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How can you evaluate an ARDS patient's fluid volume status while they are on a ventilator?
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Blood pressure measurements, respiratory related variations of pulmonary and systemic arterial pulse pressures, central venous pressures and urine output.
How can an ARDS patient's intravascular status be evaluated while they are on a ventilator?
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Pulmonary artery catheter, cardiac output, cardiac index, pulmonary vascular resistance, and venous O2 saturation (essentially, using a Swan-Ganz and a pulse ox).
How does Dobutrex/dobutamine increase perfusion in ARDS patients?
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It is a positive inotrope that increases cardiac output which then increase oxygenation.
In _________ respiratory failure, the primary problem is the inability to ventilate out sufficient CO2.
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When is a diffuse limitation most likely to cause hypoxemia?
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During exercise and not during rest?this is considered a classic sign.
What 4 groups of conditions can lead to hypercapnic respiratory failure?
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Airway and alveolar abnormalities, central nervous system abnormalities, chest wall abnormalities, or neuromuscular conditions.
True or False? Placing a patient with ARDS on their stomach can improve their oxygenation.
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_________ results in pulmonary vasodilation when continuously inhaled. It is used for patients with ARDS, pulmonary hypertension and during and after cardiac surgery.
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Nitric Oxide (NO)
What are the 5 P's of ARDS therapy?
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Perfusion, positioning, protective ventilation, protocol weaning and preventing complications.
To effectively impact a patient with ARDS using positional therapy, they must be turned to _______ degrees or more.
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40 degrees
If a patient is supine (on their back), which part(s) of the lung is/are more perfused?
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The posterior areas
________ coughing is performed by placing a hand on the abdomen below the xiphoid process and pressing down forcefully during expiration.
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Augmented or Quad coughing. It is used if a patient has a neuromuscular weakness.
What phenomenon can cause hypoxemic or hypercapnic respiratory failure?
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Alveolar hypoventilation (from restrictive lung disease, CNS disease, chest wall problems, or neuromuscular disease).
Which phase of ARDS? Neutrophils damage vascular endothelium which increases capillary permeability. This leads to interstitial edema which causes an intrapulmonary shunt. This leads to atelectasis.
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The injury/exudative phase which occurs 1 to 7 days after the insult.
Which symptom of ARDS is caused by a V/Q mismatch?
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Hypoxemia refractory to O2
Which symptom of ARDS is caused by a diffusion based respiratory failure?
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Hyaline membrane formation (the diffusion) leads to severe hypoxemia.
________ is the term for lung injury that occurs when large tidal volumes are used to ventilate non-compliant lungs, as in the instance of ARDS.
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Which phase of ARDS? Increased neutrophils, monocytes, lymphocytes, and fibroblasts. Dense fibrous tissue forms resulting in pulmonary hypertension. At this point, respiratory failure is reversible.
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Reparative/Proliferative. This occurs about 1 to 2 weeks after the injury phase.
________ failure occurs when gas exchange across the alveolar-capillary membrane is compromised by a process that thickens or destroys it.
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Diffuse limitation
What conditions can cause a diffuse limitation?
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Severe emphysema, recurrent pulmonary embolisms, pulmonary fibrosis, interstitial lung disease or ARDS.
What position has been found to increase PaO2 in patients with ARDS?
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What is continuous lateral rotation therapy?
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An ARDS treatment that involves a slow, continuous rotation of the bed to less than 40 degrees to mobilize secretions and provide postural drainage.
_________ failure occurs when blood exits the heart without participating in gas exchange.
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What interventions can help manage excess lung secretions that can result in hypoventilation? (4)
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Turning every 1 to 2 hours, chest physiotherapy to lung areas with high secretions, encourage deep breathing and coughing, and suctioning.
What is permissive hypercapnia in relation to ARDS?
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The elevation in PaCO2 that occurs from using smaller tidal volumes (6 mL/kg) and varying PEEP
How does increased intrathoracic pressure from hyperventilation (a common complication of ARDS-related ventilatory treatment) impact the heart and cardiac output?
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It increases the right ventricle's afterload which limits blood flow from the right side of the heart to the left side of the heart. This decreases cardiac output which decreases blood return to the right side of the heart.
What technique increases SaO2 by slowing respirations, allowing prolonged expiration and preventing small bronchioles from collapsing?
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Pursed lip breathing
Why does pulmonary artery edge pressure remain normal in patients with ARDS?
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The cause of ARDS is non-cardiogenic
_________ is the term for a decreased PaO2 to a level where signs and symptoms are evident.
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What determines whether a patient has an acute lung injury (ALI) or ARDS?
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The P/F ratio (PaO2 to FiO2 ratio) which is a measure of the amount of oxygen given to the amount of oxygen in the blood.

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