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Saturday, February 21, 2015

ARDS {Acute Respiratory Distress Syndrome} Explained Incredibly Easy

ARDS, Acute respiratory distress syndrome, sepsis, shock, icu, nurse, medical, nursing student, NCLEX, study tips, nursing school

ARDS {Acute Respiratory Distress Syndrome} 


I've had several patients the past couple weeks with ARDS. I needed to refresh my memory on the syndrome.

ARDS is a progressive and sudden form of acute respiratory failure. You'll see these patients in the ICU. It's life threatening. In this post I'll talk about the causes, patho, prognosis, and a couple nursing diagnosis for this type of patient.



Possible Causes of ARDS


ARDS is always secondary to another condition.

  • Sepsis - This is what caused my patients' to develop ARDS. 
  • Trauma
  • Pneumonia, or other assaults to the lungs
  • Inhalation of smoke/fumes
  • Aspiration
  • Excess Sedation or Narcotics
  • Shock
  • Multiple blood transfusions

Pathophysiology of ARDS


An inflammatory response occurs that alters the capillary membrane permeability. This allows fluid to then flow into the alveoli which will severely decrease the oxygenation of the blood. On X-rays the lungs show up as all white. The entire lung is full of infiltrates.

Clinical Signs of ARDS


  • Tachypnea and Cyanosis- this is the major signs of ARDS
  • Using accessory muscles
  • Tachycardia
  • Mental status changes
  • Abnormal ABGs- Here's a previous post you might want to glance at: The Ultimate Guide to ABGs
  • Increased dead space

Prognosis


ARDS is serious stuff. It has a 40-70% mortality rate. There are around 150,000 cases annually. ARDS from septic shock are especially worse cases. It takes weeks to months to have clear lungs again. It can result in permanent lung damage.


Diagnosis


  • Chest X-ray- it will show both lungs as being all white because they are full of fluid in their alveoli
  • ABGs- Abnormal labs that show a low level of oxygen 
  • Ruling out other possibilities
  • Bronchoscopy
  • Lung biopsy- when it's hard to establish a diagnosis

Treatment


Like everything else I ever say, it's all about treating the underlying issue. If it's from a severe infection you'll be giving antibiotics. etc.

The patient will be on mechanical ventilation, so as the nurse it is your job to monitor that ventilator is set on the correct settings to improve gas exchange. PEEP will be high to keep the alveoli open. You'll monitor those ABGs to watch the level of oxygen. Also, the patient is most likely going to be on sedation, so you might need to give them a sedation vacation (one of my favorite things to say) to assess their neuro status to see if anything has changed. Monitor their I & O for risk of fluid imbalances. We use a Roto Prone bed to place our patients in a prone position. Be sure to assess for skin breakdown where the endotracheal tube is going into the mouth and watch for pressure on your patient's cheeks. 

Nursing Diagnosis for ARDS


  • Impaired Gas Exchange- Goal is to maintain tissue oxygenation. Monitor vital signs and blood gases, monitor the effects repositioning has on the patient's oxygen levels. My patients would desat very fast when I laid them down flat to roll them or pull them up in bed. Provide mechanical ventilation support.
  • Ineffective Airway Clearance- Goal is to have clear lungs. Clear lungs take weeks to months to happen. Assess lung sounds, vitals, suction, humidify your patient's oxygen, raise the head of bed, monitor secretions.
  • Ineffective Breathing Pattern- Goal is to have normal respirations. Listen to lung sounds, assess the usage of any accessory muscles, encourage pursed lip breathing, maintain airway in your intubated patients.

OK guys. That's pretty much ARDS summed up for you.

Since your patient with ARDS will be on a vent you might want to check out my post: Ventilators Explained Extremely Easy!

You might also want to check out my ebook for $3.99 Easy Guide to Interpret Acid - Base Imbalances. If your patient has ARDS, then you'll be drawing ABGs every 6 hours or more. This is a quick guide to teach you once and for all how to interpret those lab values. It took me four different teachers, in four different classes before I FINALLY had it explained the correct way. It's cheaper than your lunch, and you don't have to have a kindle to read it!

What's something positive that's happened to you this week? It's cold outside and we can all use a little pick me up. Leave a comment below!

Xoxo,

Nightingale

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