Lewis Chapter 67: Acute Respiratory Failure and ARDS NCLEX

Lewis Chapter 67: Acute Respiratory Failure and ARDS

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29 terms jullasaPreview ARDS nclex questions 33 terms almachengray Preview Module 20 terms Can The nurse is caring for a 27-yr-old man with multiple fractured ribs from a motor vehicle crash. Which clinical manifestation, if experienced by the patient, is an early indication that the patient is developing respiratory failure?A Tachycardia and pursed lip breathing B Kussmaul respirations and hypotension C Frequent position changes and agitation D Cyanosis and increased capillary refill time C Frequent position changes and agitation (A change in mental status is an early indication of respiratory failure. The brain is sensitive to variations in oxygenation, arterial carbon dioxide levels, and acid- base balance. Restlessness, confusion, agitation, and combative behavior suggest inadequate oxygen delivery to the brain.) Arterial blood gas results are reported to the nurse for a

68-yr-old patient admitted with pneumonia: pH 7.31,

PaCO2 49 mm Hg, HCO3 26 mEq/L, and PaO2 52 mm Hg. What order should the nurse complete first?A Administer albuterol inhaler prn.B Increase fluid intake to 2500 mL per 24 hours.C Initiate oxygen at 2 liters/minute by nasal cannula.D Perform chest physical therapy four times per day.C Initiate oxygen at 2 liters/minute by nasal cannula.(The arterial blood gas results indicate the patient is in uncompensated respiratory acidosis with moderate hypoxemia. Oxygen therapy is indicated to correct hypoxemia secondary to V/Q mismatch. Supplemental oxygen should be initiated at 1 to 3 L/min by nasal cannula, or 24% to 32% by simple face mask or Venturi mask to improve the PaO2. Albuterol would be administered next if needed for bronchodilation. Hydration is indicated for thick secretions, and chest physical therapy is indicated for patients with 30 mL or more of sputum production per day.)

A 72-yr-old woman with aspiration pneumonia develops severe respiratory distress. Her PaO2 is 42 mmHg and FIO2 is 80%. Which intervention should the nurse complete first?A Stat portable chest radiography B Administer lorazepam (Ativan) 1 mg IV push C Place the patient in a prone position on a rotational bed D Position the patient with arms supported away from the chest D Position the patient with arms supported away from the chest (The nurse will first position the patient to facilitate ventilation. Additional oxygen support may be necessary. Refractory hypoxemia indicates the patient is not demonstrating acute lung injury but has now developed acute respiratory distress syndrome (ARDS). If the PaO2 is 42 mm Hg on 80% FIO2 (fraction of inspired oxygen; room air is 21% FIO2), then the PaO2/FIO2 ratio is 52.5, indicating ARDS (PaO2/FIO2 ratio < 200>

The nurse is caring for a patient who is admitted with a barbiturate overdose. The patient is comatose with a blood pressure of 90/60 mm Hg, apical pulse of 110 beats/min, and respiratory rate of 8 breaths/min. Based on the initial assessment findings, the nurse recognizes that the patient is at risk for which type of respiratory failure?A Hypoxemic respiratory failure related to shunting of blood B Hypoxemic respiratory failure related to diffusion limitation C Hypercapnic respiratory failure related to alveolar hypoventilation D Hypercapnic respiratory failure related to increased airway resistance C Hypercapnic respiratory failure related to alveolar hypoventilation (The patient's respiratory rate is decreased as a result of barbiturate overdose, which caused respiratory depression. The patient is at risk for hypercapnic respiratory failure due to an obtunded airway causing decreased respiratory rate and thus decreased CO2 elimination. Barbiturate overdose does not lead to shunting of blood, diffusion limitations, or increased airway resistance.) The nurse is providing care for an older adult patient who is experiencing low partial pressure of oxygen in arterial blood (PaO2) as a result of worsening left-sided pneumonia. Which intervention should the nurse use to help the patient mobilize his secretions?A Augmented coughing or huff coughing B Positioning the patient side-lying on his left side C Frequent and aggressive nasopharyngeal suctioning D Application of noninvasive positive pressure ventilation

(NIPPV)

A Augmented coughing or huff coughing (Augmented coughing and huff coughing techniques may aid the patient in the mobilization of secretions. If positioned side-lying, the patient should be positioned on his right side (good lung down) for improved perfusion and ventilation. Suctioning may be indicated but should always be performed cautiously because of the risk of hypoxia. NIPPV is inappropriate in the treatment of patients with excessive secretions.) A patient is in acute respiratory distress syndrome (ARDS) as a result of sepsis. Which measure would be implemented to maintain cardiac output?A Administer crystalloid fluids.B Position the patient in the Trendelenburg position.C Place the patient on fluid restriction and administer diuretics.D Perform chest physiotherapy and assist with staged coughing.A Administer crystalloid fluids.(Low cardiac output may necessitate crystalloid fluids in addition to lowering positive end-expiratory pressure (PEEP) or administering inotropes. The Trendelenburg position (not recommended to treat hypotension) and chest physiotherapy are unlikely to relieve decreased cardiac output, and fluid restriction and diuresis would be inappropriate interventions.) Which patient would most benefit from noninvasive positive pressure ventilation (NIPPV) to promote oxygenation?A A patient whose cardiac output and blood pressure are unstable B A patient whose respiratory failure is due to a head injury with loss of consciousness C A patient with a diagnosis of cystic fibrosis and who is currently producing copious secretions D A patient who is experiencing respiratory failure as a result of the progression of myasthenia gravis D A patient who is experiencing respiratory failure as a result of the progression of myasthenia gravis (NIPPV such as continuous positive airway pressure (CPAP) is most effective in treating patients with respiratory failure resulting from chest wall and neuromuscular disease. It is not recommended in patients who are experiencing hemodynamic instability, decreased level of consciousness, or excessive secretions.)

When caring for older adult patients with respiratory failure, the nurse will add which intervention to individualize care?A Position the patient in the supine position primarily.B Assess frequently for signs and symptoms of delirium.C Provide early endotracheal intubation to reduce complications.D Delay activity and ambulation to provide additional healing time.B Assess frequently for signs and symptoms of delirium.(Older adult patients are more predisposed to factors such as delirium, health care associated infections, and polypharmacy. Individualizing the older patient's care plan to address these factors will improve care. Older adult patients are not required to remain in a supine position only and should increase activity as soon as stability is determined. Endotracheal intubation is not provided early, and noninvasive positive pressure ventilation may be considered as an alternative. The nurse should consider that the aging process leads to decreased lung elastic recoil, weakened lung muscles and reduced gas exchange, which may make the patient difficult to wean from the ventilator.) The patient has pulmonary fibrosis and experiences hypoxemia during exercise but not at rest. To plan patient care, the nurse should know the patient is experiencing which physiologic mechanism of respiratory failure?A Diffusion limitation B Intrapulmonary shunt C Alveolar hypoventilation D Ventilation-perfusion mismatch A Diffusion limitation (The patient with pulmonary fibrosis has a thickened alveolar-capillary interface that slows gas transport, and hypoxemia is more likely during exercise than at rest.Intrapulmonary shunt occurs when alveoli fill with fluid (e.g., acute respiratory distress syndrome, pneumonia). Alveolar hypoventilation occurs when there is a generalized decrease in ventilation (e.g., restrictive lung disease, central nervous system diseases, neuromuscular diseases). Ventilation-perfusion mismatch occurs when the amount of air does not match the amount of blood that the lung receives (e.g., COPD, pulmonary embolus).) When caring for a patient with acute respiratory distress syndrome (ARDS), which finding indicates therapy is appropriate?A pH is 7.32.B PaO2 is greater than or equal to 60 mm Hg.C PEEP increased to 20 cm H2O caused BP to fall to

80/40.

D No change in PaO2 when patient is turned from supine to prone position B PaO2 is greater than or equal to 60 mm Hg.(The overall goal in caring for the patient with ARDS is for the PaO2 to be greater than or equal to 60 mm Hg with adequate lung ventilation to maintain a normal pH of 7.35 to 7.45. PEEP is usually increased for ARDS patients, but a dramatic reduction in BP indicates a complication of decreased cardiac output. A positive occurrence is a marked improvement in PaO2 from perfusion better matching ventilation when the anterior air-filled, nonatelectatic alveoli become dependent in the prone position.) The nurse in the cardiac care unit is caring for a patient who has developed acute respiratory failure. Which medication is used to decrease patient pulmonary congestion and agitation?A Morphine B Albuterol C Azithromycin D Methylprednisolone A Morphine (For a patient with acute respiratory failure related to the heart, morphine is used to decrease pulmonary congestion as well as anxiety, agitation, and pain.Albuterol is used to reduce bronchospasm. Azithromycin is used for pulmonary infections. Methylprednisolone is used to reduce airway inflammation and edema.) Which signs and symptoms differentiate hypoxemic respiratory failure from hypercapnic respiratory failure (select all that apply)?

• Cyanosis
• Tachypnea
• Morning headache
• Paradoxic breathing
• Use of pursed-lip breathing

a, b, d (Clinical manifestations that occur with hypoxemic respiratory failure include cyanosis, tachypnea, and paradoxic chest or abdominal wall movement with the respiratory cycle. Clinical manifestations of hypercapnic respiratory failure include morning headache, pursed-lip breathing, and decreased or increased respiratory rate with shallow breathing.)