ARDS

Question 1

What is Acute Respiratory Distress Syndrome (ARDS)?

Answer 1

A serious condition where the lungs become severely inflamed and filled with fluid, causing difficulty breathing and low oxygen levels.

Question 2

What ventilator settings are typically needed in ARDS?

Answer 2

Low tidal volume and high PEEP.

Question 3

What are the causes of ARDS?

Answer 3

Pneumonia, inhalation injuries, trauma, COVID, aspiration, sepsis.

Question 4

What must happen to trigger ARDS?

Answer 4

An assault to the respiratory system.

Question 5

How quickly does ARDS progress after lung injury?

Answer 5

Within 24–48 hours.

Question 6

Can ARDS be reversed?

Answer 6

Yes, if caught early.

Question 7

What happens if ARDS is not treated?

Answer 7

Multisystem organ failure.

Question 8

What is the mortality rate of untreated ARDS?

Answer 8

30%–40% (due to multisystem organ failure).

Question 9

What is the first phase of ARDS?

Answer 9

Exudative Phase.

Question 10

What happens in the Exudative Phase?

Answer 10

Damage to alveolar epithelium & vascular endothelium → leakage of water, protein, inflammatory cells, and RBCs into interstitium and alveoli.

Question 11

When does the Exudative Phase occur?

Answer 11

First 7 days after exposure to an ARDS risk factor.

Question 12

What is the second phase of ARDS?

Answer 12

Proliferative Phase.

Question 13

What happens in the Proliferative Phase?

Answer 13

Type II cells proliferate, epithelial regeneration, fibroblastic reaction, remodeling.

Question 14

How long does the Proliferative Phase last?

Answer 14

About 7–10 days.

Question 15

What typically happens to patients in the Proliferative Phase?

Answer 15

Most recover rapidly and are weaned from the ventilator.

Question 16

What is the third phase of ARDS?

Answer 16

Fibrotic Phase.

Question 17

What happens in the Fibrotic Phase?

Answer 17

Collagen deposition in alveolar, vascular, and interstitial beds, microcyst formation, fibrotic lung tissue.

Question 18

Can Fibrotic Phase ARDS be fixed?

Answer 18

No, lung fibrosis is irreversible.

Question 19

Clinical manifestation of ARDS: respiratory rate?

Answer 19

Tachypnea.

Question 20

Clinical manifestation of ARDS: breathing effort?

Answer 20

Dyspnea, severe SOB, retractions.

Question 21

Clinical manifestation of ARDS: lung sounds?

Answer 21

Crackles due to fluid accumulation (especially at lung bases).

Question 22

Clinical manifestation of ARDS: oxygen levels?

Answer 22

Low O2 levels (early within 24–48 hrs, even with nasal cannula).

Question 23

Clinical manifestation of ARDS: skin color?

Answer 23

Cyanosis.

Question 24

Clinical manifestation of ARDS: neurologic/mental?

Answer 24

Restlessness, anxiety.

Question 25

What do ABGs show in ARDS?

Answer 25

Decreased PaO2 (hypoxemia).

Question 26

Diagnostic criteria for ARDS?

Answer 26

History, physical exam, lab studies, ABGs, blood cultures, imaging (CXR, CT chest).

Question 27

What lab study may indicate infection in ARDS?

Answer 27

CBC (elevated WBCs).

Question 28

What blood test helps detect sepsis in ARDS?

Answer 28

Blood cultures.

Question 29

What imaging study may appear normal early in ARDS but worsen later?

Answer 29

Chest radiograph (progresses to infiltrates/whiteout).

Question 30

What does a chest CT help with in ARDS?

Answer 30

Assessing the extent of ARDS.

Question 31

ABG finding: PaO2 in ARDS?

Answer 31

Low due to poor oxygenation from fluid/inflammation.

Question 32

ABG finding: PaCO2 in early ARDS?

Answer 32

Normal or low (hyperventilation).

Question 33

ABG finding: PaCO2 in severe ARDS?

Answer 33

Elevated, indicating respiratory failure.

Question 34

ABG finding: pH in early ARDS?

Answer 34

Respiratory alkalosis (from hyperventilation).

Question 35

ABG finding: pH in late ARDS?

Answer 35

Respiratory acidosis (from CO2 retention and inadequate ventilation).

Question 36

Why does respiratory alkalosis occur in early ARDS?

Answer 36

Patient compensates for low O2 by breathing faster, blowing off CO2.

Question 37

Why does respiratory acidosis occur in late ARDS?

Answer 37

Patient becomes fatigued and hypoventilates, retaining CO2.

Question 38

What is the primary treatment approach for ARDS?

Answer 38

Remove causative factor (treat underlying cause such as pneumonia or sepsis).

Question 39

What oxygen therapy is used in ARDS?

Answer 39

Mechanical ventilation with higher PEEP and low tidal volume.

Question 40

Positioning intervention for ARDS patients?

Answer 40

Prone positioning (improves oxygenation by reducing lung compression and enhancing gas exchange).

Question 41

Fluid management in ARDS?

Answer 41

Careful fluid balance—avoid overload.

Question 42

When are sedation and analgesics used in ARDS?

Answer 42

If needed for comfort and ventilator synchrony.

Question 43

What is ECMO and when is it used?

Answer 43

Extracorporeal Membrane Oxygenation: external machine oxygenates blood; used in severe, refractory ARDS when other treatments fail.

Question 44

How does ECMO work?

Answer 44

Blood is removed, oxygenated externally, and returned to the body, bypassing lung function.

Question 45

Nursing implication: airway?

Answer 45

Maintain airway and manage mechanical ventilation.

Question 46

Nursing implication: oxygenation?

Answer 46

Monitor O2 and respiratory status; ensure adequate oxygenation.

Question 47

Nursing implication: ventilator management?

Answer 47

Monitor PEEP, FiO2, tidal volume.

Question 48

Nursing implication: ABG monitoring?

Answer 48

Regularly assess ABGs for oxygenation/ventilation status.

Question 49

Nursing implication: hemodynamic function?

Answer 49

Support circulation and monitor blood pressure/CO.

Question 50

Nursing implication: proning?

Answer 50

Provide or assist with proning as ordered; advocate via SBAR if appropriate.

Question 51

Nursing implication: positioning?

Answer 51

Elevate HOB (unless prone).

Question 52

Nursing implication: antibiotics?

Answer 52

Administer if infection is present/causative.

Question 53

Nursing implication: fluids?

Answer 53

Monitor closely for fluid overload (avoid worsening pulmonary edema).

Question 54

Nursing implication: psychosocial?

Answer 54

Provide emotional support to patient and family; education.