Ards

1. Acute respiratory
distress syndrome
ARDS

3. Acute respiratory distress syndrome (ARDS) is a life-threatening
lung condition that prevents enough oxygen from getting into the
blood. ALSO KNOWN AS
 Stiff Lung
 Shock lung
 Wet lung
 Post traumatic lung
 Adult respiratory distress syndrome
 Adult hyaline membrane disease
 Capillary leak syndrome
 Congestive atelectasis.

4. DEFINITION
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.

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

6. ETIOLOGY
Indirect lung injury
Sepsis
Severe traumatic injury
Acute pancreatitis
Anaphylaxis
Prolonged Cardiopulmonary bypass
surgery

7. Disseminated intravascular coagulation
Multiple blood transfusions
Narcotic drug overdose (e.g., heroin)
Nonpulmonarysystemic diseases
Severe head injury
Shock
Massive blood transfusion.

9. Signs and symptoms
Early manifestation
• 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 and Fever

10. Late signs& symptoms
Severe difficulty in breathing i.e., labored and rapid breathing
Shortness of breath.
Tachycardia
Cyanosis (blue skin, lips and nails)
Thick frothy sputum
Metabolic acidosis
Abnormal breath sounds, like crackles
Respiratory alkalosis.

11. Diagnostic findings
History collection
Physical examination – Auscultation reveals abnormal breath sounds
Arterial blood gas analysis
Bood tests
Chest x-ray
Bronchoscopy
Sputum cultures and analysis
Chest CT Scan
Echocardiogram

12. Complications
Nosocomial pneumonia
Barotrauma
Renal failure
O2 toxicity
Stress ulcers
Tracheal ulceration
Blood clots leading to deep vein thrombosis & pulmonary embolism.

13. Management
Patient with ARDS are hospitalized and require treatment in an intensive care
unit.
No specific therapy for ARDS exists
Supportive measures
Supplemental oxygen- The lowest possible fraction of inspired oxygen (FiO2)
necessary to meet oxygenation goals should be used.
This will decrease the likelihood that adverse consequences of supplemental
oxygen willdevelop, such as atelectasis, hyper capnia, airwayinjury, and
parenchymal injury

14. Mechanical respirator
Positioning strategies-Turn the patient from supine to prone.,lateral rotation
therapy
Fluid therapy

15. Medications
• Antibiotics
• Anti-inflammatory drugs; such as corticosteroids
• Diuretics
• Drugs to raise blood pressure
• Anti-anxiety
• Muscle relaxants
• Inhaled drugs (Bronchodilators)

16. Nursing diagnosis
1.Impaired 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 lung tissue protection related to positive pressure ventilation,
decreased pulmonary compliance & increased secretions as characterized by
crepitus, altered chest excursion, abnormal ABGs & restlessness.

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