Acute Respiratory Distress Syndrome

Which complication is associated with mechanical ventilation? A. gastrointestinal hemorrhage B. immunosuppression C. increased cardiac output D. pulmonary emboli

A Gastrointestinal hemorrhage occurs in about 25% of clients receiving prolonged mechanical ventilation because of the development of stress ulcers. Clients who are receiving steroid therapy and those with a previous hx of ulcers are most likely to be at risk. Other possible complications include incorrect ventilation, oxygen toxicity, fluid imbalance, decreased cardiac output, pneumothorax, infection and atelectasis.

A client, diagnosed with acute pancreatitis 5 days ago, is experiencing respiratory distress. Which finding should the nurse report to the healthcare provider? A. Arterial oxygen level of 46 mm Hg (6.1 kPa) B. respirations of 12 breaths/min C. lack of adventitious lung sounds D. Oxygen saturation of 96% on room air

A Manifestations of ARDS secondary to acute pancreatitis include respiratory distress, tachypnea, dyspnea, fever, dry cough, fine crackles heard throughout lung fields, possible confusion and agitation and hypoxemia with arterial oxygen level below 50 mm Hg. The nurse should report the arterial oxygen level of 46 to the HCP. A respiratory rate of 12 is normal and not considered a sign of respiratory distress. Adventitious lung sounds such as crackles, are typically found in clients with ARDS. Oxygen saturation of 96% is satisfactory and does not represent hypoxemia or low arterial oxygen saturation.

A client with acute respiratory distress syndrome (ARDS) is on a ventilator. The client's peak inspiratory pressures and spontaneous respiratory rate are increasing, and the PO2 is not improving. Using the SBAR technique for communication, the nurse calls the healthcare provider with the recommendation for: A. initiating IV sedation B. starting a high-protein diet C. providing pain medication D. increasing the ventilator rate

A The client may be fighting the ventilator breaths. Sedation is indicated to improve compliance with the ventilator in an attempt to lower peak inspiratory pressures. The workload of breathing does indicate the need for increase protein calories; however, this will not correct the respiratory rate. There is no indication that the client is experiencing pain. Increasing the rate on the ventilator is not indicated with the client's increased spontaneous rate.

A client with acute respiratory distress syndrome (ARDS) has fine crackles at lung bases, and the respirations are shallow at a rate of 28 breaths/ min. The client is restless and anxious. In addition to monitoring the arterial blood gas results, what should the nurse do? Select all that apply. A. monitor serum creatinine and blood urea nitrogen levels. B. administer a sedative. C. Keep the head of the bed flat. D. Administer humidified oxygen. E. Auscultate the lungs.

A, D, E Acute respiratory distress syndrome (ARDS) may cause renal failure and superinfection, so the nurse should monitor urine output and urine chemistries. Treatment of hypoxemia can be complicated because changes in lung tissue leave less pulmonary tissue available for gas exchange, thereby causing inadequate perfusion. Humidified oxygen may be one means of promoting oxygenation. The client has crackles in the lung bases, so the nurse should continue to assess breath sounds. Sedatives should be used with caution in clients with ARDS. The nurse should try other measures to relieve the client's restlessness and anxiety. The head of the bed should be elevated to 30 degrees to promote chest expansion and prevent atelectasis

Which action should the nurse anticipate in a client who has been diagnosed with acute respiratory distress syndrome (ARDS)? A. tracheostomy B. use of a nasal cannula C. mechanical ventilation D. insertion of a chest tube

C Endotracheal intubation and mechanical ventilation are required for ARDS to maintain adequate respiratory support. Endotracheal intubation, not a tracheostomy, is usually the initial method of maintaining an airway. The client requires mechanical ventilation; nasal oxygen will not provide adequate oxygenation. Chest tubes are used to remove air or fluid form intrapleural spaces.

Which nursing interventions would be most likely to prevent the development of acute respiratory distress syndrome (ARDS)? A. teaching cigarette smoking cessation B. maintaining adequate serum potassium levels C. monitoring the clients for signs of hypercapnia D. replacing fluids adequately during hypovolemic states

D One of the major risk factors for developing ARDS is hypovolemic shock. Adequate fluid replacement is essential to minimize the risk of ARDS in these clients. Teaching smoking cessation does not prevent ARDS. An abnormal serum potassium level and hypercapnia are not risk factors for ARDS.

Which assessment is most appropriate for determining the correct placement of an endotracheal tube in a mechanically ventilated client? A. assessing the client's skin color B. monitoring the respiratory rate C. verifying the amount of cuff inflation D. auscultating breath sounds bilaterally

D Auscultation for bilateral breath sounds is the most appropriate method for determining cuff placement. The nurse should also look for the symmetrical rise and fall the the chest and should note the location of the exit mark on the tube. Assessments of skin color, respiratory rate, and the amount of cuff inflation cannot validate the placement of the ET Tube.

To improve the oxygenation of a client with acute respiratory distress syndrome (ARDS) who is receiving mechanical ventilation, the nurse should place the client in which position? A. supine B. semi-Fowler's C. Lateral side D. prone

D Prone positioning is used to improve oxygenation in clients with ARDS who are receiving mechanical ventilation. The positioning allows for recruitment of collapsed alveolar units, improvement in ventilation, reduction in shunting, mobiliation of secretions, and improvement in functional reserve capacity (FRC). When the client is supine, side-to-side repositioning should be done every 2 hours with the head of the bed elevated at least 30 degrees.

A confused client with carbon monoxide poisoning experiences dizziness when ambulating to the bathroom. The nurse should: A. put all four side rails up on the bed B. ask the UAP to place restraints on the client's upper extremities C. request that the client's roommate put the call light on when the client is attempting to get out of bed D. Check on the client at regular intervals to ascertain the need to use the bathroom

D confusion and vertigo are risk factors for falls. Measures must be taken to minimize the risk of injury. The RN or UAP should check on the client regularly to determine needs regarding elimination. Restraints, include bed rails and extremity restraints, should be used only to ensure the person's safety or the safety of others, and there must be a written prescription from a HCP before using them. The nurse should never ask the roommate of a client to be responsible for the client's safety.

Which condition can place a client at risk for acute respiratory distress syndrome (ARDS)? A. septic shock B. chronic obstructive pulmonary disease C. asthma D. heart failure

A The two risk factors most commonly associated with the development of ARDS are gram-negative septic shock and gastric content aspiration. Nurses should be particularly vigilant in assessing a client for onset of ARDS if the client has experienced direct lung trauma or a systemic inflammatory response syndrome. COPD, asthma, and HF are not direct causes of ARDS.

The nurse interprets which finding as an early sign of acute respiratory distress syndrome (ARDS) in a client at risk? A. elevated carbon dioxide level B. hypoxia not responsive to oxygen therapy C. metabolic acidosis D. sever, unexplained electrolyte imbalance

B A hallmark of early ARDS is refractory hypoxemia. The client's PaO2 level continues to fall, despite higher concentrations of administered oxygen. Elevated carbon dioxide and metabolic acidosis occur late in the disorder. Severe electrolyte imbalances are not indicators of ARDS.

A client with acute respiratory distress syndrome (ARDS) is showing sings of increased dyspnea. The nurse reviews a report of blood gas values that recently arrived (See report). pH 7.35 PaCO2 25 mm Hg (3.3 kPa) Hco3 22 mEq/L (22mmol/L) PaO2 95 mm Hg (12.6 kPa) Which finding is abnormal? A. pH B. PaCO2 C. HCO3 D. PaO2

B The normal range for PaCO2 is 35-45. Thus, this client's PaCO2 level is low. The client is experience respiratory alkalosis (carbonic acid deficit) due to hyperventilation. The nurse should report this finding to the HCP because it requires intervention. The increase in ventilation decrease the PaCO2 level, which leads to decreased carbonic acid and alkalosis. The bicarbonate level is normal in uncompensated respiratory alkalosis along with the normal PaO2 level. Normal serum pH is 7.35-7.45; in uncompensated respiratory alkalosis, the serum pH is >7.45

The nurse has placed the intubated client with Acute Respiratory Distress Syndrome (ARDS) in prone position for 30 minutes. Which factors would require the nurse to discontinue prone positioning and return the client to the supine position? Select all that apply. A. The family is coming to visit. B. The client has increased secretions requiring frequent suctioning C. The SpO2 and Po2 have decreased. D. The client is tachycardic with drop in blood pressure. E. The face has increased skin breakdown and edema.

C, D, E The prone position is used to improve oxygenation, ventilation and perfusion. The importance of placing clients with ARDS in prone positioning allows for mobilization of secretions, and the nurse can provide suctioning. Clinical judgement must be used to determine the length of time in prone position. If the client's hemodynamic status, oxygenation or kin is compromised, the client should be returned to the supine position for evaluation. Facial edema is expected with the prone position, but the skin breakdown is of concern.

To promote effective airway clearance in a client with acute respiratory distress, what should the nurse do? A. administer oxygen every 2 hours B. turn the client every 4 hours C. administer sedatives to promote rest D. suction if cough is ineffective

D The nurse should suction the client if the client is not able to cough up secretions and clear the airway. Administering oxygen will not promote airway clearance. The client should be turned q2h to help move secretions; q4h is not often enough. Administering sedatives to promote rest is contraindicated in ARDS because sedatives can depress respirations