60 Free CNA Practice Exam Questions and Answers on Respiratory Distress
Perfect your exam preparation with 60 Free CNA Practice Exam Questions and Answers on Respiratory Distress now! This is one of the common practice tests for both nursing assistants and students to refine their critical thinking, enhance the essential knowledge and prepare better for their actual exams. Nursing assistant is a position which requires candidates to have entire understanding of nursing process and nursing care. With our following free CNA exam questions and immediate answers, you can absolutely feel self-confident when being asked about respiratory distress. In this test, we cover many specialized terminologies, the stages of respiratory distress and its manifestations in each stage. Practice with this quiz, you will feel extremely comfortable dispite taking a test. So, take a go now to refresh your mind and be ready for all the upcoming exams!
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60 Free CNA Practice Exam Questions and Answers on Respiratory Distress
What do you do if low pressure alarm sounds?
deficient amount of oxygen in the blood; leads to hypoxia if not treated
ARDS lung injury cause ie. shock, burns, severe trauma, ETOH, smoking
ARDS intervention r/t mechanical ventilations (vent. setting)
Check exhaled tidal volume, Check connections, Cuff leak, Check to see that chest is rising/falling.
What are causes of metabolic alkalosis?
AC-assist control, Wean to SIMV, Decrease rate, Trial of CPAP with pressure support, Get baseline ABG's and another set on CPAP if patient is tolerating well, Extubate with respiratory therapist, Place on cool mist mask, then nasal cannula.
ARDS intervention oxygenating blood outside of the body
Excess ingestion of antacids, Excessive administration of NaHCO3, Loss of metabolic acids as with. Vomiting, Lavage (purging), Excessive diuretics.
ARDS intervention r/t mechanical ventilations (vent. setting)
what is Positive end expiratory pressure (PEEP)?
tx of pulm edema to support perfusion by increasing CO
positive End Expiratory Pressure (PEEP): Positive airway pressure throughout exhalation. Keeps airways open at end of expiration. Use to decrease amount of FiO2 needed. Benefits: decreased shunt; improved oxygenation. Complications: barotrauma; decreased cardiac output. PEEP increases intrathorasic pressure and can impinge on the heart, decreasing cardiac output, BP will go down may need vasopressors.
Lower the positive end-expiratory pressure (PEEP).rationale:Because barotrauma is associated with high airway pressures, the level of PEEP should be decreased. The other actions will not decrease the risk for pneumothorax.
ARDS lung injury cause ie. shock, burns, severe trauma, ETOH, smoking
PE
Acute lung injury, most severe form of ARF
resp pharm: maintain fluid balance
reduced oxygenation of arterial blood
common cause of poor perfusion/good ventilation
7-10 days
Fibrotic phase occurs this many weeks after initial insult/injury in ARDS
movement of air in and out of the lungs
Blood test necessary for Dx of Resp Failure
Proliferative phase occurs this many days after initial insult/injury in ARDS
Indirect Trauma
ARDS lung injury cause ie. inhalation of toxins/smoke/chem, aspiration GI, near drowning, PE
movement of air in and out of the lungs
common causes (2) of poor ventilation/good perfusion
ARDS lung injury cause ie. shock, burns, severe trauma, ETOH, smoking
Late
Blood test necessary for Dx of Resp Failure
Alveolar‐capillary membrane injury. Decreased surfactant production-From damage to alveolar type II cells. Leakage of fluid into alveoli- Causing fibrotic changes of the lung parenchema (tissue), Shunting, V/Q mismatch.
Early/Late stage ARDS: alveolar cell damage, decrease surfactant production, diffuse infiltrates
Early/Late stage ARDS: fibrin, blood, fluid, protein exude into interstitial space around alveoli, increase distance across capp. membrane
What is the indicator of failure to ventilate?
Pain, Anxiety, Fever, Asthma, ARDS. These conditions result from hyperventilation. too little CO2
ARDS intervention r/t mechanical ventilations (vent. setting)
PaCO2. Decrease ventilation increases Co2, Increase CO2 causes vasodilation & neurologic changes.
tx of pulm edema to reduce preload and afterload
2,3 DPG
movement of air in and out of the lungs
organic phosphate (diphosphoglycerate) in the RBC that alters the affinity of Hgb for O2
resp pharm: treat infx, help reduce swelling and exudate clogging up airways
consists of three phases: exudative, proliferative, fibrotic
acute respiratory failure assessment
1. level of consciousness (first signs: restlessness, anxiety, confusion)2. distress with labored, irregular breathing3. chest wall retractions4. tachypnea leading to increased pH (alkalosis)5. dyspnea6. crackles/wheezes7. unable to lie flat8. increased sputum, cough, wet lung sounds9. cyanosis (late sign)10. decreased blood pressure11. tachycardia12. anxiety-fear of suffocation and lack of control
early?/late? CMs of hypoxemia: O2 sat drop, restlessness, HTN, dyspnea, Tachypnea, Tachycardia, Mild resp. alkalosis
resp pharm: low dose used in specific cases, used for severe anxiety and restlessness (decrease O2 demand) *must stay with pt
consists of three phases: exudative, proliferative, fibrotic
Which of these nursing actions included in the care of a mechanically ventilated patient with acute respiratory distress syndrome (ARDS) can the RN delegate to an experienced LPN/LVN working in the intensive care unit?
The patient has subcutaneous emphysema.rationale:The subcutaneous emphysema indicates barotrauma caused by positive pressure ventilation and PEEP. Bradycardia, hypoxemia, and bronchial breath sounds are all concerns and will need to be addressed, but they are not indications that PEEP should be reduced.
inserting a pulmonary artery catheter.rationale: Pulmonary artery wedge pressures are normal in the patient with ARDS because the fluid in the alveoli is caused by increased permeability of the alveolar-capillary membrane rather than by the backup of fluid from the lungs (as occurs in cardiogenic pulmonary edema). The other tests will not help in differentiating cardiogenic from noncardiogenic pulmonary edema.
Assess oxygenation using pulse oximetry.rationale: Since agitation and confusion are frequently the initial indicators of hypoxemia, the nurse's initial action should be to assess oxygen saturation. The other actions also are appropriate, but assessment of oxygenation takes priority over other assessments and notification of the health care provider.
Insert a retention catheter rationale: Insertion of retention catheters is included in LPN/LVN education and scope of practice and can be safely delegated to an LPN/LVN who is experienced in caring for critically ill patients. Placing a patient who is on a ventilator in the prone position requires multiple staff and should be supervised by an RN. Assessment of breath sounds and obtaining pulmonary artery pressures require advanced assessment skills and should be done by the RN caring for a critically ill patient.
A patient develops increasing dyspnea and hypoxemia 2 days after having cardiac surgery. To determine whether the patient has acute respiratory distress syndrome (ARDS) or pulmonary edema caused by left ventricular failure, the nurse will anticipate assisting with ____________
Insert a retention catheter rationale:Insertion of retention catheters is included in LPN/LVN education and scope of practice and can be safely delegated to an LPN/LVN who is experienced in caring for critically ill patients. Placing a patient who is on a ventilator in the prone position requires multiple staff and should be supervised by an RN. Assessment of breath sounds and obtaining pulmonary artery pressures require advanced assessment skills and should be done by the RN caring for a critically ill patient.
inserting a pulmonary artery catheter.rationale:Pulmonary artery wedge pressures are normal in the patient with ARDS because the fluid in the alveoli is caused by increased permeability of the alveolar-capillary membrane rather than by the backup of fluid from the lungs (as occurs in cardiogenic pulmonary edema). The other tests will not help in differentiating cardiogenic from noncardiogenic pulmonary edema.
Assess oxygenation using pulse oximetry.rationale:Since agitation and confusion are frequently the initial indicators of hypoxemia, the nurse's initial action should be to assess oxygen saturation. The other actions also are appropriate, but assessment of oxygenation takes priority over other assessments and notification of the health care provider.
The patient has subcutaneous emphysema.rationale:The subcutaneous emphysema indicates barotrauma caused by positive pressure ventilation and PEEP. Bradycardia, hypoxemia, and bronchial breath sounds are all concerns and will need to be addressed, but they are not indications that PEEP should be reduced.
Shunt
ARDS intervention oxygenating blood outside of the body
Acute lung injury, most severe form of ARF
Extreme V/Q mismatch resulting in the blood exiting the heart without O2.
tx of pulm edema to support perfusion by increasing CO
respiratory failure treatment
1. O2 administration2. mobilzation of secretions (effective coughing, incentive spirometry, hydration, airway suctioning)3. positive pressure ventilation (non invasive or intubation)4. drug therapy relief of bronchospasm (albuterol)reduction of airway inflammation (corticosteroids)reduction of pulmonary congestion (lasix)treatment of pulmonary infection (antibiotics)reduction of severe anxiety/pain (benzos and opioids)5. treatment of underlying cause
common cause of poor perfusion/good ventilation
Safeguard the Patient: Ambu bag; functioning suction; check settings/functioning of vent. Psychological Aspects/ Patient Teaching. Physical Activity. Nutrition: 35‐45 kcal/kg/day. Evaluate Bowel Sounds/Record BM. Pain Medication/Sedation. VAP Bundle.
ARDS intervention r/t mechanical ventilations (vent. setting)
Hypoxemic Respiratory Failure
Oxyhemoglobin Shift CMs: shallow breathing, barely responsive, low O2 sat
ARDS lung injury cause ie. shock, burns, severe trauma, ETOH, smoking
PaO2 60mm Hg or less even with supplemental oxygenEx: Pneumonia, Pulmonary emboli, Pulomary edema, alveoli disease, low CO conditions
tx of pulm edema to support perfusion by increasing CO
morphine
movement of air in and out of the lungs
Blood test necessary for Dx of Resp Failure
tx of pulm edema to decreas anxiety
tx of pulm edema to support perfusion by increasing CO
How does acute respiratory failure happen?
V/Q mismatch: Most common cause of low O2, Ratio is about 1 : 1 Ventilation is 4L/min Perfusion is 5L/min 5L/min. Low V/Q ratio produces shunting. High V/Q ratio produces increased dead space.Diffusion defects - Movement of O2 and CO2 across the alveoli‐capillary membrane is impaired.
common causes (2) of poor ventilation/good perfusion
ARDS intervention r/t mechanical ventilations (vent. setting)
common cause of poor perfusion/good ventilation
To evaluate the effectiveness of prescribed therapies for a patient with ventilatory failure, which diagnostic test will be most useful to the nurse?
inserting a pulmonary artery catheter.rationale:Pulmonary artery wedge pressures are normal in the patient with ARDS because the fluid in the alveoli is caused by increased permeability of the alveolar-capillary membrane rather than by the backup of fluid from the lungs (as occurs in cardiogenic pulmonary edema). The other tests will not help in differentiating cardiogenic from noncardiogenic pulmonary edema.
increase the oxygen flow rate.rationale:Increasing oxygen flow rate usually will improve oxygen saturation in patients with ventilation-perfusion mismatch, as occurs with pulmonary embolism. Because the problem is with perfusion, actions that improve ventilation, such as deep-breathing and coughing, sitting upright, and suctioning, are not likely to improve oxygenation.
gentamicin (Garamycin) 60 mg IV rationale:Gentamicin, which is one of the aminoglycoside antibiotics, is potentially nephrotoxic, and the nurse should clarify the drug and dosage with the health care provider before administration. The other medications are appropriate for the patient with ARDS.
Arterial blood gas (ABG) analysis rationale: ABG analysis is most useful in this setting because ventilatory failure causes problems with CO2 retention, and ABGs provide information about the PaCO2 and pH. The other tests also may be done to help in assessing oxygenation or determining the cause of the patient's ventilatory failure.
hypoxemia
movement of air in and out of the lungs
An insufficiency of oxygen in the body's tissues.
ARDS intervention oxygenating blood outside of the body
deficient amount of oxygen in the blood; leads to hypoxia if not treated
antibiotics
tx of pulm edema to support perfusion by increasing CO
Blood test necessary for Dx of Resp Failure
tx of pulm edema to decreas anxiety
resp pharm: treat infx, help reduce swelling and exudate clogging up airways
What is the usual course of ventilation settings?
cause of pulmonary edema not associated with cardiac factors. Ie. lung tumors, near drowning, pneumonia, aspiration, sepsis, inhalation smoke/toxins
AC-assist control, Wean to SIMV, Decrease rate, Trial of CPAP with pressure support, Get baseline ABG's and another set on CPAP if patient is tolerating well, Extubate with respiratory therapist, Place on cool mist mask, then nasal cannula.
tx of pulm edema to support perfusion by increasing CO
ARDS intervention r/t mechanical ventilations (vent. setting)
ARDS
refractory to supplemental O2
5 Ps of ARDS therapy
reduced oxygenation of arterial blood
Acute lung injury, most severe form of ARF
Proliferative
Tx of ARDS which reduces systemic inflammation, increases pulmonary function, decreases duration of mechanical ventilation and SAVES LIVES
phase of ARDS: irreversible deposition of fibrin into lungs (pulm fibrosis, decreased lung compliance), worsening hypoxemia, V/Q imbalance, profound arterial hypoxemia
phase of ARDS: damage of alveolar cells (type I and II), decreased surfactant (atelectasis), hypoxemia, intrapulmonary shunting, V/Q mismatch
phase of ARDS (1,2,3): increased capillary permeability, increased fluid in interstitial spaces (not alveoli), pt becoming symptomatic (anxious, reports of dyspnea)
Lungs (& chest)
Primary Function = get O2 from the air that is inhaled into the bloodstream, simultaneously eliminating CO2 from the blood through exhaled air.
An insufficiency of oxygen in the body's tissues.
Proliferative phase occurs this many days after initial insult/injury in ARDS
Extreme V/Q mismatch resulting in the blood exiting the heart without O2.
ARDS treatment
common causes (2) of poor ventilation/good perfusion
1. O2 administration2. mobilzation of secretions (effective coughing, incentive spirometry, hydration, airway suctioning)3. positive pressure ventilation (non invasive or ntubation)4. drug therapy relief of bronchospasm (albuterol)reduction of airway inflammation (corticosteroids)reduction of pulmonary congestion (lasix)treatment of pulmonary infection (antibiotics)reduction of severe anxiety/pain (benzos and opioids)5. treatment of underlying cause
1. O2 administration2. prone position3. lateral rotation therapy4. positive pressure ventilation with PEEP5. permissive hypercapnia6. alternative modes of mechanical ventilation7. treatment of underlying cause8. hemodynamic monitoring9. medications: inotropic/vasopressor meds (dopamine, dobutamine, norepinephrine), diuretics, IV fluids, sedation/analgesia, neuromuscular blockade
PaO2:FiO2 ratio (Acute Lung Injury calculation) indicating severe hypoxemia
When admitting a patient in possible respiratory failure with a high PaCO2, which assessment information will be of most concern to the nurse?
The patient's PaO2 is 45 mm Hg.rationale:The PaO2 indicates severe hypoxemia and respiratory failure. Rapid action is needed to prevent further deterioration of the patient. Although the shallow breathing, rapid respiratory rate, and low PaCO2 also need to be addressed, the most urgent problem is the patient's poor oxygenation.
The patient has subcutaneous emphysema.rationale:The subcutaneous emphysema indicates barotrauma caused by positive pressure ventilation and PEEP. Bradycardia, hypoxemia, and bronchial breath sounds are all concerns and will need to be addressed, but they are not indications that PEEP should be reduced.
The patient is somnolent.rationale:Increasing somnolence will decrease the patient's respiratory rate and further increase the PaCO2 and respiratory failure. Rapid action is needed to prevent respiratory arrest. An SpO2 of 90%, weakness, and elevated blood pressure all require ongoing monitoring but are not indicators of possible impending respiratory arrest.
increase the oxygen flow rate.rationale:Increasing oxygen flow rate usually will improve oxygen saturation in patients with ventilation-perfusion mismatch, as occurs with pulmonary embolism. Because the problem is with perfusion, actions that improve ventilation, such as deep-breathing and coughing, sitting upright, and suctioning, are not likely to improve oxygenation.
2
Oxyhemoglobin Shift CMs: shallow breathing, barely responsive, low O2 sat
phase of ARDS (1,2,3): increased capillary permeability, increased fluid in interstitial spaces (not alveoli), pt becoming symptomatic (anxious, reports of dyspnea)
tx of pulm edema to reduce preload and afterload
phase of ARDS: irreversible deposition of fibrin into lungs (pulm fibrosis, decreased lung compliance), worsening hypoxemia, V/Q imbalance, profound arterial hypoxemia
hypoxia
tx of pulm edema to decreas anxiety
An insufficiency of oxygen in the body's tissues.
common causes (2) of poor ventilation/good perfusion
5 Ps of ARDS therapy
ARDS
ARDS lung injury cause ie. shock, burns, severe trauma, ETOH, smoking
most common causes = sepsis (capillary basement membrane damage), GI aspiration (alveolar endothelial damage)
common cause of poor perfusion/good ventilation
Oxyhemoglobin Shift CMs: shallow breathing, barely responsive, low O2 sat
<200
ARDS intervention r/t mechanical ventilations (vent. setting)
PaO2:FiO2 ratio (Acute Lung Injury calculation) indicating severe hypoxemia
common causes (2) of poor ventilation/good perfusion
tx of pulm edema to support perfusion by increasing CO
severe acute respiratory syndrome
resp pharm: treat infx, help reduce swelling and exudate clogging up airways
common cause of poor perfusion/good ventilation
SARS; acute resp infection caused by coronavirus (CoV). Spread by close contact via droplets-Symptoms: fever, sore throat, rhinorhea, chills, rigors, diarrhea, HA, body aches, progressive resp changes (dry cough advances to difficulty breathing)-Treatment: isolation, antiviral, corticosteriods- ARDS lung injury cause ie. shock, burns, severe trauma, ETOH, smoking
PaO2 < 50 mmHg
ARDS intervention r/t mechanical ventilations (vent. setting)
common causes (2) of poor ventilation/good perfusion
Blood test necessary for Dx of Resp Failure
A patient with acute respiratory distress syndrome (ARDS) who is intubated and receiving mechanical ventilation develops a pneumothorax. Which action will the nurse anticipate taking?
The patient has subcutaneous emphysema.rationale:The subcutaneous emphysema indicates barotrauma caused by positive pressure ventilation and PEEP. Bradycardia, hypoxemia, and bronchial breath sounds are all concerns and will need to be addressed, but they are not indications that PEEP should be reduced.
Lower the positive end-expiratory pressure (PEEP).rationale:Because barotrauma is associated with high airway pressures, the level of PEEP should be decreased. The other actions will not decrease the risk for pneumothorax.
endotracheal intubation and positive pressure ventilation.rationale:The patient's lethargy, low respiratory rate, and SpO2 indicate the need for mechanical ventilation with ventilator-controlled respiratory rate. Administration of high flow oxygen will not be helpful because the patient's respiratory rate is so low. Insertion of a mini-tracheostomy will facilitate removal of secretions, but it will not improve the patient's respiratory rate or oxygenation. BiPAP requires that the patient initiate an adequate respiratory rate to allow adequate gas exchange.
The patient's PaO2 is 90 mm Hg, and the SaO2 is 92%.rationale:The purpose of prone positioning is to improve the patient's oxygenation as indicated by the PaO2 and SaO2. The other information will be collected but does not indicate whether prone positioning has been effective.
What are clinical manifestations of ARDS?
Sudden and progressive pulmonary edema (non cardiogenic), Increasing bilateral infiltrates ("white‐out" on chest x‐ray). Severe dyspnea, accessory muscles, retractions. Hypoxemia refractory to supplemental O2. Reduced lung compliance (stiff lungs). Change in mentation (agitation, restless), Tachypnea, tachycardia.
phase of ARDS (1,2,3): increased capillary permeability, increased fluid in interstitial spaces (not alveoli), pt becoming symptomatic (anxious, reports of dyspnea)
phase of ARDS (1,2,3): full pulmonary edema, massive inflammatory response, damage to basement membrane and alveolar epithelium, increased chasm between capp membrane and alveoli
tx of pulm edema to decreas anxiety
Hypercapnic Respiratory Failure
tx of pulm edema to reduce preload and afterload
consists of three phases: exudative, proliferative, fibrotic
The patient's respiratory rate has decreased from 30 to 10 breaths/min.rationale:A decrease in respiratory rate in a patient with respiratory distress suggests the onset of fatigue and a high risk for respiratory arrest. Therefore immediate action such as positive pressure ventilation is needed. Patients who are experiencing respiratory distress frequently sit in the tripod position because it decreases the work of breathing. Crackles in the lung bases may be the baseline for a patient with COPD. An oxygen saturation of 91% is common in patients with COPD and will provide adequate gas exchange and tissue oxygenation.
INCREASED CO2 (greater than 45mm Hg) and DECREASED pH (less than 7.35), Telling us it's a VENTILATION problem, pt either not breathing enough or has an airtrapping diagnosis such as asthma or COPD
High Frequency Ventilation
ARDS intervention r/t mechanical ventilations which combines very high respiratory rates (>60 breaths per minute) with tidal volumes that are smaller than the volume of anatomic dead space
ARDS intervention oxygenating blood outside of the body
common causes (2) of poor ventilation/good perfusion
ARDS lung injury cause ie. shock, burns, severe trauma, ETOH, smoking
What are failed weaning parameters?
RR > 30 or < 8 bpm, Changes in HR and BP, Declining O2 Sat, Dysrhythmias, Decrease in spontaneous tidal volume, Labored respirations, Decreased LOC. If these symptoms occur, place back on previous ventilator settings. Sometimes patients are weaned during the day and placed back on vent to rest during the night.
consists of three phases: exudative, proliferative, fibrotic
ARDS lung injury cause ie. shock, burns, severe trauma, ETOH, smoking
Lethargy, Kussmal breathing pattern, Diaphoresis, Use of accessory muscles, Decreased breath sounds.
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.rationale:The patient should be positioned with the "good" lung in the dependent position to improve the match between ventilation and perfusion. The obese patient's abdomen will limit respiratory excursion when sitting in the high-Fowler's or tripod positions.
Insert a retention catheter rationale:Insertion of retention catheters is included in LPN/LVN education and scope of practice and can be safely delegated to an LPN/LVN who is experienced in caring for critically ill patients. Placing a patient who is on a ventilator in the prone position requires multiple staff and should be supervised by an RN. Assessment of breath sounds and obtaining pulmonary artery pressures require advanced assessment skills and should be done by the RN caring for a critically ill patient.
Arterial blood gas (ABG) analysis rationale:ABG analysis is most useful in this setting because ventilatory failure causes problems with CO2 retention, and ABGs provide information about the PaCO2 and pH. The other tests also may be done to help in assessing oxygenation or determining the cause of the patient's ventilatory failure.
Oxygen saturation 99% rationale: The FIO2 of 80% increases the risk for oxygen toxicity. Since the patient's O2 saturation is 99%, a decrease in FIO2 is indicated to avoid toxicity. The other patient data would be typical for a patient with ARDS and would not need to be urgently reported to the health care provider.
What are complications of mechanical ventilation?
An insufficiency of oxygen in the body's tissues.
Barotrauma: Presence of extra alveolar air. PTX - air in pleural space, Subcutaneous emphysema (crepitus). Signs and symptoms: Decreased breath sounds, Tracheal deviation, Hypoxemia. Cardiovascular: Decreased cardiac output. Tension Pneumothorax, Pressurized air enters pleural space, Disconnect from vent, manually ventilate with bag-valve (ambu bag), prepare for chest tube insertion. Fluid Retention‐ Caused by decreased CO; renin‐angiotensin‐aldosterone system; vent humidification. Oxygen Toxicity‐ Prolonged FIO2 > 50%.
ARDS intervention r/t mechanical ventilations (vent. setting)
SARS; acute resp infection caused by coronavirus (CoV). Spread by close contact via dropletsSymptoms: fever, sore throat, rhinorhea, chills, rigors, diarrhea, HA, body aches, progressive resp changes (dry cough advances to difficulty breathing)Treatment: isolation, antiviral, corticosteriods
hypercapnia
reduced oxygenation of arterial blood
5 Ps of ARDS therapy
resp pharm: maintain fluid balance
PaCO2 > 50 mmHg
What are parameters for weaning a patient off a ventilator?
ARDS intervention r/t mechanical ventilations (vent. setting)
tx of pulm edema to reduce preload and afterload
The patient's respiratory rate has decreased from 30 to 10 breaths/min.rationale:A decrease in respiratory rate in a patient with respiratory distress suggests the onset of fatigue and a high risk for respiratory arrest. Therefore immediate action such as positive pressure ventilation is needed. Patients who are experiencing respiratory distress frequently sit in the tripod position because it decreases the work of breathing. Crackles in the lung bases may be the baseline for a patient with COPD. An oxygen saturation of 91% is common in patients with COPD and will provide adequate gas exchange and tissue oxygenation.
Underline problem is starting to resolve, Improved CXR, Normal breath sounds, Clear secretions, Hemodynamic stability: RR < 25 bpm, Spontaneous tidal volume 4 - 5ml/kg. Adequate ABG's: PaO2 > 60 mmHg on FiO2 < 50%, PaCO2 < 45 mmHg, PEEP < 5 cm H2O. Assess LOC: Stop sedation, paralytics. Assess nutritional status-albumin, prealbumin. Determine patients readiness to wean. Do you want to check the Hgb?
Alveolar Hypoventilation
ARDS lung injury cause ie. shock, burns, severe trauma, ETOH, smoking
cause of ventilatory failure characterized by decreased CNS drive or mechanical disruptions
clinical manifestation, not a diagnosis, r/t difficulty breathing
Increased Hgb affinity to O2, occurs with increased pH, decreased pCO2, temp and 2,3 DPG.
Methylprednisone
tx of pulm edema to decreas anxiety
tx of pulm edema to support perfusion by increasing CO
A patient can be hypoxic without being hypoxemic and pulse ox only measures the blood saturation of O2 to hemoglobin. Post-op hypoxia is typically caused by a pneumothorax or pulmonary embolism. When a patient suddenly becomes agitated, uncooperative, or behaves differenet from baseline suspect hypoxia.
Tx of ARDS which reduces systemic inflammation, increases pulmonary function, decreases duration of mechanical ventilation and SAVES LIVES
ARDS
resp pharm: maintain fluid balance
consists of three phases: exudative, proliferative, fibrotic
tx of pulm edema to decreas anxiety
common cause of poor perfusion/good ventilation
shift to the left
Increased Hgb affinity to O2, occurs with increased pH, decreased pCO2, temp and 2,3 DPG.
Extreme V/Q mismatch resulting in the blood exiting the heart without O2.
INCREASED CO2 (greater than 45mm Hg) and DECREASED pH (less than 7.35), Telling us it's a VENTILATION problem, pt either not breathing enough or has an airtrapping diagnosis such as asthma or COPD
Acute lung injury, most severe form of ARF
Non-cardiogenic
tx of pulm edema to decreas anxiety
cause of ventilatory failure characterized by decreased CNS drive or mechanical disruptions
cause of pulmonary edema not associated with cardiac factors. Ie. lung tumors, near drowning, pneumonia, aspiration, sepsis, inhalation smoke/toxins
tx of pulm edema to reduce preload and afterload
Hypoxemic
resp failure characterized by diffusion abnormalities (ie. pneumonia, secretions, atelectasis, pulmonary edema).
ARDS lung injury cause ie. shock, burns, severe trauma, ETOH, smoking
resp failure characterized by a rise in Paco2 (hypercapnia) that occurs when the respiratory load can no longer be supported by the strength or activity of the system
cause of ventilatory failure characterized by decreased CNS drive or mechanical disruptions
A patient with chronic obstructive pulmonary disease (COPD) arrives in the emergency department complaining of shortness of breath and dyspnea. Which assessment finding by the nurse is most important to report to the health care provider?
The patient's respiratory rate has decreased from 30 to 10 breaths/min.rationale:A decrease in respiratory rate in a patient with respiratory distress suggests the onset of fatigue and a high risk for respiratory arrest. Therefore immediate action such as positive pressure ventilation is needed. Patients who are experiencing respiratory distress frequently sit in the tripod position because it decreases the work of breathing. Crackles in the lung bases may be the baseline for a patient with COPD. An oxygen saturation of 91% is common in patients with COPD and will provide adequate gas exchange and tissue oxygenation.
Acute lung injury, most severe form of ARF
"PEEP prevents the lung air sacs from collapsing during exhalation."rationale:By preventing alveolar collapse during expiration, PEEP improves gas exchange and oxygenation. PEEP will not prevent the fibrotic changes that occur with ARDS, push more air into the lungs, or change the fraction of inspired oxygen (FIO2) delivered to the patient.
A patient with septicemia who has intercostal and suprasternal retractions rationale:This patient's history of septicemia and labored breathing suggest the onset of ARDS, which will require rapid interventions such as administration of oxygen and use of positive pressure ventilation. The other patients also should be assessed as quickly as possible, but their assessment data are typical of their disease processes and do not suggest deterioration in their status.
What is a volume targeted ventilator?
movement of air in and out of the lungs
Ventilator is set to allow air to flow until a preset tidal volume is delivered. Commonly used in ICU today.
deficient amount of oxygen in the blood; leads to hypoxia if not treated
Ventilator allows air to flow into lungs until a preset pressure is achieved. Tidal volumes may vary with each breath. Increased risk of hypoventilation.
remember that pulse ox has limitations
ARDS intervention oxygenating blood outside of the body
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