Causes and Nursing Management of Acute Respiratory Distress Syndrome

Definition of Acute Respiratory Distress Syndrome (ARDS):

ARDS (acute respiratory distress syndrome) may be defined as acute, diffuse pulmonary inflammatory response to either direct (via airway or chest trauma) or indirect blood-borne insults that originate from extra pulmonary pathology. It is frequently associated with other organ dysfunction (kidney, heart, gut, liver, coagulation) as a part of multiple organ failure.

It is characterized by-

• Neutrophil sequestration in pulmonary capillaries.
• Increased capillary permeability, protein-rich pulmonary oedema with hyaline membrane formation.
• “Damage to type 2 pneumocytes leading to surfactant depletion.
• Alveolar collapse and reduction in lung compliance.

The criteria defining ARDS are:

• Hypoxaemia defined as Pa02/ F102( <200 mmHg).
• Chest radiograph showing diffuse bilateral infiltrates.
• Absence of a raised left atrial pressure.
• Impaired lung compliance.

Causes of ARDS /Conditions Predisposing to ARDS:

A. Inhalation (direct):

• Aspiration of gastric contents,
• Toxic gases/burn injury,
• Pneumonia,
• Blunt chest trauma,
• Near-drowning.

B. Blood-borne indirect):

• Sepsis,
• Necrotic tissue (particularly bowel),
• Multiple traumas,
• Pancreatitis,
• Cardiopulmonary bypass,
• Severe burns,
• Drugs (heroin, barbiturates, thiazides),
• Major blood transfusion reaction,
• Anaphylaxis (wasp, bee, snake venom),
• Fat embolism,
• Carcinomatosis,
• Obstetric crises (amniotic fluid embolus, eclampsia).

How will You Manage a Case of Acute Respiratory Distress Syndrome (ARDS)?

Management of Acute Respiratory Distress Syndrome (ARDS):

Clinical Features of Acute Respiratory Distress Syndrome (ARDS):

• Rapidly progressive dyspnoea,
• Tachypnoea.
• Central cyanosis, refractory to 02 therapy.
• Bilateral crepitation, inspiratory rhonchi
• Intercostal indrawing.

Investigation:

1. Chest x-ray:

• Bilateral, diffuse fluffy shadow,
• Ground glass appearance in lung fields.

2. Arterial blood gas analysis.
3. Left atrial pressure measurement.

Treatment of Acute Respiratory Distress Syndrome (ARDS):

A. Supportive Rx:

a) Rest with propped up position

b) Oxygen inhalation with high inflation pressure & high conc. 02,

c) Positive end expiratory pressure (PEEP) by mechanical ventilation.

d) High dose of corticosteroid

e) Inhalation of nitric oxide may improve gas exchange.

B. Early & effective treatment of precipitating cause.

D/D:

• Acute left ventricular failure (LVF),
• Lung fibrosis.

Nursing Management of Acute Respiratory Distress Syndrome (ARDS):

Nursing assessment:

• Assess and note dyspnea, tachypnea, internal-muscular traction, fatigue, or pulmonary edema.
• Assess breath sounds.
• Assess the level of consciousness and ability to tolerate increased work of breathing,
• Assess the signs of hypoxemia and hypercapnia.

Nursing diagnosis:

• Ineffective breathing pattern,
• Impaired Gas Exchange,
• Ineffective airway clearance,
• Decreased Cardiac Output,
• Risk for Injury,
• Excess Fluid Volume,
• Impaired Verbal Communication,
• Impaired Physical Mobility,
• Impaired Skin Integrity,
• Sleep Pattern Disturbance,
• Ineffective Coping.

Expected outcomes:

• Stating/show loss of dyspnea.
• Maintain a patent airway with breath sounds clean / no crackles.
• Issued a secret without difficulty.
• Show behavior to improve/ maintain airway clearance.

Nursing intervention:

• Maintain a patent airway by suctioning. Use sterile, non-traumatic technique.
• Ensure adequate humidification to help liquefy tenacious secretions.
• Provide any other means of communication for the patient on mechanical ventilation.
• Gives sedatives as ordered to reduce restlessness.
• Reposition the patient often. A high fowler position may be needed.
• Note and record any changes in respiratory status, temperature, or hypotension that may indicate a deteriorating condition.
• Record caloric intake. Administer tube feedings and parenteral nutrition as ordered.
• To promote health and prevent fatigue, arrange the alternate periods of rest and activity.
• Maintain joint mobility by performing passive range-of-motion exercises.
• Provide meticulous skin care to prevent skin breakdown.
• Provide emotional support.
• Monitor the patient’s level of consciousness, noting confusion or mental sluggishness.
• Closely monitor the patient’s heart rate and blood pressure
• Frequently evaluate the patient s serum electrolyte levels.
• Monitor and record the patient’s response to medication.
• Evaluate the patient’s nutritional intake.

Maria Mona

Maria Khatun Mona is a Founder and Editor of Nursing Exercise Blog. She is a Nursing and Midwifery Expert. Currently she is working as a Registered Nurse at Evercare Hospital, Dhaka, Bangladesh. She has great passion in writing different articles on Nursing and Midwifery. Mail her at “[email protected]”