Acute Respiratory Distress Syndrome And Nursing Intervention

Acute Respiratory Distress Syndrome
Acute Respiratory Distress Syndrome
ARDS


–    Previously called adult respiratory distress syndrome.
–    Severe, acute lung injury involving diffuse alveolar damage, increased microvascular permeability and non cardiogenic pulmonary edema.
–    Fluid builds up in the lungs and causing them to stiffen. This impairs breathing, thereby reducing the amount of O2 in the capillaries that supply the lungs.
–    Alveolar capillary membrane injury lead to leakage of fluids into alveolar interstitial spaces and alteration in the capillary bed so ventilation and perfusion imbalance developed.

 

–    Assault to the pulmonary system.
–    Respiratory distress.
–    Decrease lung compliance.
–    Sever respiratory failure.
•    Hypoxia that persists even when oxygen is administered at 100%
•    Decreased pulmonary compliance
•    Dyspnea
•    Noncardiac-associated bilateral pulmonary edema
•    Dense pulmonary infiltrates seen on x-ray

Causes of Lung Injury in Acute Respiratory Distress Syndrome

•    Systemic inflammatory response is the common pathway.
•    Intrinsically the alveolar-capillary membrane is injured from conditions such as sepsis and shock.
•    Extrinsically the alveolar-capillary membrane is injured from conditions such as aspiration or inhalation injury.
•    Fat emboli and Oxygen toxicity
•    Trauma or fluid overload

Diagnostic Assessment

–    ABGs show respiratory or metabolic acidosis and hypoxemia that does not respond to increase (FiO2).
–    Chest x-ray show bilateral infiltrate (early stage) and Ground-glass appearance (end stage)
–    Blood culture shows infectious organism.
–    Sputum study reveals the infectious organism.

Clinical manifestation

–    Dyspnea, tachypnea.
–    Cyanosis.
–    Cough.
–    Crackles, decrease breath sounds.
–    Anxiety, restlessness.

Treatment and Intervention

•    Treat the cause of ARDS.
•    Oxygen therapy (FM, NC).
•    Mechanical Ventilator (high PEEP without raising FiO2 to reduce risk of O2 toxicity and provide suction to remove of secretions.
•    Monitor (V/S, I&O, and CVP).
•    Bed rest with prone position or high fowler position to promote oxygenation and chest expansion.
•    Blood and fluid therapy.
•    Diuretics (Lasix) and Steroids (hydrocortisone).
•    Monitor pulse oximetry, laboratory studies.

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Posted in Critical Care Nursing, Respiratory

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