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ACNP 2 Midterm Exam – Correctly Answered Questions
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ACNP 2 Midterm Exam – Correctly Answered Questions
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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
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