Exam (elaborations)
ACNP 2 Midterm Exam – Correctly Answered Questions
- Course
- Institution
ACNP 2 Midterm Exam – Correctly Answered Questions
[Show more]
Content preview
ACNP 2 Midterm Exam – Correctly Answered QuestionsCriteria for diagnosing ARDS Right Ans - Berlin Criteria
Acute onset (<7 days)
Bilateral diffuse opacities
Resp failure not r/t HF (echo, chest CT & BNP to r/o HF)
Mild: P/F 200-300 w/PEEP 5
Mod: P/F 100-200 w/PEEP 5
Severe: P/F < 100 w/PEEP 5
Risk factors for the development of ARDS Right Ans - Recent Hx of:
(inflammatory state) PNA, aspiration, trauma, embolism, near drowning,
inhalation injury, sepsis, cardiopulmonary bypass, OD, pancreatitis,
transfusion, transplant
Acute Hypoxemic Respiratory Failure Right Ans - Respiratory failure
occurring from impaired oxygenation
of the blood, usually defined as a PaO2 < 60 mmHg with
normal or low PCO2
PEEP to improve oxygenation Right Ans - May improve alveolar
recruitment, reduce
lung strain, and prevent atelectrauma
• Concern for end-inspiratory alveolar
overdistension, increased pulmonary shunt,
increased dead space, and higher PVR
presentation of a patient with ARDS Right Ans - Exudative Phase: immune
mediated damage → fluid accumulation
Proliferative Phase: repair, restoration of fluid and alveolar fxn
Fibrotic Phase: airspaces fill will granulation tissues & new parenchymal
cells/blood vessels → long term damage. This phase can last weeks & is linked
to prolonged ventilation & mortality
Bronchoconstriction d/t release thromboxane A2 & leukotriene B4 → ↑airway
resistance
Acute: ↑ permeability → pulm edema, hypoxia that initially improves w/↑
PEEP, ↓ compliance
Late: ↑ pulmonary vascular resistance d/t micro-clotting → RV dilation,
refractory hypoxia, ↓↓ compliance d/t fibrosis
, Ventilatory strategies in patient with ARDS Right Ans - TV 4-6 mL/kg IBW
(low)
Plateau pressure < 30
PEEP 10-15
Permissive hypercapnia w/goal pH > 7.2
Recruitment maneuvers
• Sustained inflation of lungs (specifically the
alveoli) to higher airway pressures and
volumes than during tidal ventilation for the
purpose of reducing atelectasis and
increasing end-expiratory lung volume
• Many methods, none proven superior
• Ventilation for 2 minutes in pressure-controlled
mode with inspiratory plateau pressure of 45
cmH2O, PEEP 5 cmH2O
• 40-second breath hold at 40 cmH20 airway
pressure with FiO2 1.0
• Progressive increase in PEEP (driving pressure)
until just below hemodynamic instability and then
hold for 2 minutes
RMs should be used cautiously with
patients with hypovolemia or who are in shock
Ventilator associated events and ventilator associated pneumonia prevention
strategies Right Ans - VAP
New/worsening fever, leukocytosis, purulent secretions, new infiltrates
VAP= 48 hrs or > after intubation
2nd most common nosocomial infection
Deadliest
Increase LOS by 7 days at least, cost by $40k
Risk factors
Anything increasing bacterial burden and aspiration risk
Prevention
Oral care
HOB elevated
Selective digestive or oral decontamination
PPI, H2 blockers
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller LeCrae. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $13.99. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
83100 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now