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ARDS develops from an _______ injury.
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What are the 2 most common triggers of deaths in patients with ARDS?
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Sepsis and pneumonia
Most cases of VAP are the result of...
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aspiration of bacteria from the mouth and GI tract
For a patient with ARDS, enteral nutrition should begin within _______ of admission.
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24 hours
_______ = pulmonary edema, _______ = COPD, _______ = atelectasis or pleural effusion, _______ = pneumonia
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crackles = pulmonary edema, rhonchi = COPD, dimished/absent = atelectasis/effusion, bronchial sounds over lung periphery = pneumonia
How does milrinone lactate/ Primacor increase perfusion in ARDS patients?
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Inotrope and vasodilates pulmonary bed.
_______ is when the alveolar- capillary membrane becomes damaged and more permeable to intravascular fluid.
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Hypoxemia and a PaO2/FIO2 ratio below _______ despite increased FIO2 by mask, NC or ET tube are hallmarks of ARDS.
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below 200 (may have a normal PaCO2 despite severe dysnpnea and hypoxemia)
What are 4 direct lung injuries that can lead to ARDS?
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Near drowning, aspiration, chemical irritation, and aspiration pneumonia.
How does prone positioning benefit a patient with ARDS?
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Improves V/Q, increases aeration by decreasing compression of the posterior areas of the left lung by the heart, clears out debris, decreases inflammation, increases O2 and perfusion.
Which positional therapy can be used to position patients at angles up to 60 degrees?
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Kinetic (bilateral turning)
When placing someone prone, how should their arms be positioned?
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Swimmer's pose: one at side and one extended above head.
In a 24 hour period, an ARDS patient should be prone for at least _______.
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What are the disadvantages of prone positioning?
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Tube dislodgement, patient desaturation, skin breakdown, and facial edema.
How does mechanical ventilation positively impact the alveoli with ARDS?
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It opens them up.
A patient who is lateral or side-lying should be placed with the _______ lung down.
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What are the clinical signs of hypoxia?
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Changes in mental status like confusion; anxiety; dusky skin; and dysrhythmias.
What is the normal 1:E ratio?
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1:2, expiration twice as long as inspiration.
A _______ should be done if a PE is still suspected despite unclear findings from an EKG, CXR, ABGs, D-dimer and ultrasound.
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ventilation/perfusion scintigraphy, normal is 0.8:1 (*2 or more segmental perfusion defects = increased likelihood of PE)
How is a personal best determined for an asthmatic?
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Test 3 different times on 2 good days between 12-2 pm. *Check every morning and during attack against this personal best .
_______ is a highly accurate diagnostic tool for PE, but requires the patient to cooperate and hold their breath for 20-30 seconds.
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Computed tomography (Helical/spiral)
A saddle embolus is one that occludes...
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the bifurcation of the pulmonary artery
What test is useful in differentiating between massive PE and other causes of hemodynamic compromise?
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Echocardiography. *Can see RV hypocontractility and dysfunction.
What are the specific PaO2 and SaO2 goals when providing O2 therapy?
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PaO2 at 55-60 and higher; SaO2 at 90% or more on the lowest O2 concentration possible.
How is polycythemia treated in patients with COPD?
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Fluids, heparin/coumadin, and phlebotomy.
What % of oxygen concentration is delivered via BVM (bag-valve-mask)?
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For a patient with a PE, how frequently should neuro and vascular assessments be done to monitor therapy effects?
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What is the determining factor for whether a patient has ARDS or a heart problem?
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With ARDS, the pulmonary artery wedge pressure is 18 or less. (PAWP 18 or less)
How can you tell an acute lung injury is progressing to ARDS?
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A patient's O2 requirements increases but their SaO2 decreases. P/F decreases. Refractory hypoxemia
Patients with chronic hypercapnia (COPD) should get O2 delivered via _______ at a rate of _______.
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NC at 1-2 L/min; Venturi 24-28%

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