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ACUTE RESPIRATORYDISTRESS SYNDROME      (ARDS)  Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hub...
INTRODUCTION TO RESPIRATORY SYSTEM        Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli   2
INTRODUCTION TO RESPIRATORY SYSTEM                                                                                     con...
INTRODUCTION TO RESPIRATORY SYSTEM                                                                                      co...
INTRODUCTION TO RESPIRATORY SYSTEM                                                                                       c...
RESPIRATORY DISTRESS SYNDROME (ARDS)• Acute respiratory distress syndrome (ARDS) is a life-threatening  lung condition tha...
DEFINITION• Acute respiratory distress syndrome (ARDS) is a  sudden and progressive form of acute  respiratory failure in ...
STAGES OF ODEMA FORMATION IN ACUTE   RESPIRATORY DISTRESS SYNDROME          Mr sanjay. M. Peerapur, Principal, KLES       ...
ETIOLOGY & RISK FACTORS• Direct Lung Injury   – Common causes      • Aspiration of gastric contents or other substances.  ...
ETIOLOGY & RISK FACTORS                                                                         contd…….• Indirect Lung In...
SCHEMATIC REPRESENTATION OF PATHOPHYSIOLOGY OF ARDS                                                  Lung injury   Damaged...
CLINICAL MANIFESTATIONS• Early signs/symptoms  – Restlessness  – Dyspnea  – Low blood pressure  – Confusion  – Extreme tir...
CLINICAL MANIFESTATIONS                                                                     CONTD………… Late signs & symptom...
DIAGNOSITC EVALUATION• History of above symptoms• On physical examination   – Auscultation reveals abnormal breath sounds•...
COMPLICATIONS• Common complications are;  – Nosocomial pneumonia:  – Barotrauma  – Renal failure• Other complications are ...
MEDICAL MANAGEMENT• Persons with ARDS are hospitalized and require  treatment in an intensive care unit.• No specific ther...
TURNING PATIENT PRONE ON VOLLMAN PRONE POSITIONER                                                                         ...
PATIENT LYING PRONE ON VOLLMAN PRONE POSITIONER                                                                           ...
LATERAL ROTATION THERAPY BED                                                                                19 Mr sanjay. ...
MEDICAL MANAGEMENT                                                                          contd…….• Medications :  – Ant...
NURSING DIAGNOSIS1. Ineffective breathing pattern related to decreased   lung compliance, decreased energy as characterize...
NURSING DIAGNOSIS                                                                        CONTD……..5. Impaired physical mob...
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  1. 1. ACUTE RESPIRATORYDISTRESS SYNDROME (ARDS) Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli 1
  2. 2. INTRODUCTION TO RESPIRATORY SYSTEM Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli 2
  3. 3. INTRODUCTION TO RESPIRATORY SYSTEM contd………… Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli 3
  4. 4. INTRODUCTION TO RESPIRATORY SYSTEM contd………… 4 Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli
  5. 5. INTRODUCTION TO RESPIRATORY SYSTEM contd………… Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli 5
  6. 6. 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. Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli 6
  7. 7. 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. Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli 7
  8. 8. STAGES OF ODEMA FORMATION IN ACUTE RESPIRATORY DISTRESS SYNDROME Mr sanjay. M. Peerapur, Principal, KLES 8 Institute of Nursing Sciences, Hubli
  9. 9. 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 Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli 9
  10. 10. 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 Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli
  11. 11. 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 Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli 11
  12. 12. 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 Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli 12
  13. 13. 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 Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli 13
  14. 14. 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 Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli 14
  15. 15. 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. Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli 15
  16. 16. 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 Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli 16
  17. 17. TURNING PATIENT PRONE ON VOLLMAN PRONE POSITIONER 17 Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli
  18. 18. PATIENT LYING PRONE ON VOLLMAN PRONE POSITIONER 18 Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli
  19. 19. LATERAL ROTATION THERAPY BED 19 Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli
  20. 20. MEDICAL MANAGEMENT contd…….• Medications : – Antibiotics – Anti-inflammatory drugs; such as corticosteroids – Diuretics – Drugs to raise blood pressure – Anti-anxiety – Muscle relaxers – Inhaled drugs (Bronchodilators) Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli 20
  21. 21. NURSING DIAGNOSIS1. 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 ventilation4. Ineffective protection related to positive pressure ventilation, decreased pulmonary compliance & increased secretions as characterized by crepitus, altered chest excursion, abnormal ABGs & restlessness. Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli 21
  22. 22. 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. Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli 22
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