Questions and Answers
What defines the clinical criteria for ARDS?
Which option is a characteristic of ARDS?
What syndrome is ARDS the most severe form of?
What is a precipitating cause of ARDS?
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What is typically observed on chest imaging in patients with ARDS?
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What is the primary characteristic of the early exudative phase of ARDS?
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What might indicate an increase in lung injury score?
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Which symptom is most likely associated with the assessment of the respiratory system in ARDS?
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What can cyanosis in a patient indicate during the progression of ARDS?
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What is a common nursing diagnosis associated with ARDS?
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Which phase of ARDS is characterized by persistent capillary endothelial damage?
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In late stage ARDS, which condition may become more pronounced?
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What result on an early arterial blood gas (ABG) test is indicative of ARDS?
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What is typically one of the primary causes of Acute Respiratory Distress Syndrome (ARDS)?
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During which stage of ARDS is it most difficult to make a diagnosis?
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What physiological change occurs in the body during Systemic Inflammatory Response Syndrome (SIRS)?
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What is a hallmark feature of ARDS that affects lung function?
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What is indicated by a PaO2/FiO2 ratio of 150 mmHg?
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Which of the following is a potential indirect pulmonary insult that may lead to ARDS?
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Which inflammatory mediator is stimulated by bacterial endotoxin and causes fever?
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What is a possible consequence of the accumulation of fibroblastic tissue within the lungs after an injury?
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What does the term V/Q mismatch refer to in the context of ARDS?
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What is a respiratory rate indicative of SIRS?
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What is one of the primary goals of mechanical ventilation in ARDS?
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What is the purpose of using PEEP during ventilation therapy?
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What is a common complication associated with mechanical ventilation?
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Which of the following techniques prevents the overdistention of normal lung tissue?
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What can result from using O2 for longer than 12-24 hours at a concentration above 50%?
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In pressure-controlled inverse-ratio ventilation, what is typically changed?
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What is a disadvantage of using Super PEEP?
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Which method can assist injured lungs by directly oxygenating the blood?
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What is the 'small lung theory' in ARDS management?
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What is a consequence of volutrauma during mechanical ventilation?
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Study Notes
Etiology and Pathophysiology
- Acute Lung Injury (ALI) is characterized by non-cardiogenic pulmonary edema, reduced lung compliance, and refractory hypoxemia.
- Acute Respiratory Distress Syndrome (ARDS) is the most severe form of ALI, marked by inflammation and increased permeability.
- ARDS definition includes:
- PaO2/FIO2 ratio < 200 mmHg
- Bilateral lung infiltrates
- Pulmonary Artery Occlusive Pressure < 18 mmHg
- Criteria for ARDS diagnosis involve acute onset lung injury, bilateral opacities, and respiratory failure not related to heart failure.
Systemic Inflammatory Response Syndrome (SIRS)
- SIRS results from an exaggerated host defense reaction to bodily insults or tissue damage.
- Commonly associated with bacterial infections and can arise from trauma, hypoxia, and other conditions.
- Manifestations include fever, tachycardia, tachypnea, and elevated white blood cell count.
Precipitating Causes of ARDS
- Direct pulmonary insults are caused by:
- Aspiration, inhalation of toxic substances, pneumonia, and pulmonary contusion.
- Indirect insults stem from conditions such as sepsis, multiple trauma, burns, and anaphylaxis.
Pathophysiology of ARDS
- Damage to the alveolar-capillary membrane increases permeability, leading to fluid and protein accumulation in the alveoli.
- Ineffective surfactant results in alveolar collapse and ventilation/perfusion mismatch, worsening oxygenation despite increased oxygen supply.
- Lung healing may progress to fibrosis and scarring, obstructing gas exchange.
Stages of ARDS
- Phase 0: Injury stage (first 12 hours - subtle signs).
- Phase I: Early exudative phase (alveolar edema with cellular debris).
- Phase II: Proliferative phase (persistent endothelial damage).
- Phase III: Fibroproliferative phase (chronic ARDS with significant fibrosis).
Assessment
- Assessment should focus on neurologic status, respiratory function, and cardiovascular health.
- Neurologic signs: altered consciousness, restlessness, or lethargy.
- Respiratory indicators: dyspnea, tachypnea, cough with sputum, and chest X-ray changes.
- Cardiovascular signs: tachycardia, potential cardiac failure, and elevated pulmonary pressure.
Nursing Diagnoses
- Ineffective airway clearance.
- Impaired gas exchange.
- Ineffective breathing pattern.
- Decreased cardiac output and altered tissue perfusion.
Collaborative Management
- Airway management may involve endotracheal intubation and mechanical ventilation.
- Goals of mechanical ventilation include improving gas exchange and relieving respiratory distress while preventing atelectasis.
- Challenges include ventilator-induced lung injury, O2 toxicity, and hypotension due to positive pressure.
Advanced Management Techniques
- High-Frequency Jet Ventilation reduces peak airway pressure with small tidal volumes.
- Pressure-controlled ventilation adjusts the inspiratory/expiratory time ratio for consistent gas delivery.
- Super PEEP aims to maintain PaO2 while minimizing barotrauma and hypotension risks.
Additional Techniques
- Low tidal volume ventilation prevents normal lung overdistension.
- Permissive hypercapnia allows higher CO2 levels with minimal side effects.
- Pharmacologic support includes antioxidants to mitigate lung injury.
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Description
This quiz covers the key concepts of Acute Lung Injury (ALI), Acute Respiratory Distress Syndrome (ARDS), and the Systemic Inflammatory Response Syndrome (SIRS). It highlights the definitions, diagnostic criteria, and the various precipitating causes that lead to these conditions. Test your knowledge on the pathophysiology and etiology of these critical respiratory and systemic responses.
