Ards
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Ards Acute respiratory distress syndrome
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Ards
- 1. Care of the Client with Acute Respiratory Distress Syndrome (ARDS) 1
- 2. Acute Respiratory Distress Syndrome _____________________________________ Is a sudden, progressive disorder characterized by: 1. Acute Lung Inflammation 2. Diffuse Alveolocapillary Injury 2
- 3. Cause Of ARDS ___________________________ A. Insult (Bacteria) B. Medical Condition (Multiple Trauma, CABG, Burns) C. Noxious Event ( Smoke Inhalation, Radiation) 3
- 4. Conditions Causing ARDS ___________________________ 1. Direct Pulmonary Trauma 2. Indirect Pulmonary Trauma 4
- 5. Early Signs & Symptoms of ARDS _____________________________________ Rapid, Shallow Breathing Air Hunger Cough Restlessness Respiratory Alkalosis Marked Dyspnea Hypoxemia Lung Sounds Clear to Fine Crackles 5
- 6. ARDS -Later Signs & Symptoms ___________________________ Decreased Lung Compliance Diffuse Bilateral Crackles & Rhonchi Diffuse Bilateral Infiltrates Metabolic or Respiratory Acidosis Intercostal & Suprasternal Retractions Tachycardia & AMS Low PaO2 & High PaCO2 Cyanosis & Pallor Extensive Interstial & Alveolar Infiltrates (White Lung) 6
- 7. Clinical Progression of ARDS ___________________________________ Hyperventilation | Respiratory Alkalosis | Dyspnea & Hypoxemia | Metabolic Acidosis | Respiratory Acidosis | Further Hypoxemia | Hypotension & Decreased Cardiac Output | Death 7
- 8. Treatment Goals for Clients with ARDS _____________________________ 1. Respiratory Support 2. Treat Cause 3. Prevent Complications 8
- 9. Treatment for the Client with ARDS _____________________________ 1. Mechanical Ventilation with PEEP 2. Sedation 3. Neuromuscular Blocking Agents a. Pavulon (Pancuronium) b. Vecuronium c. Atracuronium 9
- 10. Treatment for the Client with ARDS _____________________________ 4. Sedative/Anesthetic Agent a. Diprivan 1. Dose: 5-50 mcg per kg per minute 5. Treat Cause – Shock or Infection 6. Monitor for Complications 10
- 11. ARDS Complications ___________________________ Cardiac Dysrhythmias O2 Toxicity Renal Failure Thrombocytopenia GI Bleed Sepsis DIC 11
- 12. Mechanical Ventilation _____________________________ 1. Intubation a. Endotracheal Tube 1. Laryngoscope 2. E.T. Cuff b. Tracheostomy Tube 1. Keep at bedside: 2nd trach. tube, obturator, trach. dilator 2. Suctioning a. Wall pressure adult – 80 –120 mmHg b. Suctioning distance – 20 – 24 cm 12
- 13. Complications of Positive Pressure Ventilation ___________________________________ 1. Decreased Cardiac Output 2. Decreased Blood Flow to the Splanchnic Area a. Ischemic Gastric Mucosa b. Decreased Renal Blood Flow 3. Respiratory Alkalosis 4. Barotrauma 5. Volu-pressure Trauma 6. Alveolar Hypoventilation 7. Alveolar Hyperventilation 8. Ventilator Associated Pneumonia 13
- 14. Nursing Care of the Client on a Ventilator ________________________________ 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Respiratory Assessment Suctioning Oral Care ABG &/or continuous O2 sats. Supplementary Respiratory Treatments Providing for hydration Maintaining Nutrition ROM Exercises Rest & Sleep Anxiety Communication 14