Adult Health- Part 2

Acute Nephrolithiasis, ARDS- (Acute resp distress syndrome),

What is ARDS?

A: Acute Respiratory Distress Syndrome—life-threatening respiratory failure caused by injury to the alveoli and capillaries.

What causes ARDS?

A: Damage to the alveolar-capillary membrane → increased permeability → fluid leaks into alveoli.

Why does oxygenation decrease in ARDS?

A: Fluid in the alveoli prevents normal gas exchange.

What happens to lung compliance in ARDS?

A: Lung compliance decreases (stiff lungs).

What is a cytokine storm?

A: Massive inflammatory response that damages the alveoli and pulmonary capillaries.

What are common causes/risk factors for ARDS?

A:

• Sepsis

• Pneumonia

• Aspiration

• Acute pancreatitis

• Near drowning

• Severe burns/trauma

What are the classic signs of ARDS?

A:

• Severe dyspnea

• Refractory hypoxemia

• Tachypnea

• Accessory muscle use

• Crackles

• Anxiety

What is refractory hypoxemia?

A: Low oxygen levels that do not improve despite increasing oxygen therapy.

What diagnostic findings are seen in ARDS?

A:

• ABGs: Hypoxemia ± respiratory acidosis

• Chest X-ray: Diffuse bilateral infiltrates ("white-out")

What are the priority nursing interventions for ARDS?

A:

• Oxygen therapy

• Mechanical ventilation with PEEP

• Prone positioning

• Fluid restriction (if ordered)

• Frequent ABGs

Why is PEEP used in ARDS?

A: Keeps alveoli open, improving oxygenation.

Why is prone positioning helpful in ARDS?

A: Improves ventilation and oxygen exchange.

What complications should nurses monitor for in ventilated ARDS patients?

A:

• Barotrauma (pneumothorax)

• Hypotension

• Delirium

• Stress ulcers

• Acute kidney injury (AKI)

• DVT

What nursing care helps prevent complications while intubated?

A:

• DVT prophylaxis

• Monitor intake & output

• Frequent ABGs

• Increase FiO₂ to 100% before suctioning (per protocol)

Nephrolithiasis

Formation fo stones (renal calculi) within the urinary tract.

How do kidney stones form

Salts in concentrated urine crystallize → crystals aggregate → stones form.

where do kidney stones usually form

in the kidneys, then travel through the urinary tract

what are the three major types of kidney stones

Calcium (most common), uric acid (gout-related), Struvite (infection- related)

which kidney stones are associated with UTIs

struvite stones

which type of stones are associated with gout

Uric acid stones

What are the major risk factors for nephrolithiasis

Dehyudration, Hypercalcemia, Hyperparathyriodism, Family history, Immobilization, Gout, Chronic urinary stasis/UTIs.

Why does dehydration increase kidney stone risk

concentrated urine promotes crystal formation

what is the classic pain of nephrolithiasis

Severe flank pain radiating to the groin (renal colic)

Renal colic

Severe, intermittent flank pain caused by a kidney stone

Kidney stone dance

The patient constantly changes position because they cannot get comfortable.

What symptoms commonly occur with kidney stones

flank pain, n/v, hematuria, dysuria, urinary urgency-frequency

why do kidney stones cause hematuria

the stones irritates and scratches the urinary tract

How is nephrolithiasis diagnosed?

A:

• CT scan (gold standard)

• Ultrasound for pregnancy or children

Why should passed stones be strained and analyzed?

A: To determine the stone composition and underlying cause.

What are complications of kidney stones?

A:

• Urinary obstruction

• Hydronephrosis

• Infection

• AKI (if prolonged obstruction)

What is hydronephrosis?

A: Swelling of the kidney due to urine backing up behind an obstruction.

What are the priority nursing interventions for nephrolithiasis?

A:

• Pain management

• Increase fluids (if not contraindicated)

• Antiemetics

• Strain urine

• Encourage ambulation

• Monitor kidney function

What is lithotripsy?

A: Shock waves are used to break large kidney stones into smaller fragments.

What teaching is important before lithotripsy?

A:

• NPO before procedure

• Obtain informed consent

What findings are expected after lithotripsy?

A:

• Mild flank pain

• Slight hematuria

• Sand-like stone fragments in urine

• Mild flank bruising