Respiratory

32. The nurse understands that patients diagnosed with ARDS may be allowed to have permissive hypercapnia. Which patient should the nurse recognize as being contraindicated for this practice? a. A patient with a C5 spinal cord injury b. A patient with opacities on chest x-ray and a P/F ratio of 225 c. A patient who has metabolic acidosis from acute kidney injury d. A patient with increased intracranial pressure after blunt trauma to the skull

32. b. Permissive hypercapnia is contraindicated in patients with increased intracranial pressure as increased CO2 levels will cause an increase in cerebral flow worsening the patient's intracranial pressure.

9. Which assessment finding would lead the nurse to suspect the early onset of hypoxemia? a. Restlessness b. Hypotension c. Central cyanosis d. Dysrhythmias

9. a. Because the brain is very sensitive to a decrease in oxygen delivery, restlessness, confusion, agitation, and combative behavior are early signs of hypoxemia, for which the nurse should be alert. Mild hypertension is also an early sign, accompanied by tachycardia. Central cyanosis is an unreliable, late sign of hypoxemia. Dysrhythmias also occur later.

normal p/f ration?

>400

Which information will the nurse include when a patient with respiratory failure asks about the purpose of the prescribed arterial blood gases (ABGs)? Select all that apply.

ABGs are used to assess changes in pH (acid-base status), arterial oxygen tension and saturation (PaO2 and SaO2), carbon dioxide (PaCO2), and bicarbonate (HCO3). ABG testing requires that blood be obtained from an arterial puncture and is invasive. Although ABG testing may indicate improvement in a patient's respiratory status, normal ABGs do not always indicate resolution of respiratory failure since patients may still require administration of high oxygen concentrations and mechanical ventilation to achieve normal ABGs.

In which order do the various pathophysiologic changes occurring in the exudative phase of acute respiratory distress syndrome (ARDS) occur?

After an initial direct or indirect injury to the alveolar-capillary membrane, inflammatory mediators are released and cause a more permeable alveolar-capillary membrane. The "leaky" membrane allows fluid and cells to move from the pulmonary capillaries into the interstitial space and alveoli, causing noncardiac pulmonary edema. The fluid-filled alveoli are unable to participate in gas exchange, leading to ventilation/perfusion (V/Q) mismatch, intrapulmonary shunting, and refractory hypoxemia.

Which clinical manifestations of acute respiratory distress syndrome (ARDS) are caused by increased pulmonary capillary permeability during the initial phase of ARDS? Select all that apply.

An increase in pulmonary capillary permeability results in fluid movement from the pulmonary capillaries into the interstitial space and alveoli, causing crackles with breathing. Fluid within the alveoli and interstitium also decreases oxygen saturation between the alveoli and pulmonary capillaries, leading to hypoxemia. Interstitial fluid also makes the lungs stiffer and less compliant, increasing the work of breathing and causing labored respirations with intercostal retractions. Tracheal deviation occurs with tension pneumothorax and is not a symptom of ARDS. The lungs have infiltrates with ARDS and will be dull to percussion.

Which clinical manifestations of acute respiratory distress syndrome (ARDS) are caused by increased pulmonary capillary permeability during the initial phase of ARDS? Select all that apply

An increase in pulmonary capillary permeability results in fluid movement from the pulmonary capillaries into the interstitial space and alveoli, causing crackles with breathing. Fluid within the alveoli and interstitium also decreases oxygen saturation between the alveoli and pulmonary capillaries, leading to hypoxemia. Interstitial fluid also makes the lungs stiffer and less compliant, increasing the work of breathing and causing labored respirations with intercostal retractions. Tracheal deviation occurs with tension pneumothorax and is not a symptom of ARDS. The lungs have infiltrates with ARDS and will be dull to percussion.

When caring for a patient who has pulmonary edema, which finding will the nurse expect when listening to breath sounds?

Because air moving through fluid in the alveoli will make a crackling or popping sound, crackles heard on inspiration may indicate pulmonary edema. Rhonchi are heard when respiratory secretions obstruct larger airways and may be symptomatic of pneumonia or chronic obstructive pulmonary disease (COPD). Bronchial breath sounds heard over the lung periphery indicate consolidation of lung tissue, which often occurs with pneumonia or pleural effusion. Absent or diminished breath sounds may indicate hypoventilation or pneumothorax.

An arterial oxygen value (PaO2) less than which number in millimeters of mercury indicates hypoxemic respiratory failure when a patient is receiving an inspired oxygen concentration of more than 60%? Record your answer using a whole number. _____

Hypoxemic respiratory failure is commonly defined as a PaO2 of less than 60 mm Hg when the patient is receiving an inspired oxygen concentration of 60% or more. This definition incorporates two important concepts: first, the PaO2 level indicates inadequate oxygen in the arterial blood; second, this PaO2 level exists despite administration of supplemental oxygen at a percentage (60%) that is about three times that in room air (21%).

Which benefits does noninvasive positive pressure ventilation (NIPPV) have over other artificial airways? Select all that apply.

NIPPV provides positive pressure ventilation without the need for endotracheal intubation and decreases the need for intubation in patients who are spontaneously breathing. Respiratory drive is not affected by NIPPV, and patients need to have adequate spontaneous respiratory rate to use this treatment. NIPPV traps secretions in the mask and is not appropriate for patients who have a lot of respiratory secretions. Patients who receive NIPPV may still need to receive bronchodilator therapy because NIPPV does not decrease airway spasm or narrowing

After observing a patient whose chest and abdomen move inward during inspiration, how will the nurse document this finding?

Normally, the thorax and abdomen move outward on inspiration and inward on exhalation. During paradoxical breathing, the abdomen and chest move inward during inspiration due to maximal use of the accessory muscles of respiration. Intercostal retractions are an abnormal finding during inspiration and signify increased work of breathing and use of accessory muscles to assist in breathing. Three-word dyspnea means that the patient can only say thd. ree words before another breath is neede Pursed-lip breathing occurs during the expiratory cycle and is used to exhale more completely and avoid air trapping.

Which intervention will the nurse anticipate when a patient is diagnosed with acute respiratory distress syndrome

Patients with ARDS will likely require mechanical ventilation because positive pressure ventilation and use of positive end-expiratory pressure (PEEP) is necessary to treat refractory hypoxemia. Fluid restriction is not typically used because patients with ARDS require fluid to maintain adequate cardiac output and BP. The pulmonary edema with ARDS is noncardiac, and diuretics are minimally used in treatment of ARDS. Continuous renal replacement therapy (CRRT) may be needed if the patient develops acute kidney injury as a complication of ARDS, but hemodialysis is avoided because patients with ARDS cannot tolerate the rapid fluid shifts that occur during hemodialysis.

Which pathophysiologic processes occur during the fibrotic phase of acute respiratory distress syndrome (ARDS)

The fibrotic phase, also known as the chronic or late phase of ARDS, occurs two to three weeks post-lung injury. The lung is completely remodeled by this time with dense and fibrous tissues. The scarring and fibrosis result in the decrease of lung compliance. Impairment in gas exchange is significant because the interstitium is fibrotic in nature. Pulmonary edema occurs in the initial exudative phase of ARDS as the alveolar-pulmonary capillary membrane permeability increases and fluid leaks into the alveoli. Formation of hyaline membranes also occurs in the exudative phase as necrotic cells, proteins, and fibrin line the alveoli, forming membranes that slow gas exchange.

20. The patient progressed from acute lung injury to acute respiratory distress syndrome (ARDS). He is on the ventilator and receiving propofol (Diprivan) for sedation and fentanyl (Sublimaze) to decrease anxiety, agitation, and pain to decrease his work of breathing, O2 consumption, carbon dioxide production, and risk of injury. What intervention may be recommended in caring for this patient? a. A sedation holiday b. Monitoring for hypermetabolism c. Keeping his legs still to avoid dislodging the airway d. Repositioning him every 4 hours to decrease agitation

20. a. A sedation holiday is needed to assess the patient's condition and readiness to extubate. A hypermetabolic state occurs with critical illness. Enteral or parenteral nutrition is started within 24 to 48 hours. With these medications, the patient will be assessed for cardiopulmonary depression. Venous thromboembolism prophylaxis will be used, but there is no reason to keep the legs still. Repositioning the patient every 2 hours may help decrease discomfort and agitation

30. Prone positioning is considered for a patient with ARDS who has not responded to other measures to increase PaO2 . To benefit the PaO2 the nurse knows that this strategy will a. increase the mobilization of pulmonary secretions. b. decrease the workload of the diaphragm and intercostal muscles. c. promote opening of atelectatic alveoli in the upper part of the lung. d. promote perfusion of nonatelectatic alveoli in the anterior part of the lung.

30. d. When a patient with ARDS is supine, alveoli in the posterior areas of the lung are dependent and fluid-filled and the heart and mediastinal contents place more pressure on the lungs, predisposing to atelectasis. I f the patient is turned prone, airfilled nonatelectatic alveoli in the anterior part of the lung receive more blood and perfusion may be better matched to ventilation, causing less V/Q mismatch. Lateral rotation therapy is used to stimulate postural drainage and help mobilize pulmonary secretions.

Which assessment findings are the earliest indicators of hypoxemic respiratory failure? Select all that apply.

Because the brain is very sensitive to changes in oxygen level, restlessness, confusion, and agitation are early indications of hypoxemia. Cyanosis is a late sign and does not occur until hypoxemia is severe. Lethargy is a clinical manifestation of hypercapnic respiratory failure and is seen with a high carbon dioxide level. High carbon dioxide levels seen in hypercapnic (ventilatory) respiratory failure also cause headache because of dilation of the blood vessels in the brain and increase in intracranial pressure.

Which process causes hypercapnic respiratory failure in a patient who arrives in the emergency department after an overdose of opioids?

Central nervous system depressants, such as opioids, decrease the carbon dioxide (CO2) reactivity in the brainstem, leading to decreased respiratory rate and depth. Decreased ability to expand the lungs, such as in a patient with rib fractures, causes hypercapnic respiratory failure due to decreased ability to "blow off" carbon dioxide. Trapping of carbon dioxide in the airways leads to hypercapnic respiratory failure in patients with chronic obstructive pulmonary disease or asthma. Damage to the nerve supply to the diaphragm or intercostal muscles may lead to hypercapnic respiratory failure in patients with cervical spinal cord injury or diseases such as Gillian-Barré syndrome.

The nurse is caring for a patient with acute respiratory distress syndrome (ARDS) who is receiving mechanical ventilation. The nurse monitors for which complications? Select all that apply.

Complications of ARDS are many and develop because of the condition itself or its treatment. These complications include barotrauma, stress ulcers, acute kidney injury, venous thromboembolism, and ventilator-associated pneumonia. Barotrauma occurs when alveoli are overdistended during mechanical ventilation. I n ARDS, blood is diverted from the gastrointestinal (GI) system to the lungs in an effort to increase body oxygenation, thereby producing stress ulcers. Decreased renal perfusion and decreased oxygen delivery to the kidneys in ARDS often results in acute kidney injury. ARDS puts patients at risk for venous stasis and immobility resulting in venous thromboembolism. Finally, ventilator-associated pneumonia occurs for many reasons, including prolonged mechanical ventilation, impaired host defense, and aspiration of gastric contents. CHF is not a complication associated with mechanical ventilation.

During which phase of acute respiratory distress syndrome (ARDS) does atelectasis occur due to decreased synthesis of surfactant and inactivation of existing surfactant?

During the injury phase (exudative phase), atelectasis occurs due to decreased synthesis of surfactant and inactivation of existing surfactant. During the proliferative phase, continued inflammation leads to damage to the pulmonary vasculature, fibrosis, and further decreased compliance. The fibrotic phase is characterized by remodeling of the lung with collagenous and fibrous tissues. Refractory hypoxemia is not a stage of ARDS but is first noticed during the injury (exudative) phase as the patient's hypoxemia continues to worsen despite use of high concentrations of oxygen.

During which phase of acute respiratory distress syndrome (ARDS) does atelectasis occur due to decreased synthesis of surfactant and inactivation of existing surfactant?

During the injury phase (exudative phase), atelectasis occurs due to decreased synthesis of surfactant and inactivation of existing surfactant. During the proliferative phase, continued inflammation leads to damage to the pulmonary vasculature, fibrosis, and further decreased compliance. The fibrotic phase is characterized by remodeling of the lung with collagenous and fibrous tissues. Refractory hypoxemia is not a stage of ARDS but is first noticed during the injury (exudative) phase as the patient's hypoxemia continues to worsen despite use of high concentrations of oxygen

Which pathophysiologic process results in surfactant dysfunction during the injury phase of acute respiratory distress syndrome (ARDS)?

During the injury phase of acute respiratory distress syndrome (ARDS), the alveolar type I and II cells (which produce surfactant) will be damaged. Along with accumulation of fluid and proteins, this cell damage results in surfactant dysfunction The hyaline membranes that line the alveoli lead to the decrease in gas exchange capability. Engorgement of the peribronchial and perivascular interstitial space results in interstitial edema. Ventilation to perfusion (V/Q) mismatch results in hypoxemia.

Which early clinical manifestations of acute respiratory distress syndrome (ARDS) will the nurse monitor for when caring for a patient admitted with sepsis? Select all that apply.

Early clinical manifestations of ARDS usually appear within 24 to 48 hours after a lung injury. The patient may cough, feel restless, and exhibit signs of dyspnea and tachypnea. Chest auscultation reveals adventitious lung sounds that can include crackles and rhonchi. Oliguria caused by acute kidney injury may occur later as a complication of ARDS. Because respiratory rate increases early in ARDS, the patient will initially have respiratory alkalosis. Respiratory acidosis is a later complication as the patient is no longer able to compensate.

Which process causes hypoxemic respiratory failure?

Hypoxemic respiratory failure occurs due to inadequate oxygen transfer between the alveoli and the pulmonary capillaries. The patient experiences hypercapnic respiratory failure because of the inability to remove sufficient carbon dioxide to maintain a normal partial pressure of carbon dioxide in arterial blood (PaCO2). An imbalance between ventilatory supply and demand increases PaCO2 and leads to hypercapnia. An inability to increase ventilation in response to metabolic demands also causes hypercapnia and hypercapnic respiratory failure.

Which conditions predispose a patient to acute respiratory distress syndrome (ARDS) by causing an indirect lung injury? Select all that apply.

In indirect lung injury, a problem outside the lung leads to widespread inflammation, which affects the lung as well as other organs. Sepsis caused by gram-negative bacteria can predispose patients to the development of ARDS with an indirect lung injury. Excessive use of opioid drugs can indirectly lead to ARDS. Indirect injury to the lung by a severe massive trauma caused by a head injury can also lead to ARDS. In direct lung injury, pathogens come into direct contact with the lungs as occurs with pneumonia. Aspiration of gastric contents also causes direct lung injury as gastric contents come into contact with lung tissues.

Following a direct lung injury, which pathophysiologic process occurs in the first few days as the patient develops acute respiratory distress syndrome (ARDS)?

In the injury or exudative phase of ARDS (the first few days), there is an engorgement of the peribronchial interstitial space because of increased permeability of the alveolar-capillary membrane. Destruction of the pulmonary vasculature occurs one or two weeks later during the reparative or proliferative phase. As the pulmonary vasculature is destroyed, the patient develops pulmonary hypertension. Lung scarring with permanently decreased lung compliance occurs in the fibrotic or fibroproliferative phase, two to three weeks after the initial acute lung injury.

Following a direct lung injury, which pathophysiologic process occurs in the first few days as the patient develops acute respiratory distress syndrome (ARDS)?

In the injury or exudative phase of ARDS (the first few days), there is an engorgement of the peribronchial interstitial space because of increased permeability of the alveolar-capillary membrane. Destruction of the pulmonary vasculature occurs one or two weeks later during the reparative or proliferative phase. As the pulmonary vasculature is destroyed, the patient develops pulmonary hypertension. Lung scarring with permanently decreased lung compliance occurs in the fibrotic or fibroproliferative phase, two to three weeks after the initial acute lung injury.

After reviewing a patient's assessment findings, the nurse suspects a diagnosis of acute respiratory distress syndrome (ARDS). Which phase of ARDS is the patient experiencing?

The injury, or exudative phase, is the first phase in the progression of ARDS. This phase usually occurs 24 to 72 hours after the lung insult or injury and lasts seven days. It is characterized by mild respiratory symptoms (dyspnea, tachypnea, cough, and restlessness). Lung auscultation shows normal lungs or fine scattered crackles. The arterial blood gases (ABGs) show mild hypoxemia and respiratory alkalosis due to hyperventilation. The chest x-ray is usually normal. In the reparative phase (also known as the proliferative phase), signs and symptoms worsen. The chest x-ray begins to show diffuse bilateral infiltrates. In the fibroproliferative phase, scarring of the lungs occurs, and lung compliance is decreased.

22. What are the primary pathophysiologic changes that occur in the injury or exudative phase of ARDS (select all that apply)? a. Atelectasis b. Shortness of breath c. Interstitial and alveolar edema d. Hyaline membranes line the alveoli e. Influx of neutrophils, monocytes, and lymphocyte

a, c, d. The injury or exudative phase is the early phase of ARDS when atelectasis and interstitial and alveolar edema occur. Hyaline membranes composed of necrotic cells, protein, and fibrin line the alveoli. Together, these decrease gas exchange capability and lung compliance. Shortness of breath occurs but it is not a physiologic change. The increased inflammation and proliferation of fibroblasts occurs in the reparative or proliferative phase of ARDS, which occurs 1 to 2 weeks after the initial lung injury

10. Which changes of aging contribute to the increased risk for respiratory failure in older adults (select all that apply)? a. Alveolar dilation b. Increased delirium c. Changes in vital signs d. Increased infection risk e. Decreased respiratory muscle strength f. Diminished elastic recoil within the airways

a, e, f. Changes from aging that increase the older adult's risk for respiratory failure include alveolar dilation, decreased respiratory muscle strength, and diminished elastic recoil in the airways. Although delirium can complicate ventilator management, it does not increase the older patient's risk for respiratory failure. The older adult's BP and heart rate (HR) increase, but this does not affect the risk for respiratory failure. The ventilatory capacity is decreased and the larger air spaces decrease the surface area for gas exchange, which also increase the risk.

21. Although ARDS may result from direct lung injury or indirect lung injury from systemic inflammatory response syndrome (SIRS), the nurse is aware that ARDS is most likely to occur in the patient with damage resulting from what? a. Sepsis b. Oxygen toxicity c. Prolonged hypotension d. Cardiopulmonary bypass

a. Although ARDS may occur in the patient who has any severe illness and may be both a cause and a result of systemic inflammatory response syndrome (SIRS), the most common precipitating injuries of ARDS are sepsis, gastric aspiration, and severe massive trauma

27. The best patient response to treatment of ARDS occurs when initial management includes what? a. Treatment of the underlying condition b. Administration of prophylactic antibiotics c. Treatment with diuretics and mild fluid restriction d. Endotracheal intubation and mechanical ventilation

a. Because ARDS is precipitated by a physiologic insult, a critical factor in its prevention and early management is treatment of the underlying condition. Prophylactic antibiotics, treatment with diuretics and fluid restriction, and mechanical ventilation are used as ARDS progresses

16. Priority Decision: After endotracheal intubation and mechanical ventilation have been started, a patient in respiratory failure becomes very agitated and is breathing asynchronously with the ventilator. What is most important for the nurse to do first? a. Evaluate the patient's pain level, ABGs, and electrolyte values. b. Sedate the patient to unconsciousness to eliminate patient awareness. c. Give as-needed vecuronium to promote synchronous ventilations. d. Slow the ventilator's rate of ventilations to allow for the patient to spontaneously breathe.

a. It is most important to assess the patient for the cause of the restlessness and agitation (e.g., pain, hypoxemia, electrolyte imbalances) and treat the underlying cause before sedating the patient. Although sedation, analgesia, and neuromuscular blockade are often used to control agitation and pain, these treatments may contribute to prolonged ventilator support and hospital days.

12. Patient-Centered Care: A patient has a PaO2 of 50 mm Hg and a PaCO2 of 42 mm Hg because of an intrapulmonary shunt. Which therapy should the nurse expect the patient to respond to best? a. Positive pressure ventilation b. Oxygen administration at a fractional inspired oxygen concentration (FIO2 ) of 100% c. Applying O2 per nasal cannula at 1 to 3 L/min d. Clearing airway secretions with coughing and suctioning

a. Patients with a shunt are usually more hypoxemic than patients with a V/Q mismatch because the alveoli are filled with fluid, which prevents gas exchange. Hypoxemia from an intrapulmonary shunt is usually not responsive to high O2 concentrations. The patient will usually need positive pressure ventilation. Hypoxemia associated with a V/Q mismatch usually responds favorably to O2 at 1 to 3 L/min by nasal cannula. Removing secretions with coughing and suctioning is generally not effective in reversing an acute hypoxemia resulting from a shunt

28. When mechanical ventilation is used for the patient with ARDS, what is the reason for applying positive end-expiratory pressure (PEEP)? a. Prevent alveolar collapse and open collapsed alveoli b. Permit smaller tidal volumes with permissive hypercapnia c. Promote complete emptying of the lungs during exhalation d. Permit extracorporeal oxygenation and carbon dioxide removal outside the body

a. Positive end-expiratory pressure (PEEP) used with mechanical ventilation applies positive pressure to the airway and lungs at the end of exhalation, keeping the lung partially expanded and preventing collapse of the alveoli and helping open collapsed alveoli. Permissive hypercapnia is allowed when the patient with ARDS is ventilated with smaller tidal volumes to prevent barotrauma. Extracorporeal membrane oxygenation and extracorporeal CO2 removal involve passing blood across a gasexchanging membrane outside the body and then returning oxygenated blood to the body.

24. In caring for the patient with ARDS, what is the most characteristic sign the nurse would expect the patient to exhibit? a. Refractory hypoxemia b. Bronchial breath sounds c. Progressive hypercapnia d. Increased pulmonary artery wedge pressure (PAWP)

a. Refractory hypoxemia, hypoxemia that does not respond to increasing concentrations of oxygenation by any route, is a hallmark of ARDS and is always present. Bronchial breath sounds may be associated with the progression of ARDS. PaCO2 levels may be normal until the patient is no longer able to compensate in response to the hypoxemia. Pulmonary artery wedge pressure (PAWP) that is normally increased in cardiogenic pulmonary edema is normal in the pulmonary edema of ARDS

25. Which findings would lead the nurse to suspect the early stage of ARDS in a seriously ill patient? a. Develops respiratory acidosis b. Exhibits dyspnea and restlessness c. Has diffuse crackles and wheezing d. Has a decreased PaO2 and an increased PaCO2

b. Early signs of ARDS are insidious and difficult to detect, but the nurse should be alert for any early signs of hypoxemia, such as dyspnea, tachypnea, cough, and restlessness in patients at risk for ARDS. Later, tachycardia, diaphoresis, mental status changes, cyanosis, and pallor may be present. Abnormal findings on physical examination or diagnostic studies, such as worsened lung sounds and respiratory distress, respiratory alkalosis, or decreasing PaO2 , are usually indications that ARDS has progressed beyond the initial stages.

29. The nurse suspects that a patient with PEEP has negative effects of this ventilatory maneuver when which finding is present? a. Increasing PaO2 b. Decreasing blood pressure c. Decreasing heart rate (HR) d. Increasing central venous pressure (CVP)

b. There is often a dramatic decrease in BP with decreased preload (CVP) and cardiac output (CO). PEEP increases intrathoracic and intrapulmonic pressures and reduces blood return to both the right and left sides of the heart. Increased PaO2 is an expected effect of PEEP.

26. A patient with ARDS has a nursing diagnosis of risk for infection. To detect the presence of infections commonly associated with ARDS, what should the nurse monitor? a. Gastric aspirate for pH and blood b. Quality, quantity, and consistency of sputum c. Subcutaneous emphysema of the face, neck, and chest d. Mucous membranes of the oral cavity for open lesions

b. Ventilator-associated pneumonia (VAP) is one of the most common complications of ARDS. Early detection requires frequent monitoring of sputum smears and cultures and assessment of the quality, quantity, and consistency of sputum. Prevention of VAP is done with strict infection control measures and ventilator bundle protocol. Blood in gastric aspirate may show a stress ulcer and subcutaneous emphysema of the face, neck, and chest occurs with barotrauma during mechanical ventilation. Oral infections may result from prophylactic antibiotics and impaired host defenses but are not common

23. In patients with ARDS who survive the acute phase of lung injury, what manifestations are seen when they progress to the fibrotic phase? a. Chronic pulmonary edema and atelectasis b. Resolution of edema and healing of lung tissue c. Continued hypoxemia because of diffusion limitation d. Increased lung compliance caused by the breakdown of fibrotic tissue

c. In the fibrotic phase of ARDS, diffuse scarring and fibrosis of the lungs occur, resulting in decreased surface area for gas exchange and continued hypoxemia caused by diffusion limitation. Although edema is resolved, lung compliance is decreased because of interstitial fibrosis. Long-term mechanical ventilation is needed. The patient has a poor prognosis for survival.

33. The nurse caring for a patient diagnosed with ARDS understands that low tidal volume ventilation will be prescribed while the patient is on mechanical ventilation. Using this knowledge, what is the most appropriate tidal volume if this patient weighs 175 lbs? a. 700 mL b. 800 mL c. 525 mL d. 477 m

d. Low tidal volume ventilation is calculated using 4 to 8 mL/kg. The patient weighs 79.5 kg (175 lbs divided by 2.2). Using 4 mL/kg the tidal volume would equal 318 mL; 5 mL/kg equals 398 mL; 6 mL/kg equals 477 mL; 7 mL/kg equals 557 mL and 8 mL/kg equals 636 mL

11. The nurse determines that a patient in respiratory distress is developing respiratory fatigue and the risk of respiratory arrest when the patient displays which behavior? a. Cannot breathe unless he is sitting upright b. Uses the abdominal muscles during expiration c. Has an increased inspiratory-expiratory (I/E) ratio d. Has a change in respiratory rate from rapid to slow

d. The increase in respiratory rate needed to blow off accumulated CO2 predisposes to respiratory muscle fatigue. The slowing of a rapid rate in a patient in acute distress shows tiring and the possibility of respiratory arrest unless ventilatory assistance is provided. Orthopnea, accessory muscle use, and decreased inspiratory-expiratory (I/E) ratio are common findings in respiratory distress but do not necessarily signal respiratory fatigue or arrest. Abdominal muscle use is normal