Exemplar 15.A - ARDS

The nurse educator prepares to speak to a group of nursing students about direct and indirect insults to the lungs that may lead to the development of acute respiratory distress syndrome (ARDS). Which conditions will the nurse include in the teaching session? Select all that apply. A) Sepsis B) Viral pneumonia C) Drug overdose D) Near drowning in saltwater E) Fractured humerus

A) Sepsis B) Viral pneumonia C) Drug overdose D) Near drowning in saltwater ARDS is a severe form of acute respiratory failure that occurs in response to pulmonary or systemic insults. Such insults include, but are not limited to, sepsis, pulmonary infections, saltwater inhalation, and drug overdose. A fractured humerus is not a risk factor for the development of ARDS.

The nurse is providing care to a client admitted to the emergency department with the diagnosis of acute respiratory distress syndrome (ARDS). When educating the client's family, what should the nurse say is the expected progression of the disease process? A) Initiation of ARDS B) Onset of pulmonary edema C) End-stage ARDS D) Alveolar collapse

Answer: A, B, D, C ARDS begins with inflammatory cellular responses and biochemical mediators that damage the alveolar-capillary membrane. Increased interstitial pressure and damage to the alveolar membrane allow fluid to enter the alveoli. The inflammatory process damages surfactant-producing cells, leading to a deficit of surfactant, increased alveolar surface tension, and alveolar collapse. Multiple-organ system dysfunction of the kidneys, liver, gastrointestinal tract, central nervous system, and cardiovascular system are the leading causes of death in ARDS

The nurse is providing care to a client with ARDS who has a tracheostomy. The nurse will monitor the client for complications related to the loss of which protective mechanism? A) The ability to cough B) Filtration and humidification of inspired air C) Decrease in oxygen-carrying capacity of the trachea D) The sneeze reflex initiated by irritants in the nasal passages

B) Filtration and humidification of inspired air When the nasal passages are bypassed, as they would be in the case of a client with a tracheostomy, the filtration, humidification, and warming provided by the nasal passages are also bypassed. The client can still cough and sneeze, and there is no decrease in the oxygen-carrying capacity of the trachea.

A client with a respiratory rate of 8 breaths per minute has an oxygen saturation of 82%. Which nursing diagnosis is a priority for this client? A) Risk for Infection B) Impaired Spontaneous Ventilation C) Risk for Acute Confusion D) Decreased Cardiac Output

B) Impaired Spontaneous Ventilation A priority nursing intervention for a client with a respiratory rate of 8 breaths per minutes and an oxygen saturation of 82% is Impaired Spontaneous Ventilation. If the current pattern continues without intervention, the client could experience respiratory arrest. While the other nursing diagnoses may also be appropriate, they are not the priority for this client.

A client admitted with smoke inhalation injuries develops signs and symptoms of acute respiratory distress syndrome (ARDS). The nurse anticipates the healthcare provider will prescribe which course of action with regard to oxygenation? A) Oxygen via a nasal cannula B) Mechanical ventilation C) Oxygen via a face mask D) Oxygen via a Venturi mask

B) Mechanical ventilation With ARDS, it is rarely possible to maintain adequate tissue oxygenation with oxygen therapy alone. Therefore, mechanical ventilation is often necessary. Oxygen administered via nasal cannula, face mask, or venture mask all require active and adequate breathing by the client, which may not be possible for the client with ARDS.

Which data supports the nurse's assessment that a newborn with acute respiratory distress syndrome (ARDS) is improving? A) Increased PaCO2 B) Oxygen saturation of 92% C) Pulmonary vascular resistance increases D) Thick secretions from the respiratory tract

B) Oxygen saturation of 92% An expected outcome for a client being treated for ARDS is maintaining an oxygen saturation of greater than 90%. The newborn diagnosed with ARDS with an oxygen saturation of 92% is improving. Increased PaCO2, increased pulmonary vascular resistance, and thick secretions from the respiratory tract are indicative of continued distress.

A client with acute respiratory distress syndrome (ARDS) is being weaned from ventilatory support. Which nursing actions are appropriate for this client? Select all that apply. A) Increase percentage of oxygen being provided through the ventilator. B) Place in the Fowler position. C) Provide morning care during the weaning procedures. D) Begin weaning procedures in the morning. E) Medicate with morphine for pain as needed.

B) Place in the Fowler position. D) Begin weaning procedures in the morning. Weaning a client from ventilatory support should begin in the morning when the client is well-rested. The client should be in the Fowler or high-Fowler position, as this facilitates lung expansion and reduces the work of breathing. Activities and care should be limited during the weaning process to reduce the demand for oxygen. The client should not be given any medication known to suppress respirations, as this would interfere with the weaning process. The percentage of oxygen is typically reduced during the weaning process.

The nurse is caring for a client diagnosed with acute respiratory distress syndrome (ARDS). The client is intubated and placed on mechanical ventilation with positive pressure ventilation. Which assessment finding indicates a decrease of cardiac output secondary to positive pressure ventilation? A) Blood pressure increases from 88/58 mmHg to 90/60 mmHg B) Urine output decreases from 30 mL/hr to 25 mL/hr C) Heart rate drops from 108 bpm to 104 bpm D) Oxygen saturation increases from 82% to 90%

B) Urine output decreases from 30 mL/hr to 25 mL/hr Reduced cardiac output results in reduced perfusion of the kidneys, with a resulting decrease in urine output. Expected urine output is at least 30 mL/hr. This client's urine output is decreased; therefore, this finding supports the diagnosis of decreased cardiac output. Although hypotension and tachycardia are indicative of a decreased cardiac output, both indicate improvement from the previous assessment, suggesting that they are not contributing to decreased cardiac output. The oxygen saturation level is within normal limits for this client and improving from the previous assessment.

The client with ARDS who is likely to have the poorest outcome is A) a Hispanic male with pneumonia. B) an African American male with sepsis. C) a Caucasian female with sepsis. D) an African American female with chest trauma.

B) an African American male with sepsis. The risk for mortality from ARDS is greater for men than for women, and it is greater for African Americans than people from other races. In addition, clients who develop ARDS from sepsis have poorer outcomes than clients who develop ARDS from pulmonary infections or trauma. Therefore, the African American male with ARDS from sepsis will likely have the poorest outcome.

One primary method for preventing ARDS in hospitalized clients is A) performing postural drainage for clients with respiratory congestion. B) elevating the head of the bed for clients who are ingesting food. C) providing smoking cessation literature to clients who smoke. D) administering oxygen as ordered by the healthcare provider.

B) elevating the head of the bed for clients who are ingesting food. Aspiration of gastric contents is a major risk factor for developing ARDS. Therefore, simple interventions such as elevating the head of the bed for clients who are ingesting food can help prevent ARDS. Performing postural drainage and administering oxygen will not prevent ARDS. Although smoking may increase the risk for ARDS, it is not a direct cause of ARDS, so smoking cessation literature will not prevent ARDS in hospitalized clients.

The nurse is providing care to a client with sepsis due to a severely infected leg wound. The client states that he is having trouble breathing. Upon assessment, the nurse notes dyspnea, a respiratory rate of 32, the use of accessory muscles to breathe, and rales and rhonchi upon auscultation of the lungs. The nurse recognizes these findings as characteristic of what condition? A) Allergic response from antibiotic therapy B) Deep vein thrombosis C) Acute respiratory distress syndrome D) Anemia

C) Acute respiratory distress syndrome Sepsis is the most common cause of acute respiratory distress syndrome (ARDS). The client has a systemic infection, which is sepsis, and is complaining that it is getting hard to breathe. Pulmonary assessment data indicate that the client is developing acute respiratory distress. Deep vein thrombosis, anemia, or allergic response from antibiotic therapy may or may not be associated with a systemic infection from an infected leg wound and are not associated with the development of ARDS.

A client receiving treatment for acute respiratory distress syndrome (ARDS) is demonstrating anxiety related to having to stay on the ventilator indefinitely. Which interventions by the nurse are appropriate? Select all that apply. A) Explain about care areas specifically designed for long-term ventilatory support. B) Dim the lights and reduce distracting noise, such as the television. C) Instruct that intubation and ventilation are temporary measures. D) Encourage family visits and participation in care. E) Remain with the client as much as possible.

C) Instruct that intubation and ventilation are temporary measures. D) Encourage family visits and participation in care. E) Remain with the client as much as possible. A critical illness creates anxiety for any client. For the client with ARDS, anxiety is compounded by intubation and mechanical ventilation. To reduce this client's anxiety, the nurse should encourage the family to visit and participate in care. The nurse should also remain with the client as much as possible and instruct that intubation and ventilation are temporary measures to allow the lungs to rest and heal. Explaining that there are care areas designed for long-term ventilatory support could increase the client's anxiety. The nurse should provide distractions such as television or radio and not dim the lights or turn off the television, which could also increase the client's anxiety.

The nurse is caring for a client admitted with septic shock. Which early clinical manifestation might indicate the development of ARDS? A) Intercostal retractions B) Cyanosis C) Tachypnea D) Tachycardia

C) Tachypnea Dyspnea and tachypnea are early clinical manifestations of ARDS. As the distress progresses, the client would demonstrate an increasing respiratory rate, intercostal retractions, and use of accessory muscles, as well as tachycardia. Cyanosis is a late manifestation.

Which clinical manifestation does the nurse correctly attribute to hypoxia in a client with acute respiratory distress syndrome (ARDS)? A) Fluid imbalance B) Hypertension C) Bradycardia D) Dyspnea

D) Dyspnea Dyspnea is a clinical manifestation of clients experiencing hypoxia secondary to ARDS. Fluid and electrolyte imbalances occur due to the nutritional imbalances associated with ARDS. The nurse would expect tachycardia, not bradycardia, as a result of hypoxia.

The nurse is caring for a woman who is 32 weeks pregnant and requires mechanical ventilation for ARDS. In addition to standard nursing interventions for adult clients with ARDS, what special interventions need to be implemented for this client? A) Inducing labor B) Administering nitric oxide and corticosteroids C) Providing nutritional support D) Fetal monitoring

D) Fetal monitoring Care for pregnant clients with ARDS who are at least at 20-24 weeks' gestation should include close fetal monitoring for potential emergency delivery. If the ARDS leads to compromised placental oxygen transfer, the neonate should be delivered immediately for the best outcome. However, not all pregnant women with ARDS will need immediate emergency delivery of the neonate. Providing nutritional support and administering nitric oxide and corticosteroids are interventions for all adult clients with ARDS, not only pregnant women.