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ARDS, Cites: Ignatavicius, D., Workman, L., Rebar, C., & Heimgartner,…
ARDS
Pathophysiology
ARDS is acute respiratory failure with these features:
hypoxemia that persists even when 100% oxygen is given (refractory hypoxemia)
decreased pulmonary compliance
dyspnea
non cardiac associated bilateral pulmonary edema
dense pulmonary infiltrates on x-ray (ground-glass appearance)
Occurs after an acute lung injury
systemic inflammatory response injuries the alveolar- capillary membrane. It becomes permeable to large molecules (normally is only permeable to small membranes), and the lung space is filled with fluid
a reduction in surfactant weakens the alveoli, which causes collapse or filling of fluid
causes:
sepsis is most common cause
direct lung injury, pneumonia, near drowning, or inhaling toxic fumes
shock, DIC, aspiration, pulmonary emboli, pneumonia, multiple blood transfusions, drug ingestion
Patient Education
If the patient is being mechanical ventilation, explain to the family why they have a tube down their throat and why its necessary
During intubation, explain if you can to the patient and the family what you are doing
Explain to the patient that they will wake up with a tube down their throat and they may have soft wrist restraints on
Establish a communication method before intubating if possible
If patient is in prone position explain to family why patients with ARDS do better in that position
Assessment
Manifestations:
dyspnea, bilateral pulmonary edema, reduced lung compliance, patchy bilateral pulmonary infiltrates, severe hypoxemia despite administration of 100% oxygen
labs
ABGs
PaO2 less than 60 mmHg and oxygen saturation less than 90% on room air
PaCO2 greater than 45 mmHg and pH less than 7.35
diagnostic:
chest x - ray (showing pulmonary edema, infiltrates)
ECG - to rule out cardiac involvement
hemodynamic monitoring (important for fluid management)
Asses and note sputum color and amount, assess lung sounds, monitor for pneumothorax, continually monitor vital signs
Interventions
Priority is early recognition of patients at high risk
Follow good hand hygiene, infection control guidelines, and contact precautions
Meds
benzodiazepines
reduces anxiety and resistance to ventilation
Corticosteriods
reduces WBC migration and decreases inflammation
Opioids
pain management
neuromuscular blocking agents
Antibiotics
Fluid Therapy
Alternative therapies
Mechanical Ventilation
Prone positon
Airway pressure release ventilation (APRV) and high frequency oscillatory ventilation (HFOV) are alternative therapies to intubation and mechanical ventilation
ECMO if needed
Cites:
Ignatavicius, D., Workman, L., Rebar, C., & Heimgartner, N. (2021). Medical-surgical nursing:
Patient-centered collaborative care.
Evolve
, (10th ed.). ISBN: 978-0-323-61242-5
Holman, H. C., Williams, D., Johnson, J., Ball, B. S., Wheless, L., Leehy, P., & Lemon, T. (2019). RN Adult medical surgical nursing: Review module. Assessment Technologies Institute