Acute Respiratory Distress Syndrome (Sherpath)

The nurse is caring for a patient with acute respiratory distress syndrome (ARDS) who is having difficulty breathing and an oxygen saturation of 85%. The patient's spouse is at the bedside and asks why the patient is having difficulty breathing. What is the best response by the nurse?

"Your spouse has refractory hypoxemia, which is low blood oxygen that is not being resolved with the therapies we are trying." This patient has refractory hypoxemia associated with ARDS as evidenced by the low oxygen saturation and difficulty breathing.

The nurse is receiving a report on a patient diagnosed with acute respiratory distress syndrome (ARDS). The patient is intubated and mechanically ventilated. On assessment, the nurse notes crackles in the lungs, poor skin turgor, and decreased capillary refill. The patient is receiving nothing by mouth (NPO) with normal saline solution infusing at 100 mL/hr. Urine output was 100 mL over the last 4 hours. Which action should the nurse perform first?

Administer dopamine as ordered. A patient with a urine output of less than 30 mL/hr and ARDS is likely experiencing decreased cardiac output. A medication such as dopamine or dobutamine is needed to support cardiac output and function.

A patient is being evaluated for acute respiratory distress syndrome (ARDS). On assessment of the patient, the nurse notes tachypnea, dyspnea, and confusion. For which test would the nurse expect to prepare the patient to confirm the diagnosis of ARDS?

Chest x-ray A chest x-ray is commonly used to detect the presence of ARDS. Initially, the x-ray may reveal normal findings or minimal evidence of infiltrates. Severe cases of ARDS may show a "white lung" on x-ray because of massive infiltration.

A nurse is caring for a patient with acute respiratory distress syndrome (ARDS). At the start of the shift, the nurse finds that the patient has been placed in a prone position. Functional saturation of oxygen (SpO2) is 93%. How does the nurse respond?

Continue to monitor per hospital protocol. No action is needed if the patient is comfortable and vital signs/oxygen saturation are within normal limits. Some patients do better clinically when they are in the prone position. Oxygenation may be improved when patients are in the prone position than when they are in the supine position. Additionally, prone positioning could prevent ventilator-induced lung injury.

A nurse is caring for a patient with severe acute respiratory distress syndrome (ARDS). The patient had an arterial catheter placed in the morning. The nurse observed a decrease in cardiac output and blood pressure after vital signs were measured in the afternoon. What medication does the nurse anticipate administering?

Dopamine Dopamine is an inotropic drug that can be used to increase cardiac output and blood pressure.

A nurse is caring for a patient who is suspected of developing acute respiratory distress syndrome (ARDS). The patient is receiving oxygen at 15 L /min through a nonrebreather mask while awaiting further evaluation. What should the nurse implement for this procedure to be most effective?

Ensure the mask fits snuggly on the patient's face. Ensuring the mask fits snugly and properly over the mouth and nose will ensure that oxygen therapy is most effective.

A patient is diagnosed with acute respiratory distress syndrome (ARDS) two days after a crushing chest injury during a motor vehicle collision. Which statement best explains the cause of the patient's worsening symptoms?

Inflammatory mediators are released. Injury to the lung tissue results in an influx of inflammatory mediators and immune cells to the area of injury. These cells cause a release of mediators that induce changes in the lungs, which eventually progress to ARDS.

A patient with pneumonia reports increased sweating, persistent coughing, shortness of breath and palpitations. The nurse notes tachycardia and cyanosis. The patient is receiving oxygen via a nasal cannula at 2 L/min. Which action would the nurse take next? Select all that apply.

Measurement of arterial blood gases (ABGs) Measurement of ABGs can be used to obtain information about oxygenation and acid-base balance. The goal is to rule out the presence of acute respiratory distress syndrome, which can develop after lung injury, such as that caused by aspiration pneumonia.

A patient with pneumonia reports increased sweating, persistent coughing, shortness of breath and palpitations. The nurse notes tachycardia and cyanosis. The patient is receiving oxygen via a nasal cannula at 2 L/min. Which action would the nurse take next?

Notify the health care provider. The health care provider needs to be informed of the change in the patient's status. The nurse should be prepared to change the oxygen delivery system or administer additional medications. Inform the respiratory therapist. The respiratory therapist needs be informed of the change in the patient's status because of a possible need for intubation or change in oxygenation/ventilation treatment.

A nurse is assessing a patient with acute respiratory distress syndrome (ARDS) who is intubated and receiving mechanical ventilation. Arterial blood gases reveal a partial pressure of oxygen in arterial blood (PaO2) of 55 mm Hg. The nurse knows that the respiratory therapist may recommend which types of treatment? Select all that apply.

Permissive hypercapnia Permissive hypercapnia is an alternative setting during mechanical ventilation that allows a slow increase in the positive pressure of carbon dioxide and is sometimes used when hypoxemia persists despite use of positive end-expiratory pressure. Airway pressure release ventilation Airway pressure release ventilation is an alternative setting during mechanical ventilation and is sometimes used when hypoxemia persists despite use of positive end-expiratory pressure. Pressure-control inverse-ratio ventilation Pressure-control inverse-ratio ventilation is an alternate setting used during mechanical ventilation when hypoxemia persists despite use of positive end-expiratory pressure.

A patient has developed acute respiratory distress syndrome (ARDS) after aspiration and is now arriving at the hospital by ambulance. The patient is hyperventilating and has been receiving oxygen at a rate of 15 L/min via a simple facemask. Which provider order would the nurse anticipate?

Prepare for intubation and mechanical ventilation with positive end-expiratory pressure (PEEP). Intubation and mechanical ventilation with PEEP will be required because the patient is still hyperventilating even after receiving a large amount oxygen. PEEP should be used to help the patient breathe.

A patient with acute respiratory distress syndrome (ARDS) secondary to a chest injury has crackles in the bilateral posterior lung fields. The nurse also notes tachycardia, delayed capillary refill, decreased urine output, and the following arterial blood gas (ABG) results: pH 7.56, PaO2 51, PaCo2 28, HCO3 24, SaO2 76%. Which provider order would the nurse implement first?

Prepare the patient for mechanical ventilation. Assessment and diagnostic data are consistent with hypoxemia and decreased perfusion. The priority for this patient is restoring oxygenation.

The nurse knows that patients with which diagnoses are at risk of developing acute respiratory distress syndrome (ARDS)? Select all that apply.

Septic shock Patients with sepsis or septic shock are at the highest risk for developing ARDS. This is especially true when the sepsis is due to a gram-negative infection. The nurse should monitor respiratory status of these patients closely. Severe head injury Patients with severe head injuries can have a secondary injury to the lungs resulting from central nervous system damage. This can result in the development of ARDS, and the nurse should monitor these patients accordingly. Amniotic fluid embolus Patients with any type of embolism—fat, air, amniotic fluid, or thrombus—are at higher risk for developing ARDS. The nurse should monitor the respiratory status of these patients accordingly.

The nurse is caring for a patient diagnosed with acute respiratory distress syndrome (ARDS). On assessment, the nurse notes crackles in the lungs and peripheral edema. Which nursing assessments are appropriate for the nurse to obtain?

Skin integrity Peripheral edema can cause impaired skin integrity or skin breakdown. The nurse should assess and monitor for any of these changes. Intake/output The patient is showing signs of fluid overload. The nurse should monitor the intake and output in order to assess fluid status. Oxygen saturation The nurse should continuously monitor oxygenation in the patient with ARDS; this is a priority.

The nurse is teaching a nursing student about acute respiratory distress syndrome (ARDS). The student asks how to recognize symptoms of the disease as it progresses. In which order does the nurse describe the symptoms?

Tachypnea and cough Decreased mental status Respiratory distress Decreased urine output

A nurse is caring for a patient with acute respiratory distress syndrome (ARDS) and notes a hemoglobin of 7 g/dL. The nurse anticipates what order?

Transfusion of packed red blood cells (RBCs) The patient's hemoglobin level is low, indicating the need for packed RBC transfusion. The goal of treatment is to raise the hemoglobin level to at least 9 to 10 g/dL.

The nurse is caring for a patient with acute respiratory distress syndrome (ARDS) secondary to sepsis. The patient is receiving kinetic therapy. The nurse should ensure that the nursing assistant performs which intervention?

Turns the patient every 2 hours. Even though the patient is receiving kinetic therapy, he or she will still need to be turned in order to prevent skin breakdown and development of pressure ulcers.

The nurse is concerned about which findings when assessing Mr. Whaley at the start of a shift? Select all that apply.

Urine output of <30 mL/hr Low urine output can indicate decreasing cardiac output and kidney function, which can indicate complications that require immediate intervention. Mr. Whaley's chest x-ray results A chest x-ray showing new infiltrates is concerning because it can indicate the development of acute respiratory distress syndrome in this patient. The nurse should report the findings to the physician. Partial arterial oxygen tension (PaO2) of 56 mm Hg PaO2 of 56 is below the normal range and requires further assessment by the nurse. Mr. Whaley may need the ventilator settings adjusted.