Nursing Prioritization Delegation Assignment Q 66
A patient with acute respiratory distress syndrome (ARDS) is receiving oxygen by a non-rebreather mask, but arterial blood gas measurements still show poor oxygenation. As the nurse responsible for this patient’s care, you would anticipate a physician order for what action?
A. Perform endotracheal intubation and initiate mechanical ventilation.
B. Immediately begin continuous positive airway pressure (CPAP) via the patient's nose and mouth.
C. Administer furosemide (Lasix) 100 mg IV push stat.
D. Call a code for respiratory arrest.
Correct Answer: A. Perform endotracheal intubation and initiate mechanical ventilation
A non-rebreather mask can deliver nearly 100% oxygen. When the patient’s oxygenation status does not improve adequately in response to the delivery of oxygen at this high concentration, refractory hypoxemia is present. Usually, at this stage, the patient is working very hard to breathe and may go into respiratory arrest unless healthcare care providers intervene by providing intubation and mechanical ventilation to decrease the patient’s work of breathing.
Option B: To maintain oxygenation, ARDSnet recognizes the benefit of PEEP. The protocol allows for a low or a high PEEP strategy relative to FiO2. Either strategy tolerates a PEEP of up to 24 cm HO in patients requiring 100% FiO2. Interestingly, the mode in which a patient is ventilated affects lung recovery. Evidence suggests that some ventilatory strategies can exacerbate alveolar damage and perpetuate lung injury in the context of ARDS.
Option C: The chief treatment strategy is supportive care and focuses on 1) reducing shunt fraction, 2) increasing oxygen delivery, 3) decreasing oxygen consumption, and 4) avoiding further injury. Patients are mechanically ventilated, guarded against fluid overload with diuretics, and given nutritional support until evidence of improvement is observed.
Option D: The major cause of death in patients with ARDS was sepsis or multiorgan failure. While mortality rates are now around 9% to 20%, it is much higher in older patients. ARDS has significant morbidity as these patients remain in the hospital for extended periods and have significant weight loss, poor muscle function, and functional impairment.