Acute Respiratory Distress Syndrome

1. Acute Respiratory
Distress Syndrome
Case Study

2. Tracy Nicole C.
Baustista
Jeraldine
C. Pascual
Meet The Team
Ylliella Christine C.
Mateo
Carla Jayne J.
San Juan

3. Content Outline
01.
02.
Topic For Discussion
Case Scenario
Nursing Diagnosis
Assessment
Planning for Health Restoration
and Maintenance
03.
04.
05 Implementation
06. Pharmacologic Management
06. Nutritional and Diet Therapy

4. Risk Factors
• Localized infection ( bacterial, fungal or
viral pneumonic)
• Inhalation of high concentration of
oxygen , smoke or corrosive substances.
• Direct and Indirect lung injury

5. Case Scenario
On September 17, 2022 around 8:00 pm, A 55-
year-old woman was admitted at the hospital.
According to her daughter, she experienced
headache, fever, difficulty of breathing, and myalgia.
She stated that her mother has a productive cough.
The patient is also a smoker , she also stated
that her mother is experiencing sudden and intense
sharp, stabbing pain when inhaling and exhaling
prior to consultation.
At the time of her admission to the hospital, she
had central and peripheral cyanosis and severe
respiratory distress. Her initial vital signs were as
follows: BP = 100/70 mmHg, PR = 122/min, RR = 27
, and temperature =38.7 °C. Oxygen saturation in the
room air was 64%.
The final diagnosis is Pneumonia related to

6. Nursing history
-Presented with pneumonia related to
ARDS due to shortness of breath and
intense sharp stabbing pain when
inhaling and exhaling
- Had central and peripheral cyanosis
and severe respiratory distress
“Ang init daw ng pakiramdam
nahihirapan din daw siyang huminga at
kada hihinga siya parang may
tumutusok sa dibdib niya” as verbalized
Assessment
Subjective data

7. Nursing history
- Shortness of Breath
- Bluish Discoloration
- Facial grimace
(pain scale 8/10)
- Restlessness
Vital Signs:
T: 38. 7 C
PR: 122 bpm
RR: 27 cpm
BP: 100/70mmHg
Spo2: 64%
Objective Data

8. Physical Assessment Abnormal Findings
• SKIN
Febrile. Cyanosis due to poor oxygenation. Delayed
Skin turgor. Appears smooth, warm, pallor due to
poor perfusion.
• NAILS
Pale nail beds
• MOUTH
Visible dryness of lips and oral mucosa
• LUNGS
Dyspnea
Coarse breath sounds, rhonchi, crackles, or
decreased breath sounds
• HEART

9. Diagnostic Procedure
Client-Based
• Chest X-ray
- Increasing bilateral infiltrates
seen on the CXR
• Sputum Cultures and Analysis
- Sputum Culture test positive for
bacteria that can cause an infection
• ABG
- PAO2 = 150 mm hg

10. Book: Based
• Chest X-ray.
• Sputum Culture.
• ABG.
• Blood test
Others:
• Bronchoscopy
• Chest CT scan
• Echocardiogram

11. Nursing Diagnosis
Ineffective Breathing Pattern related to
decreases in lung function, secondary to
ARDS as manifested by difficulty breathing,
restlessness, increase respiration rate and
shortness of breath.
Stabbing chest pain related to ARDS as
evidenced by shortness of breath and
restlessness
Elevated body temperature related to
ARDS secondary to bacterial lung
infection as evidenced by temperature of
38.5 degrees Celsius.

12. Planning for Health Restoration
and Maintenance
• Ineffective Breathing Pattern related to decreases
in lung function, secondary to ARDS as
manifested by difficulty breathing, restlessness,
increase respiration rate and shortness of breath.
Short term:
After 3-4 hours of effective nursing
intervention the patient will able to established a
normal effective respiratory pattern AEB: (-)
Restlessness, with productive cough and regular
breathing pattern
Long term:
After 8 hours of nursing intervention the
patient will verbalized awareness of causative
factors, demonstrate appropriate coping behaviors

13. Planning for Health Restoration
and Maintenance
Stabbing chest pain related to ARDS as
evidenced by shortness of breath and
restlessness
Short term:
After 4 hours of nursing intervention the
patient will be able to report reduction of
stabbing chest pain as evidence by pain scale
5 out of 10, stable vital signs and decrease
feeling of restlessness.
Long term:
After 8 hours of nursing intervention the
patient will be able to demonstrate abdominal
breathing and relaxation techniques as
evidenced by relieve of pain in scale of 2 /10

14. Planning for Health Restoration
and Maintenance
• Elevated body temperature related to
ARDS secondary to bacterial lung
infection as evidenced by temperature of
38.5°C
Short term:
After 4 hours of nursing intervention the
patient’s temperature will decrease to 37.2 degree
Celsius and relief of discomfort such as facial
grimace and restlessness.
Long term:
After 8 hours of nursing intervention the
patient will maintain and stable body temperature
and will no longer exhibit facial grimace

15. Implementation
-Prone positioning will help in
increasing perfusion to the non-
consolidated regions of the lung. It also
facilitates removal of secretions.
-We must closely monitor the patient
because ARDS may change into a life
threatening condition
Monitor O2 administration, nebulizer
therapy, chest physiotherapy, ET, or
tracheostomy
Monitor Cardio PEEP
-Nursing Management

16. Medical Management
-Mechanical ventilation can partially or
fully replace spontaneous breathing. Its
main purpose is to improved gas exchange
and decreased work of breathing by
delivering preset concentrations of oxygen
at an adequate tidal volume. An artificial
airway (endotracheal tube) or
tracheostomy is needed to a client
requiring mechanical ventilation.
- Provide adequate fluids to maintain
hydration of the patient

17. Medical Management
It is otherwise called as artificial lung or
membrane/fiber oxygenator. There are
three techniques involved in this method.
They are Extra Corporeal Membrane
Oxygenation (ECMO), Extra Corporeal
Carbon dioxide Removal (ECCO2R) and
Intra Vascular Oxygenation (IVOX)
The primary focus in the management of
ARDS includes identification and
treatment of the underlying condition.
Aggressive, supportive care must be
provided to compensate for the severe
respiratory dysfunction. This supportive
therapy almost always includes

18. Medical Management
PEEP (Positive end-expiratory
pressure) is a critical part of the
treatment of ARDS. PEEP usually
improves oxygenation, but it does not
influence the natural history of the
syndrome. Use of PEEP helps increase
functional residual capacity and reverse
alveolar collapse by keeping the alveoli
open, resulting in improved arterial
oxygenation and a reduction in the
severity of the ventilation-perfusion
imbalance.

19. Pharmacological
Management
There is no specific pharmacologic treatment
for ARDS except supportive care. Numerous
pharmacologic treatments are under
investigation to stop the cascade of leading to
ARDS. These include surfactant replacement
therapy, pulmonary antihypertensive agents,
and antisepsis agents. To date, supportive
strategies and lung-protective ventilation are the
only approaches that have been shown to
improve outcomes in these patients.
-Neuromuscular blocking agents

20. Complementary and
Alternative Medicine
Some natural products are reviewed whose
biological effects may be useful in the
development of new therapies for ARDS.
Many of these agents have pleiotropic
effects, such as inhibiting pro inflammatory
signaling while activating antioxidant
defense mechanisms.

21. Nutritional and Diet
Therapy
Adequate nutritional support is vital in the
treatment of ARDS. Enteral feeding is the
first consideration; however, parenteral
nutrition also may be required.
• OMEGA 3 (SALMON/TUNA)
• HIGH FAT- LOW CARBOHYDRATE
• FOOD RICH IN ANTIOXIDANT
( BROCCOLI, SPINACH, CARROTS AND
POTATOES)

22. Implementation
• PROPER HAND WASHING
Depression is common after ARDS:
• ENCOURAGE the family to have an
emotional support to the patient.
• Do not smoke
• Limit or do not intake alcohol f
• Advise patient to seek vaccine for
prevention of accumulating respiratory
diseases.
• Educate the patient on how to do proper
breathing exercises
• Do follow-up check ups
Clients Education, After recovery

23. Evaluation
Accurate diagnosis and detection are
significant to improve patient
outcomes. This study will provide the
student-nurses a broader knowledge
and understanding on taking good care
of the patient in the real clinical setting
and educate the student-nurses to
provide efficient care and effectively to
achieve quality nursing care.

24. Thank you for listening
Group 3