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ARDS and Respiratory FailureMedical-Surgical Nursing-7th edition

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What conditions can cause a diffuse limitation?
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Severe emphysema, recurrent pulmonary embolisms, pulmonary fibrosis, interstitial lung disease or ARDS.
What position has been found to increase PaO2 in patients with ARDS?
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Prone
What is continuous lateral rotation therapy?
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An ARDS treatment that involves a slow, continuous rotation of the bed to less than 40 degrees to mobilize secretions and provide postural drainage.
_________ failure occurs when blood exits the heart without participating in gas exchange.
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Shunt
What interventions can help manage excess lung secretions that can result in hypoventilation? (4)
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Turning every 1 to 2 hours, chest physiotherapy to lung areas with high secretions, encourage deep breathing and coughing, and suctioning.
What is permissive hypercapnia in relation to ARDS?
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The elevation in PaCO2 that occurs from using smaller tidal volumes (6 mL/kg) and varying PEEP
How does increased intrathoracic pressure from hyperventilation (a common complication of ARDS-related ventilatory treatment) impact the heart and cardiac output?
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It increases the right ventricle's afterload which limits blood flow from the right side of the heart to the left side of the heart. This decreases cardiac output which decreases blood return to the right side of the heart.
What technique increases SaO2 by slowing respirations, allowing prolonged expiration and preventing small bronchioles from collapsing?
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Pursed lip breathing
Why does pulmonary artery edge pressure remain normal in patients with ARDS?
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The cause of ARDS is non-cardiogenic
_________ is the term for a decreased PaO2 to a level where signs and symptoms are evident.
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Hypoxia
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What determines whether a patient has an acute lung injury (ALI) or ARDS?
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The P/F ratio (PaO2 to FiO2 ratio) which is a measure of the amount of oxygen given to the amount of oxygen in the blood.
What is a normal P/F ratio?
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500 mm Hg
What are three basic characteristics of what is happening with ARDS?
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Inflammation, increased permeability of the alveoli and cytokine activation. Edema formation occurs due to protein pulling fluid into the alveolar spaces.
What should be the first intervention for a patient with secretions blocking their airway?
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Instruct them to cough
What are signs and symptoms of ARDS during the first 24 to 48 hours?
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Dyspnea, tachypnea, dry cough, fatigue, tachycardia, cyanotic or mottled skin, adventitious breath sounds, absent breath sounds, restlessness, confusion, anxiety, bilateral infiltrates, respiratory alkalosis.
What causes the pulmonary edema associated with ARDS?
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The alveolar epithelium is inflamed, cytokines damage it. This leads to proteins leaking from the vascular spaces to the alveolar spaces.
The basic interventions for improving perfusion in ARDS partients are: (3)
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Fluids (crystalloids, colloids, blood transfusions), medications (vasopressors, inotropes), and prone positioning.
Which phase of ARDS? Sparesely collagenous and fibrous lung tissues, decreased lung compliance, decreased surface area for gas exchange, and pulmonary hypertension and fibrosis.
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Fibrotic/Chronic/Late (occurs within 2-3 weeks)
If a patient cannot breathe comfortably unless sitting upright, this would be a sign of _______ respiratory distress (mild, moderate or severe)?
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Severe
If a patient can lie down, but prefers to sit in order to facilitate breathing, this would be a sign of _________ respiratory distress (mild, moderate or severe)?
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Moderate
The most common initial indicator of respiratory failure is?
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Changes in mental status, for example, restlessness, confusion, agitation, combativeness.
  
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