ARDS and Mechanical Ventilation, Study Guides, Projects, Research of Nursing

Download ARDS and Mechanical Ventilation and more Study Guides, Projects, Research Nursing in PDF only on Docsity! APEA_EXAMS QUESTIONS WITH ANSWERS ,TESTED AND VERIFIED NEW EXAM SOLUTIONS Patient Profile Mr. S. is a 54-year-old African American man who was admitted 72 hours ago to a general surgical unit after surgery for a bowel obstruction. The surgical procedure involved extensive abdominal surgery to repair a perforated colon, irrigate the abdominal cavity, and provide hemostasis. During surgery his systolic blood pressure dropped to 70 mm Hg. Seven units of packed red blood cells and 4 L of normal saline were administered intravenously to restore blood loss and circulating volume. He is receiving 60% O2 through an aerosol face mask. He is being monitored with a cardiac monitor and pulse oximeter. He has a central intravenous catheter in place and is receiving 0.9% normal saline IV at 125 ml per hour. A urinary catheter is in place. Subjective Data ● Complains of shortness of breath, inability to lie flat, and diffuse abdominal pain Objective Data Physical Assessment ● General: alert, well-nourished man who appears restless and anxious; head of bed elevated 45 degrees; skin cool with moderate diaphoresis ● Respiratory: no accessory muscle use, retractions, or paradoxic breathing; respiratory rate 28 breaths/min; SpO2 88%; fine crackles at lung bases. The nurse also assessed the patient’s chest and abdominal wall excursion as well as depth and pattern of respiration. ● Cardiovascular: blood pressure 100/60 mm Hg; cardiac monitor shows sinus tachycardia at 120 beats/min, with equal apical-radial pulse; temperature 101° F (38° C) orally. ● Gastrointestinal: surgical dressing dry and intact; sharp pain on palpation over incisional area ● Urologic: urinary catheter draining concentrated urine, less than 30 mL per hour Diagnostic Findings ● ABG results: pH 7.35, PaO2 59 mm Hg, PaCO2 27 mm Hg, bicarbonate 16 mEq/L, O2 sat 89%. ● Chest x-ray shows new scattered interstitial infiltrates compatible with an ARDS pattern as interpreted by the radiologist. Critical Thinking Questions 1. How does the pathophysiology of ARDS predispose to the development of refractory hypoxemia? - Alveolar injury causes the release of proinflammatory cytokines that pull neutrophils into the lungs. These neutrophils become activated and release toxic mediators - The released toxic mediators damage both the capillary and alveolar endothelium - The permeability of the alveolocapillary membranes is increased which allows fluid to start to accumulate within the lung interstitial, alveolar spaces and the small airways - This buildup of fluid causes the lung to stiffen - This stiffening of the lung causes ventilation to become impaired, which reduces the oxygenation of pulmonary capillary blood - Capillary pressure becomes elevated leading to an increase in interstitial and alveolar edema - Alveolar closing pressure exceeds pulmonary pressures causing alveoli to close and collapse - Supplemental oxygen is not able to correct this oxygen problem 2. What clinical manifestations does Mr. S. exhibit that support a diagnosis of ARDS? - Heart rate of 120 bpm (sinus tachycardia) abilities to perform tasks. OT can work with him to meet his goals and get back to his abilities prior to surgery - Nutrition – a pt. needs to maintain a good diet after surgery to promote healing. Since he had complications and since it was abdominal surgery there is a chance he may not want to eat or will need other forms of nutrition to meet his needs. Dietary/nutritionist will be able to figure out the correct way to keep the pts. Nutrition balanced - Spiritual care – surgery itself can be a stressful thing and can be even more stressful when there are complications. Spiritual care will allow for the pt. to have his spiritual or religious needs met. This may help with his coping and help him heal emotionally as well as physically. - Physician – since the pt. is having continual problems there will likely be a lot of communication with the physician about what they would like to do next. The physician is the one that will generally be making all of the calls about the treatment and care that will be given to the pt. 8. Mr. S. needs to be placed on a mechanical ventilator. Explain mechanical ventilation and indication for use. - There are two different types of mechanical ventilation: non-invasive and invasive. The two types of non-invasive options include BiPAP (provides 2 levels of airway pressure) and CPAP (provides 1 level of airway pressure). Both BiPAP and CPAP use air pressure as a splint in order to keep the airway open and they also prevent the body from obstructing itself. Invasive mechanical ventilation involves the usage of an endotracheal tube, a nasogastric tube and a mechanical ventilator. This option involves the control of inspiratory and expiratory pressure. - The usage of mechanical ventilation may come about for multiple different reasons. Some of these include, during surgery to control respirations, to oxygenate the blood when a patients ventilatory efforts are not adequate and to give the respiratory muscles a break and time to rest. - Mechanical ventilation is generally indicated when a patient has a compromised airway or respiratory failure. A patients arterial blood gas levels are a good indicator of when these measures are indicated. 9. What are the classification of ventilators and explain each one? - There are two different classifications of ventilators, including positive- pressure ventilators and negative-pressure ventilators. - Negative-pressure ventilators: o Older methods of ventilatory support and are generally not used anymore - Positive-pressure ventilators: o Inflate the lungs by exerting positive pressure on the airway, pushing air in, and forces the alveoli to expand during inspiration o Expiration occurs on its own (passively) o A tracheostomy or endotracheal intubation may be needed o Three types classified by the method of ending the inspiratory phase of respiration ▪ Volume cycled • Deliver a preset volume of air with each inspiration • After the preset volume is delivered, the ventilator turns off and exhalation occurs on its own • Volume of air delivered is constant and consistent with adequate breaths ▪ Pressure cycled • Delivers a flow of air (inspiration) until it reaches a preset pressure, cycles off and expiration occurs • Volume of air or oxygen can vary with resistance or compliance changes • Volume of air delivered may be inconsistent ▪ High-frequency oscillatory support • Deliver very high respiratory rates (180-900 breaths per minute) along with very low tidal volumes and high airway pressures • Small pulses of oxygen enriched air go down through the center of airways, giving the alveolar air to exit the lungs around the outer part of the airway • Used in situations with closed small airways o One type that does not require intubation ▪ Noninvasive positive-pressure ventilation (NIPPV) • Given via facemasks that cover the nose and mouth • Endotracheal intubation or tracheostomy are not needed • Indicated in acute or chronic respiratory failure, acute pulmonary edema, COPD, chronic heart failure or a sleep-related breathing disorder • CPAP – most effective treatment for obstructive sleep apnea o Positive pressure acts like a splint which keeps the upper airway and trachea open while a person is sleeping • BiPAP – offers independent control of inspiratory and expiratory pressures while providing pressure support ventilation o Delivers two levels of positive airway pressure o Inspirations can either by initiated by the patient or the machine – backup of the machine ensures that the patient receives a set number of breaths every minute gums, bruises,petechiae Omeprazol Prevent Antiulcer Back pain, Use cautiously Assess for e ulcers flatulence, with hypokalemia osteoporosis, gastrin nausea, and respiratory level rises in first 2vomiting, alkalosis weeks of therapy,abdominalpain, drug increases itsconstipation bioavailability withrepeated doses Albuterol Relaxes bronchodilato Bronchospasm, CV disorders, Monitor for sulfate bronchial r hypokalemia, hyperthyroidism effectivenessand tachycardia, or diabetes vascular epistaxis mellitus smoothmuscle Sodium Metabolic antacid Hypokalemia, Metabolic or Obtain blood pH,bicarbonat acidosis metabolic respiratory PaO2, PaCO2 ande alkalosis, alkalosis, electrolyte levelshypernatremia hypocalcemia,hypertension,seizures orheartfailure Morphine Pain Opioid Bradycardia, GI obstruction, Monitor vitals, pain sulfate analgesic cardiac arrest, head injury, level, respiratoryshock, increased ICP, status and sedationthrombocytopeni seizures, level. 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Monitorhepatitis, for signs anddiverticulitis, symptoms ofseizures. Pt. more infection, if therapysusceptibleto lasts longerthan 6infection weeks monitor IOP epinephrin Anaphylaxi vasopressor Cerebral Angle-closure Observe closely fore s hemorrhage, glaucoma, shock, adverse reactions. Ifstroke, organic brain BP increasessubarachnoid damage, HF, sharply, give rapid-hemorrhage, cardiac dilation, acting vasodilatorsventricular arrhythmias orfibrillation, cerebral shock arteriosclerosis. 12.Devise a detailed educational plan for a patient with ARDS. Include the family in the plan as well. - Disorder: ARDS is an abbreviate for acute respiratory distress syndrome – it is a serious lung problem that keeps you from getting enough oxygen into your blood. Fluid builds up within the lungs causing increased pressure making it more difficult to breath. This lack of oxygen to your blood means you are unable to get enough oxygen to the rest of your body. There is many different reason ARDS can develop, in your case it is likely from the blood transfusion you received due to your surgery complications. When not treated promptly, this can be life threatening. - Medications: o Analgesic – pain medication may be used in order to help relieve some discomfort. Take medication before pain becomes severe. The medication may cause dizziness, ask for help when needed and do not drive. o Antibiotic – to help fight/prevent infection caused by bacteria. Take the prescribed dose and do not stop taking them even if you start to feel better. - Breathing exercises: due to the fluid build-up in the lungs, while active you may become short of breath. Practicing deep breathing can help with this. Breathe using your diaphragm and with pursed or puckered lips. - Complications: o Pneumothorax o Respiratory failure o Blood clot o Pneumonia o Lung scarring - Mechanical ventilation: Since the supplemental oxygen was not helping you the way your doctor