This document provides information on acute respiratory distress syndrome (ARDS). It defines ARDS as severe acute lung injury involving diffuse alveolar damage and increased permeability. It notes the criteria for diagnosing ARDS including acute onset of respiratory failure, low blood pressure, low oxygen levels and bilateral lung infiltrates. Common causes include viral or bacterial pneumonia and chest trauma. The management of ARDS focuses on respiratory support through mechanical ventilation with low tidal volumes, application of positive end expiratory pressure and prone positioning. Other treatments aim to correct fluid and electrolyte imbalances while preventing complications like infection. Nursing care centers around monitoring the patient's respiratory status, managing oxygen therapy and supporting ventilation.
Acute respiratory distress syndrome nursing care plan & managementNursing Path
1. Acute respiratory distress syndrome is a form of acute respiratory failure that occurs as a complication of some other condition, is caused by a diffuse lung injury, and leads to extravascular lung fluid.
Acute respiratory distress syndrome (ARDS) occurs when fluid builds up in the tiny, elastic air sacs (alveoli) in your lungs. The fluid keeps your lungs from filling with enough air, which means less oxygen reaches your bloodstream. This deprives your organs of the oxygen they need to function.
Acute respiratory distress syndrome nursing care plan & managementNursing Path
1. Acute respiratory distress syndrome is a form of acute respiratory failure that occurs as a complication of some other condition, is caused by a diffuse lung injury, and leads to extravascular lung fluid.
Acute respiratory distress syndrome (ARDS) occurs when fluid builds up in the tiny, elastic air sacs (alveoli) in your lungs. The fluid keeps your lungs from filling with enough air, which means less oxygen reaches your bloodstream. This deprives your organs of the oxygen they need to function.
This is an ARDS case study presentation done by a group of Respiratory care students in UOD:
Aziza AlAmri, Fay AlBuainain, Mashail AlRayes, Nora AlWohayeb, Salma Almakinzi .
The original case study:(http://www.researchgate.net/publication/50399037_Acute_Respiratory_Distress_SyndromeA_Case_Study)
CARDIAC TAMPONADE ( Cardiac emergency) • Cardiac Tamponade is a life threatening complication caused by excessive accumulation of fluid in the pericardium. Or • Compression of all cardiac chambers due to excessive accumulation of pericardial fluid leading to compromised cardiac out put.
Respiratory Disorders
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TEACHING IS ONE PROFESSION THAT CREATE ALL OTHER PROFESSION
Mitral valve replacement is a procedure whereby the diseased mitral valve of a patients heart is replaced by either a mechanical or tissue(bioprosthetic )valve.’
A powerpoint presentation on the respiratory illness seen in newborns/neonates.
the diseases mentioned in this presentation are among the most commonly seen in the population.
This is an ARDS case study presentation done by a group of Respiratory care students in UOD:
Aziza AlAmri, Fay AlBuainain, Mashail AlRayes, Nora AlWohayeb, Salma Almakinzi .
The original case study:(http://www.researchgate.net/publication/50399037_Acute_Respiratory_Distress_SyndromeA_Case_Study)
CARDIAC TAMPONADE ( Cardiac emergency) • Cardiac Tamponade is a life threatening complication caused by excessive accumulation of fluid in the pericardium. Or • Compression of all cardiac chambers due to excessive accumulation of pericardial fluid leading to compromised cardiac out put.
Respiratory Disorders
Disease Condition Pneumothorax, Causes, Sign and Symptoms, Pathophysiology, Types, Assessment and Dignostic Test, Management
By HIREN GEHLOTH For Nursing Students Medical Surgical Nursing
LAUGH A LOT IT CLEARS THE LUNGS
TEACHING IS ONE PROFESSION THAT CREATE ALL OTHER PROFESSION
Mitral valve replacement is a procedure whereby the diseased mitral valve of a patients heart is replaced by either a mechanical or tissue(bioprosthetic )valve.’
A powerpoint presentation on the respiratory illness seen in newborns/neonates.
the diseases mentioned in this presentation are among the most commonly seen in the population.
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Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
3. DEFINITION OF ARDS
Severe, acute lung injury involving diffuse alveolar damage, increased micro-
vascular permeability and non-carcinogenic pulmonary edema
Acute refractory hypoxemia
Annual incidence 75/100,000 in the US
High mortality: 40%-60%
First described in 1967
4. CRITERIA OF ARDS
ARDS
Criteria
Acute onset
of
respiratory
failure
PCWP
<18 or
absence of left
atrial HTN
PaO2/FiO2
< 200
Bilateral
infiltrate on
CXR or with
pleural
effusion
6. MORTALITY Rate
40-60% Deaths due to:
*multi-organ failure
*sepsis
Mortality may be decreasing in recent years by:
*better Ventilatory strategies
*earlier diagnosis and treatment
7. CAUSES OR RISK FACTORS
Direct
lung injury
Aspiration of
gastric
contents
Viral/
bacterial
pneumonia
Chest trauma
Embolism:
fat,air,amniotic
fluid
Inhalation of
toxic
substances
Near
drowning
Radiation
pneumonitis
20. MECHANICAL VENTILATION
Lung protective strategy
Higher levels of PEEP required(10-20)mm H2O to attain FiO2 of 60 or less
Treatment strategy is one of low volume and high frequency ventilation(ARDSnet
protocol)
If fails alternative modalities to be tried
21.
22. Permissive Hypercapnoea
Low tidal volume (6ml/kg) to prevent over-distention
Increase respiratory rate to avoid very high level of hypercapnoea
PaCO2 allowed to rise
Usually well tolerated
May be beneficial
Potential Problems: tissue acidosis, autonomic dysregulation, CNS effect, and
circulatory effects
23. PRONE VENTILATION
Ventilatory Strategies other than Lung Protective Strategy.
- Prone Ventilation
- Liquid Ventilation
- High Frequency Ventilation
- Extracorporeal Gas Exchange
Hemodynamic Management – Fluids, Vasopressors.
Selective Pulmonary vasodilators.
Surfactant replacement therapy.
Anti-inflammatory Strategies.
a) Corticosteroids.
b) Cycloxygenase inhibitors.
Antioxidants
Anticoagulants.
24. Prone Position
Effect on gas exchange
Improves oxygenation – allows decrease Fio2; PEEP
response rate – 50-70%
Proposed mechanism – how it improves oxygenation
1) Increase in FRC
2) Improved ventilation of previously dependent regions.
25.
26. HIGH FREQUENCY VENTILATION
Utilizes small volume (<VD) and high RR (100 b/min)
Avoids over distention (Vili).
Alveolar recruitment.
Enhances gas mixing, improves V/Q.
APPLICATIONS
*Neonatal RDS.
*ARDS.
*BPF.
COMPLICATIONS:
*Shear at interface of lung.
*Air trapping.
27. PARTIAL LIQUID VENTILATION
In ARDS there is increased surface tension which can be eliminated by filling the
lungs with liquid (PFC).
Perflurocarbon:
Colourless, clear, odourless, inert, high vapour pressure
Insoluble in water or lipids
Most Commonly used – perflubron (Perfluoro octy bromide) (Liquivent)
Bromide radiopaque
28. EXTRACORPOREAL MEMBRANE OXYGENATION
Adaptation of conventional cardiopulmonary bypass technique.
Oxygenate blood and remove CO2 extra corporally.
29. HEMODYNAMIC MANAGEMENT
Controversial
Restriction of Fluid
Benefit Vs detrimental effects
Negative fluid balance is associated with improved survival.
Net positive balance <1 lt. in first 36 hrs. a/w improved survival decrease length of
ventilation, ICU stay and hospitalization.
35. Predictors of outcome
Factors whose presence can be used to predict the risk of death at the time of
diagnosis of acute lung injury and the acute respiratory distress syndrome include
a)chronic liver disease
b)non-pulmonary organ dysfunction,
c)sepsis,
d)advanced age.
36. ARDS net and Long-term outcome
120pts randomized to low Vt or high Vt
a) 25%mortality w/ low tidal volume
b) 45% mortality w/ high tidal volume
Standardized tested showed health-related quality of life lower than normal
38. Nursing Management:-
Assess respiratory rate and depth.
Maintain head of bed elevated 20 to 30 degree or provide semi-fowlers or fowlers
position to reduce O2 consumption and demands also this position help to
promote maximum lung inflation.
Monitor ABG analysis.
Administer supplement oxygen by cannula or mask as indicated to enhance
Oxygen delivery.
The five Ps of supportive therapy includes perfusion, positioning, protective lung
ventilation, protocol waning and preventing complications.
Provide proper nutritional support and flood management.
39. Contd...
Assess colour of mucous membrane or skin for detect cyanosis.
Encourage expectoration of sputum suction if necessary, provide mucolytics.
Assist with respiratory treatments eg., spirometry, chest physiotherapy.
Nebulize patient with anticholinergic drugs e.g., ipratropium bromide.
Encourage for bed rest to reduce oxygen consumption.
Teach and encourage good hand washing technique to reduce nosocomial risk
factors, use alcohol based hand rubs by caregivers.
Teach self care management plan to patient.
40. Nursing Diagnosis:-
Impaired tissue perfusion r/t hypoxia, decreased cardiac output secondary to PEEP,
fluid volume deficit
Impaired gas exchange r/t alveolar hypoventilation, ventilation-perfusion
mismatch, and diffusion impairment as evidenced by hypoxemia and / or
hypercapnoea
Risk for injury r/t artificial ventilation, emboli formation.
Anxiety/ fear r/t effects of hypoxemia, situational crisis, fear of death possibly
evidenced by increased tension, restlessness,simpathetic stimulation
41. Contd...
Risk for fluid volume imbalance r/t sodium and water retention
Imbalanced nutrition :less than body requirements r/t poor appetite, SoB, presence
of artificial airway, decreased energy, increased calorie requirement as evidenced
by weight loss, weakness, muscle wasting
Deficient knowledge related to disease condition treatment and other self care
needs.
Risk for infection related to disease condition.
42. BIBLIOGRAPHY
Lewis.Heitkemper; Medical surgical nursing-assessment and management of
clinical problems;7th ;Mosby Elsevier;1812-18
Braunwald; Harrison's principle of internal medicine;16th ;McGraw Hill;1523-31
Kumar and Abbas; Robbins Basic Pathology ;8th ;Saunders Elsevier; 481-83
Marilynn E Doenges; Nurses Pocket guide Diagnoses, prioritized interventions, and
rationales;FA Davis 2006
Xiaoming Jia et al ;Risk factors for ARDS in Patients receiving mechanical ventilation
for >48 hrs;CHEST;April 2008:133;4;853-860
43. R Phillip Dellinger et al; Surviving sepsis campaign: International guidelines for
management of severe sepsis and septic shock :2008;CRITICAL ARE
MEDICINE;36;1:296-318
John J Marini; Propagation Prevention: a complementary mechanism for "lung
Protective ventilation in ARDS;CRITICAL CARE MEDIINE2008;36;12:3252-57
Dougulas J.E Schuerer;Extra corporeal membrane Oxygenation-Current clinical
practice ,coding and reimbursement; CHEST 2008;134;1:179-184
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