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ACUTE RESPIRATORY DISTRESS SYNDROME ARDS_

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Introduction to Critical Care Nursing (3rd Edition) Sole, Lamborn, ... Diaphoresis. Crackles, Rhonchi, and Bronchial Sounds. Vitals Signs. Fever. Hypotension ... – PowerPoint PPT presentation

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Title: ACUTE RESPIRATORY DISTRESS SYNDROME ARDS_


1
ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS)_
  • Presented and Modified by
  • Christopher W. Blackwell, ARNP, MSN, PhD(c)
  • Based on
  • Materials Prepared by
  • Lucy Baccus Stella, RN, MN
  • and
  • Introduction to Critical Care Nursing (3rd
    Edition) Sole, Lamborn, Hartshorn (2001)

2
Definition
  • Noncardiac pulmonary edema
  • A form of respiratory failure
  • Complication of hospitalized patients
  • Serious med-surg problem
  • May not be lung related
  • Mortality remains 50-60

3
Pathophysiology
  • Frequently associated
  • Low perfusion
  • Single organ
  • Multi-organ (MODS)
  • Total body system (shock)
  • Etiology Severe CNS Disorder, Trauma, CVA, Inc.
    CSF.
  • Hallmark of ARDS
  • Hypoxia

4
Pathophysiology
  • Other characteristics
  • Severe dyspnea
  • Diffuse bilateral infiltrates

5
Pathophysiology
  • Injury to lungs (Scoring)
  • Abnormal gas exchange
  • Intrapulmonary shunting
  • Reduced lung compliance
  • Decreased surfactant activity
  • Amt. of Infiltrates on CXR.
  • Degree of Hypoxemia.
  • Amount of PEEP.
  • Static Lung Compliance.

6
Pathophysiology
  • Physiologic alterations
  • Injury to pulmonary endothelium and alveolar
    epithelium causes increase in lung permeability.
  • Fluid leaks into interstitial spaces causing
    pulmonary edema.
  • INCIDENCE AND PREVALENCE

7
Pathophysiology
  • Physiologic alterations
  • Injury to Type II pneumocytes, causes increase in
    surface tension and atelectasis
  • Alveolar-capillary membrane damage, inflammation
    occurs, substances gather at site of injury
    decreasing gas exchange

8
Pathophysiology
  • American-European Consensus Conference (1994)
    Defines ARDS as
  • PaO2/FiO2 lt200
  • Bilat. Infiltrates
  • PCWP lt18mm Hg (or more easily understood, no
    clinical evidence of L Atrial HTN).

9
Pathophysiology
  • Results of physiologic alterations
  • Ventilation-perfusion anomalies
  • Decreased lung compliance
  • Increase work of breathing

10
Etiology
  • No single exogenous or endogenous precipitating
    factor? Multiple causes.
  • Exact causative mechanism is unknown
  • Direct and Indirect Causes

11
Etiology
  • Many conditions associated
  • Most common
  • Non pulmonary
  • Gram (-) sepsis
  • Trauma
  • Pulmonary related
  • Aspiration
  • AIDS/PCP
  • Near drowning
  • Pulmonary embolism

12
Etiology
  • Other conditions
  • Amniotic fluid embolism
  • Bowel infarction
  • Drug abuse
  • Multiple fractures
  • Heat stroke
  • Peritonitis
  • Multiple blood transfusions

13
Clinical manifestations
  • Acute respiratory failure
  • Change in Personality, disorientation, dec. LOC.
  • Initial Dyspnea w/ Hyperventilation (Tachypnea)
  • Grunting respirations
  • Cyanosis
  • Pallor
  • Retractions

14
Clinical manifestations
  • Dry cough
  • Diaphoresis
  • Crackles, Rhonchi, and Bronchial Sounds.
  • Vitals Signs
  • Fever
  • Hypotension
  • Tachycardia (dysrhythmias)
  • Altered sensorium
  • PaCO2 dec.? Resp. Alkalosis (initial)
  • Lactic Acid? Met. Acidosis (later)

15
Diagnostic studies
  • Radiologic
  • CXR
  • Diffuse, bilateral infiltrates
  • Laboratory
  • ABGs
  • Hypoxemia
  • Respiratory alkalosis

16
Phases of ARDS
  • Phase I
  • Client exhibits dyspnea and tachypnea
  • Support client with oxygenation
  • Phase 2
  • Increasing pulmonary edema
  • Mechanical ventilation support

17
Phases of ARDS
  • Phase 3
  • Progressive refractory hypoxemia
  • Maintain oxygenation
  • Prevent complications
  • Phase 4
  • Pulmonary fibrosis pneumonia
  • Chronic problem
  • Maybe ventilator dependent

18
Management
  • Vent. Settings should be Lung-Protective.
  • Unconventional Modes (High Frequency Ventilation,
    Pressure-Controlled Ventilation, and
    Inverse-Ratio Ventilation) have failed to
    demonstrate efficacy and are not standard
    acceptable Tx.

19
Nursing diagnosis
  • Anxiety
  • Impaired gas exchange
  • Altered nutrition
  • Depression
  • Decreased cardiac output
  • Knowledge deficit

20
Interventions
  • Assess
  • Sputum production
  • Oxygenation
  • Heart sounds
  • Lung sounds
  • Urinary output
  • Cardiac rhythm

21
Interventions
  • Monitor
  • ABGs
  • Pulse oximetry
  • Ventilator settings
  • Fluid maintenance
  • Teach
  • Ventilator
  • Lines

22
Medical management
  • Ventilator
  • IMV
  • PEEP
  • Fluid control
  • Swan Ganz line

23
Medical management
  • Medications
  • Diuretics
  • Anti anxiety
  • Neuromuscular blocking agents
  • Analgesics
  • Antibiotics
  • Dopamine
  • Corticosteroids

24
Nursing Management
  • Possible Prone Positioning (Vollman, 1997).
  • F/E Balancing Monitor R Arterial Pressure (RAP)
    and Pulmonary Artery Diastolic (PAD) Pressure.
  • Nutrition ARDS increases nutritional
    requirements by 1.5 to 2 times.

25
Nursing Management
  • Psychosocial Support
  • Complications of ARDS
  • 1. Heart failure
  • 2. Acidosis
  • 3. Hyper- hypo- kalemia
  • 4. De- over- hydration
  • 5. Pulmonary embolism

26
Nursing Management
  • Cardiac arrest
  • DIC
  • GI bleed
  • Renal failure
  • Prognosis
  • Pts. Who recover typically return to
    relatively normal lung function. Studies of ARDS
    survivors from 9 months- 4 years after lung
    injury show a mild restrictive pulmonary function.
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