ARDS DSMs

A pregnant woman at 37 weeks of gestation has been diagnosed with acute respiratory distress syndrome (ARDS) after having pneumonia. The patient wants to know how this will affect her delivery date. Which response by the nurse is appropriate?

"We'll monitor the baby very closely, and that will help us determine the best time for delivery." Rationale: Close fetal monitoring is essential when caring for a pregnant patient with ARDS and can help to determine the best time to deliver. Delivery does not appear to resolve the symptoms of ARDS but can improve outcomes for the fetus (due to the potential for compromised placental oxygen transfer). A cesarean section would not be planned. Information regarding the risk factors, incidence, and mortality of ARDS across the lifespan include the following: People of any age can get ARDS, though older adults over the age of 70 are at higher risk. Older adults also have a higher mortality rate. There is a relatively low rate of ARDS in children, though the disease is most commonly caused by pneumonia, aspiration, trauma, near-drowning, and systemic infection. ARDS is rare in pregnant women, though there is a significant mortality rate among women who do get the disease.

The nurse is caring for four patients on the unit. Which patient should the nurse consider to be at highest risk for developing acute respiratory distress syndrome (ARDS)?

A 72-year-old man with a history of liver failure who became septic after pneumonia Rationale: People over the age of 70 have the highest rate of mortality following ARDS, with sepsis being the most common cause. Liver failure and a prior respiratory infection are also risk factors for ARDS. Even though the 65-year-old woman who is currently taking a tricyclic antidepressant has not overdosed, this is what increases the risk. While having a blood transfusion also increases the risk, the patient is a young woman and is at lower risk than the older man. Risk factors for ARDS include: Pulmonary injury or infection due to Aspiration of gastric contents. Inhalation injuries (smoke inhalation, saltwater inhalation from near-drowning). Body sepsis. Trauma. Gastrointestinal infection. Drug overdose (especially tricyclic antidepressants). Multiple blood transfusions. Being immunocompromised. History of chronic liver failure. Smoking. Exposure to high levels of air pollution.

A patient is scheduled to receive a tracheostomy. The patient's family wants to know how the procedure will be carried out. Which statement should the nurse include in the explanation?

A tube is inserted through the neck and into the trachea for long-term airway support Rationale:

The nurse is planning care for a patient with acute respiratory distress syndrome (ARDS). Which nursing diagnosis is the priority for the nurse to initiate?

Airway clearance, ineffective Rationale:

The nurse is developing new protocols to reflect updated pediatric acute respiratory distress syndrome (ARDS) guidelines. Which instruction should the nurse include?

Avoidance of intubattion, except in certain patients Rationale: New pediatric ARDS guidelines advise against intubation, except in patients with worsening ARDS who do not respond to other treatments. The guidelines also advise against routine administration of exogenous surfactant, inhaled nitric oxide, and prone positioning. Physiologic differences between children and adults that make treating ARDS more difficult in children include: More compliant chest walls. Higher sedation requirements. Higher baseline airway resistance. Lower hematocrit. Lower functional residual capacity.

A patient is to begin the process of being weaned off of mechanical ventilation. Which time does the nurse consider as appropriate to begin the procedure?

8am Rationale: It is best to begin weaning procedures early in the morning when the patient is well rested and alert. It is possible to discontinue weaning overnight to promote rest, which is an important part of the process. A T-piece, or "blow-by," unit for weaning from mechanical ventilation is shown in the image below. When weaning a patient off of mechanical ventilation, nursing interventions include: Monitoring vital signs every 15 to 30 minutes following changes in ventilator settings and during T-piece trials. Placing the patient in high Fowler or Fowler position. Explaining the procedure to the family and the patient. Remaining with the patient during the initial changes in ventilator settings to provide reassurance and for close monitoring. Limiting procedures and activities during weaning periods. Providing diversion. Keeping oxygen at the bedside Providing pulmonary hygiene with percussion and postural drainage.

A patient is admitted with aspiration pneumonia. Which independent nursing intervention is most appropriate to decrease the risk of developing acute respiratory distress syndrome?

Elevating the head of the bed when the patient is ingesting food Rationale:

A patient is suspected of having acute respiratory distress syndrome (ARDS). The patient wants to know about the tests that the nurse plans to conduct. Which diagnostic test should the nurse include in the response?

Chest x-ray Rationale: A chest x-ray can help to visualize infiltrates or fluid in the lungs, and can be used to assist in the diagnosis of ARDS. V-Q scans can diagnose pulmonary emboli, not ARDS. Pulmonary function scans can diagnose asthma. Capnography can diagnose chronic obstructive pulmonary disease.

A patient is receiving mechanical ventilation to treat acute respiratory distress syndrome (ARDS) and sepsis following pneumonia. Which factor should the nurse monitor to ensure fluid balance?

Daily weights Rationale: To monitor fluid balance, the nurse should monitor daily weights. Serum hemoglobin and albumin levels do not provide information about fluid status. Oxygen saturation gives information about perfusion, not fluid status.

An older adult patient is diagnosed with pneumonia and sepsis. The patient's arterial blood gas (ABG) results indicate a complication of acute respiratory distress syndrome (ARDS). Which ABG result should the nurse expect?

Decrease PaO2 and increased PaCO2 Rationale:

The nurse is caring for a patient who is receiving tube feedings via a nasogastric tube. Which intervention can decrease the risk of this patient developing acute respiratory distress syndrome (ARDS)?

Elevating the head of the bed during feedings Rationale:

The nurse is assessing a patient who is anxious and does not seem to know where they are. The patient's respiratory rate is 27 breaths/min and pulse oximetry is 85%. Which condition should the nurse suspect?

Hypoxemia Rationale: Anxiety, agitation, and confusion are all early signs of hypoxemia, especially in the older adult. The nurse should perform a focused assessment that includes lung auscultation, vital signs, and oxygen saturation. These clinical signs are not associated with infection, electrolyte imbalance, or impaired skin integrity. When performing a health history, the nurse must ask about: Previous respiratory alterations. Previous illnesses and surgeries. Any illness and direct or indirect injury in the past 3-4 days.

The nurse is caring for a patient who is diagnosed with sepsis. Which clinical finding indicates that the patient may be experiencing acute respiratory distress syndrome (ARDS)?

Hypoxemia Rationale: Hypoxemia is a clinical manifestation of ARDS. The fever is related to the sepsis. Cough is not a clinical manifestation of ARDS. Tachycardia, not bradycardia, is a clinical manifestation of ARDS. Clinical manifestations of ARDS include: Dyspnea. Tachypnea. Intercostal retractions. Accessory muscle use. Tachycardia. Cyanosis. Changes in mental status. Agitation Confusion Lethargy

The nurse is preparing to discharge a patient who is recovering from acute respiratory distress syndrome (ARDS). Which patient statement indicates understanding of the routine vaccinations that are recommended for patients recovering from ARDS?

I should contact my primary healthcare provider for a pneumonia and influenza shot Rationale:

The nurse is caring for a pregnant woman who is at 37 weeks of gestation and has been diagnosed with acute respiratory distress syndrome (ARDS) after getting the flu. Which order for this patient should the nurse question?

Place the patient in the prone position Rationale: While placing a pregnant woman in the prone position may help her breathe a little bit better, it can also be dangerous for a very pregnant woman due to the risk of inadequate blood flow to the placenta and baby. Nutritional and ventilatory support are essential when caring for a pregnant woman with ARDS. Nitric oxide and corticosteroids can be administered to pregnant women. Pregnant women rarely get ARDS, but there is an increased maternal mortality rate when pregnant women do get the disease. Obstetric causes include: Preeclampsia. Amniotic fluid embolism. Obstetric hemorrhage. Sepsis. infection of the uterus, fetal membranes, or kidneys.

The nurse is caring for a patient diagnosed with acute respiratory distress syndrome (ARDS) and places them into a prone position. The patient wants to know the reason for this change of position. Which response by the nurse is correct?

Prone positioning helps to improve oxygenation Rationale: The nurse explains that placing the patient into a prone position will help to improve oxygenation. Prone positioning does not help to avoid fluid imbalances or prevent thrombophlebitis. The nurse does not place the patient in the prone position just to make the patient comfortable. Nursing interventions for enhancing oxygenation include: Providing analgesia, anxiolytics, and sedation medications as ordered. Providing beta agonists to maintain patent airway as ordered. Suctioning the airway as needed. Performing chest percussion, vibration, and postural drainage (PVD) as ordered. Ensuring that the endotracheal or tracheostomy tubes are secured.

The nurse notes that a patient with acute respiratory distress syndrome (ARDS) has sustained alveolar collapse, and respiratory acidosis is developing. Which event in the pathophysiology of ARDS should the nurse expect next if the patient receives no airway support?

Respiratory failure Rationale: Respiratory acidosis is a step in the end stage of ARDS. The next step in the pathophysiology of ARDS is respiratory failure, so that is what the nurse would expect to happen to the patient if they do not receive respiratory support. Hyaline membranes form before respiratory acidosis occurs. The nurse would not expect surfactant to be lost or fluid to enter the alveoli at this stage because these are steps in the pathophysiology of alveolar collapse, which has already occurred. As ARDS progresses, the following events occur: Tissue hypoxia Impaired carbon dioxide exchange and oxygen exchange leading to combined respiratory and metabolic acidosis Sepsis and multiple organ system dysfunction of the kidneys, liver, gastrointestinal tract, central nervous system, and cardiovascular system, which are the leading causes of death If the process is halted before sepsis or organ system dysfunction occurs, the long-term prognosis for recovery is good.

The nurse is helping an older adult patient with acute respiratory distress syndrome (ARDS) plan the menu for the next day. Which meal option should the nurse recommend for this patient?

Salmon with an olive oil pesto and steamed vegetables

A 73-year-old patient presents to the emergency department with worsening productive cough and shortness of breath. The nurse notes a respiratory rate of 28 breaths/min. Which laboratory test should the nurse anticipate the healthcare provider to order?

Sputum culture Rationale: A sputum culture can help identify the exact organism causing the patient's infection, as well as the appropriate antibiotic to treat the infection. Much of acute respiratory distress syndrome (ARDS) prevention involves identifying and preventing the risk factors for ARDS and initiating timely interventions. Pulmonary infections, such as pneumonia and influenza, are a direct insult to lung tissue. Complete blood count, urine culture, and serum electrolytes are not relevant for this patient's respiratory infection. Diagnostic tests that can be used to identify patients with ARDS include: Arterial blood gas (ABG) analysis. Chest x-ray or computerized tomography (CT) scan. Blood testing. Complete blood count (CBC) Blood chemistry Blood culture Sputum culture and sensitivity.

The nurse is assessing a patient who has been receiving mechanical ventilation and notes a crackling sensation in the skin on top of the clavicles. Which condition should the nurse suspect in the patient?

Subcutaneous emphysema Rationale: Subcutaneous emphysema is air in the subcutaneous tissues and is the result of barotrauma associated with mechanical ventilation. It causes a crackling sensation on palpation over the chest, neck, or face. Pneumothorax occurs when air escapes into the pleural space. Pneumomediastinum is the presence of air in the mediastinum. Atelactasis is the collapse of a lung. Pneumothorax, acute bronchiolosis, and atelectasis do not cause the crackling sensation felt on palpation over the chest and neck.

The nurse is teaching a patient who is about to be discharged after having acute respiratory distress syndrome (ARDS). Which action by the patient indicates successful teaching?

The patient verbalized the need to avoid secondhand smoke Rationale:

The nurse is teaching a colleague about acute respiratory distress syndrome (ARDS). Which etiology is related to infection and is appropriate for the nurse to include?

Viral pneumonia Rationale:

An older adult patient is intubated due to respiratory failure. The patient's daughter asks how their father will be fed while on the ventilator. Which response should the nurse provide?

We willl provide nutrition through a feeding tube Rationale: Nutrition is important when a patient is receiving mechanical ventilation to promote healing. However, an endotracheal tube prevents the patient from eating normally. A feeding tube is placed to provide enteral nutrition for the patient. Intravenous nutrition would not be used unless the patient is not tolerating feeding via the tube.