ARDS ppt

ACUTE RESPIRATORY
DISTRESS SYNDROME
(ARDS)

Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli 1

INTRODUCTION TO RESPIRATORY SYSTEM


contd…………


contd…………

4
Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli

contd…………


RESPIRATORY DISTRESS SYNDROME (ARDS)
• Acute respiratory distress syndrome (ARDS) is a life-threatening
lung condition that prevents enough oxygen from getting into the
blood.
• Acute respiratory distress syndrome was first described in 1967 by
Ashbaugh and colleagues.
• ARDS is also referred with variety of terms like
• Stiff Lung
• Shock lung
• Wet lung
• Post traumatic lung
• Adult respiratory distress syndrome
• Adult hyaline membrane disease
• Capillary leak syndrome &
• Congestive atelectasis.

DEFINITION

• Acute respiratory distress syndrome (ARDS) is a
sudden and progressive form of acute
respiratory failure in which the alveolar
capillary membrane becomes damaged and
more permeable to intravascular fluid resulting
in severe dyspnea, hypoxemia and diffuse
pulmonary infiltrates.


STAGES OF ODEMA FORMATION IN ACUTE
RESPIRATORY DISTRESS SYNDROME

Mr sanjay. M. Peerapur, Principal, KLES
8
Institute of Nursing Sciences, Hubli

ETIOLOGY & RISK FACTORS
• Direct Lung Injury
– Common causes
• Aspiration of gastric contents or other substances.
• Viral/bacterial pneumonia
– Less Common causes
• Chest trauma
• Embolism: fat, air, amniotic fluid
• Inhalation of toxic substances
• Near-drowning
• O2 toxicity
• Radiation pneumonitis

ETIOLOGY & RISK FACTORS contd…….
• Indirect Lung Injury
– Common causes
• Sepsis
• Severe traumatic injury
– Less common causes
• Acute pancreatitis
• Anaphylaxis
• Prolonged Cardiopulmonary bypass surgery
• Disseminated intravascular coagulation
• Multiple blood transfusions
• Narcotic drug overdose (e.g., heroin)
• Nonpulmonary systemic diseases
• Severe head injury
• Shock
• Massive blood transfusion.
10

SCHEMATIC REPRESENTATION OF PATHOPHYSIOLOGY OF ARDS
Lung injury

Damaged Type II alveolar cell Release of Vasoactive substances
(serotonin, histamine, bradykinin)
Surfactant production
Alveolocapillary Vascular
membrane narrowing &
Alveolar
permeability obstruction
Compliance and recoil
Bronchoconstriction

Outward migration
Atelectasis
of blood cells &
fluids from capillaries
Hyaline membrane
formation Pulmonary Edema

Lung
compliance
Impairment in
gas exchange

Pulmonary
ARDS hypertension

CLINICAL MANIFESTATIONS
• Early signs/symptoms
– Restlessness
– Dyspnea
– Low blood pressure
– Confusion
– Extreme tiredness
– Change in patient’s behavior
• Mood swing
• Disorientation
• Change in LOC
– If pneumonia is causing ARDS then client may have
• Cough
• Fever

CLINICAL MANIFESTATIONS CONTD…………

Late signs & symptoms
– Severe difficulty in breathing i.e., labored, rapid
breathing.
– Shortness of breath.
– Tachycardia
– Cyanosis (blue skin, lips and nails)
– Think frothy sputum
– Metabolic acidosis
– Abnormal breath sounds, like crackles
– PaCo2 with respiratory alkalosis.
– PaO2

DIAGNOSITC EVALUATION
• History of above symptoms
• On physical examination
– Auscultation reveals abnormal breath sounds
• The first tests done are :
– Arterial blood gas analysis
– Bood tests
– Chest x-ray
– Bronchoscopy
– Sputum cultures and analysis
• Other tests are :
– Chest CT Scan
– Echocardiogram

COMPLICATIONS
• Common complications are;
– Nosocomial pneumonia:
– Barotrauma
– Renal failure
• Other complications are :
– O2 toxicity,
– stress ulcers,
– Tracheal ulceration,
– Blood clots leading to deep vein thrombosis &
– pulmonary embolism.

MEDICAL MANAGEMENT
• Persons with ARDS are hospitalized and require
treatment in an intensive care unit.
• No specific therapy for ARDS exists.
• Supportive measures :
– Supplemental oxygen
– Mechanical respirator
– Positioning strategies
• Turn the patient from supine to prone.
• Another position is lateral rotation therapy
• Fluid therapy

TURNING PATIENT PRONE ON VOLLMAN PRONE POSITIONER

17

PATIENT LYING PRONE ON VOLLMAN PRONE POSITIONER

18

LATERAL ROTATION THERAPY BED

19

MEDICAL MANAGEMENT contd…….
• Medications :
– Antibiotics
– Anti-inflammatory drugs; such as corticosteroids
– Diuretics
– Drugs to raise blood pressure
– Anti-anxiety
– Muscle relaxers
– Inhaled drugs (Bronchodilators)


NURSING DIAGNOSIS
1. Ineffective breathing pattern related to decreased
lung compliance, decreased energy as characterized
by dyspnea, abnormal ABGs, cyanoisis & use of
accessory muscles.
2. Impaired gas exchange related to diffusion defect as
characterized by hypoxia (restlessness, irritability &
fear of suffocation), hypercapnia, tachycardia &
cyanosis.
3. Risk for decreased Cardiac output related to positive
pressure ventilation
4. Ineffective protection related to positive pressure
ventilation, decreased pulmonary compliance &
increased secretions as characterized by crepitus,
altered chest excursion, abnormal ABGs &
restlessness.

NURSING DIAGNOSIS CONTD……..

5. Impaired physical mobility related to monitoring
devices, mechanical ventilation & medications as
characterized by imposed restrictions of
movement, decreased muscle strength & limited
range of motion.
6. Risk for impaired skin integrity related to
prolonged bed rest, prolonged intubation &
immobility.
7. Knowledge deficit related to health condition,
new equipment & hospitalization as characterized
by increased frequency of questions posed by
patient and significant others.

ARDS ppt

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