially compensated respiratory acidosis?
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What causes elevated PaCO2?
What causes elevated PaCO2?
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How do kidneys respond to respiratory acidosis?
How do kidneys respond to respiratory acidosis?
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Hypoxemia Diagnosis
Hypoxemia Diagnosis
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Respiratory Failure Risk Factors?
Respiratory Failure Risk Factors?
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What indicates respiratory compromise?
What indicates respiratory compromise?
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Lung protective Ventilation includes?
Lung protective Ventilation includes?
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IV Fluid Management includes?
IV Fluid Management includes?
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Indication that the Patient is ready for weaning?
Indication that the Patient is ready for weaning?
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Study Notes
- Active learning guides help students focus study time and provide context for course and career skills.
- Review the guide before and during module content engagement.
- The active learning guide serves to assist students in navigating course content effectively.
Case Study 1
- A 68-year-old client arrives at the ED reporting difficulty breathing and a feeling of being unable to get air in.
- The client's spouse reports recent travel to Florida 6 days prior, with breathing difficulties starting 3 days ago, and expresses concern about COVID-19.
- The client appears anxious, diaphoretic, and is using accessory muscles for respiration.
- It's important to assess vital signs (SpO2, respiratory rate, blood pressure, heart rate, temperature) and history of present exacerbation (onset, duration, progression of signs/symptoms, fever, cough, chest pain, effect of position on breathing).
- Additional history is needed regarding COPD, asthma, cardiac conditions, recent infections or sick contacts, medications (cardiac, anticoagulants), and travel history (long plane flights for VTE risk, COVID-19 exposure, vaccination status).
- Prioritized hypotheses include Impaired Gas Exchange, determined by dyspnea, use of accessory muscles, hypoxia, anxiety, and diaphoresis.
- Ineffective Airway Clearance determined by dyspnea, respiratory distress, and decreased oxygen saturation.
- Ineffective Breathing Pattern determined by use of accessory muscles, tachypnea, dyspnea, and reported difficulty breathing.
- An arterial blood gas (ABG) reveals partially compensated respiratory acidosis with hypoxemia.
- A PaCO2 of 65 mm Hg, pH of 7.31, and HCO3 of 19 mEq/L indicates partially compensated respiratory acidosis.
- The pH is low (7.31) indicating acidosis, but not fully uncompensated.
- The body has started to compensate via the renal system, but the pH hasn't returned to normal.
- Elevated PaCO2 (65 mmHg) is the main cause of respiratory acidosis due to hypoventilation leading to CO2 retention.
- Low HCO-3 (19 mEq/L) suggests partial renal compensation.
- Kidneys try to compensate by increasing bicarbonate reabsorption to buffer excess acid.
- The client has an eight-year history of COPD and continues to smoke ½ pack of cigarettes daily.
- The client is febrile (101.2°F), reports chills, has a productive cough with purulent sputum, and reports chest pain, with accompanying anorexia and constipation for 3 days.
- COVID-19 and pneumonia are being ruled out.
- Relevant cues pointing to respiratory dysfunction include COPD history, smoking, fever, chills, productive cough with purulent sputum, chest pain, anorexia, and constipation.
- After a negative Covid-19 result, community-acquired pneumonia is diagnosed.
- Despite improved oxygenation, the client remains diaphoretic, uses accessory muscles, and reports exhaustion and air hunger, leading to intubation and mechanical ventilation.
- Actions within the ED nurse's scope of practice during intubation include informing respiratory therapy (RT) to obtain a ventilator.
- The RN can select the proper sized endotracheal tube to be used during an intubation procedure.
- The RN can insure beside suction is in working order.
- The RN can choose an appropriately sized laryngoscope.
- Securing pre-procedure vital signs is within the RN scope of practice for intubation.
- Selecting pre-and post-medication is within the RN scope of practice for intubation.
- Positioning the client in a sniffing position within the RN scope of practice for preparing for intubation.
- After 3 days of mechanical ventilation, the client's healthcare team decides to perform a ventilator weaning trial.
- A pH of 7.34 indicates resuming mechanical ventilation after a weaning trial.
- Blood pressure of 120/76 mm Hg indicates extubation is possible.
- SaO2 of 90% indicates resuming mechanical ventilation.
- PaCO2 of 55 mm Hg indicates resuming mechanical ventilation.
- PaO2 of 76 mm Hg indicates extubation is possible.
- Heart rate of 84 beats per minute indicates extubation is possible.
- HCO3 of 24 mEq/L indicates extubation is possible.
Case Study 2
- Ms. S, a 42-year-old female, is admitted to the ED after a single-car motor vehicle crash, with vital signs of Temp 96.2 F, HR 110, RR 28, BP 142/70, and O2sat 93% on 4 liters nasal cannula.
- The patient complains of severe central and right-sided chest pain and has visible bruising from the seatbelt.
- The pain is worse with inspiration and coughing, rating it 10/10.
- The patient is taking shallow breaths and has visible use of accessory muscles.
- Additional data to confirm clinical cues include ABGs, chest X-ray, CT scan, CBC, electrolyte levels, sputum culture, and pain assessment.
- Risk factors for respiratory failure development include multiple rib fractures, pulmonary contusions, seatbelt injury, chronic smoker status, productive cough, and recent cold/possible infection.
- Cues that suggest respiratory compromise include tachypnea, shallow breathing, use of accessory muscles, hypoxia (O2 sat 93%), pulmonary contusions, multiple rib fractures, and severe chest pain.
- Likely problems include impaired gas exchange (pulmonary contusions, shallow breathing), ineffective breathing pattern (chest pain, difficulty breathing), acute pain (displaced radial/ulnar fractures, worsened pain with breathing), and risk for pneumonia (ineffective cough due to pain).
- Incentive spirometry every 2 hours, the patient is able to draw 550 ml on repeated attempts but continues to be reluctant to take deep breath.
- 12 hours after admission the patient reports inability to catch her breath, with vital signs: Temp 101.4, HR 127 bpm, RR 35 Breaths/min, BP 108/64, O2 sat 89% on 40% oxygen venti mask, ABG with pH 7.49, PaCO2 34, PaO2 52, HCO3 24.
- After initial treatment for hypoxemia, a chest x-ray revealed a small right upper lobe pneumothorax, diffuse bilateral infiltrates and cardiac silhouette that is less than 1/2 the chest diameter.
- The ABG shows pH 7.49, PaCO2 34, PaO2 52, HCO3 24, indicating high alkalosis due to hyperventilation without metabolic issues.
- The A-a gradient is 190.7, elevated and indicative of impaired oxygen diffusion, possible acute injury, or early ARDS.
- The P/F ratio is 130, indicating hypoxemia.
- The P/F ratio of 52 / 0.40 = 130 indicates moderate risk for ARDS due to bilateral infiltrates.
- The patient exhibits continued respiratory compromise through tachypnea, use of accessory muscles, shortness of breath, PaO2 of 52 on 0.40 FiO2, and SpO2 of 89%
- The patient is in hypoxia Type 1, with ARDS due to bilateral infiltrates.
- Short term goals include optimizing oxygenation/ventilation, reducing breathing effort, management of pneumothorax, and infection control.
- Improved P/F Ratio to > 200 after hypoxemia.
- Improvement in Lung Fields, no infiltrates after hypoxemia.
- Stable Heart Rate within normal ranges of 60 - 100 after hypoxemia.
- After the patient is transfered to critical care and placed on a mechanical ventilator, the PaO2 remains in the low 70s with an O2 saturation of 88% despite FiO2 100%.
- Further deterioration occurs and the patient is placed on AC PC with PEEP 15 cm.
- Current ABGs while on AC PC Pressure 30 cm, Rate 30, FiO2 100%, Peep 20 cm are as follows: pH 7.25 paCO2 60 paO2 52 HCO3 16 O2 sat 89%
- After the patient is transfered to critical care and placed on a mechanical ventilator, the PaO2 remains in the low 70s with an O2 saturation of 88% despite FiO2 100%.
- Her oxygenation continues to deteriorate, and has a very severe hypoxemia.
- The patient has ARDS, prolonged Hypoxia, Pneumonia and a pulmonary contusion.
- Collaborative and nursing treatments include Lung Protection Ventilation, IV Fluid Management, and Broad Spectrum Antibiotics.
- Improved P/F Ration indicates it is appropriate to consider weaning.
- Tolerating being taken off of sedation indicates it is appropriate to consider weaning.
- Minimum sedation required indicates it is appropriate to consider weaning.
- The patient needs a breathing trial to assess ability to breathe independently of administered oxygen.
- The health care team decides to perform a spontaneous breathing trial, her ventilator is set to CPAP or spontaneous mode, FiO2 40%, Pressure support 15 cm, Peep 10 cm.
- The patient is ready to wean and meets most criteria set.
- The patient is tolerating tube feedings at 50 ml/hr, the decision is made to wean her from the ventilator.
- Her weaning parameters include a negative inspiratory pressure of -18 cm H2O and a vital capacity of 11 ml per kilogram.
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