The document provides information on a reflective learning session for nursing staff on acute respiratory distress syndrome (ARDS). It includes case scenarios of a patient's progression to ARDS over 6 days. Objectives are defined to help staff understand ARDS, differentiate it from other causes, discuss gaps in nursing practice, and demonstrate monitoring ventilator parameters. A discussion is prompted on the case, and an action plan is proposed to notify managers, ensure compliance, involve multidisciplinary teams early, provide training on ventilators, and conduct an immediate feedback interview.

1. Nursing & Midwifery Education
Department
Reflective Learning
Session

2. Disclosures
• This activity is an Accredited Group Learning Activity Category 1 as defined by the Ministry of Public
Health’s Department of healthcare Professions-Accreditation Section and is approved for a maximum of
XX hours.
• All individuals in a position to control content (SPC, Nurse Planer, content expert, presenters, faculty,
authors, and content reviewers) disclosed no relevant relationships with any commercial organization to
influence the content of this activity. (No COI to be disclosed)
• The scientific planning committee has reviewed all disclosed financial relationships of speakers,
moderators, facilitators and/or authors in advance of this CPD activity and has implemented procedures
to manage any potential or real conflicts of interest.
• This activity is held without receiving any financial or in-kind support
• The activity will be recorded as an evidence for learners’ interaction in online synchronous activity.
• Evidence of participation will be done as follows:
– Each person must join the session separately
– Kindly type your name and corporation number at the beginning of the session in “Chat”
– Keep the video option open. Only close the microphone
– Screenshots will be taken as an evidence for online synchronous activity at the beginning, in
between at regular intervals and at the end.
– The facilitator will track attendance record (sign in /out)
• To successfully complete the activity Learners must
– attend the entire activity
– complete the participant feedback tool.
– please list any additional requirements for successful completion

3. By the end of the session staffs will be able to:
• Define ARDS
• Distinguish between cardiogenic and non-cardiogenic ARDS
• Discuss about the gaps identified in nursing practice in handling
ARDS patients
• List out parameters to monitor in an ARDS patient
• Early recognition and nursing management of ARDS
• Concept of ventilatory support and its settings
• Demonstrate monitoring ventilator parameters and adjustments
Objectives

4. Case scenario
History:
Mr. X is a 55yrs old man presented
with complaints of productive cough,
progressive increase in SOB, fatigue
which was started in the last 24hrs.
He was having low grade fever.
Recently treated Covid infection.
Diagnosis:
Inferior wall MI late presentation.
Past history: DM, HTN, obesity,
smoker
Vital Signs:
BP- 122/73mmhg
HR-102bpm
RR-26/min
Temp-37.8C, SPO2-88 %on room air
DAY 1

5. Day 3
Complaints:
Mr. X has still cough, fatigue and on and
off body pain and intermittent SOB.
Manageable to lie flat with nasal
cannula 4 lit of o2
Coronary angiogram done and showed
normal except RCA which showed 40%
ectatic vessels, suggested for medical
management.

6. Case scenario
Complaints:
Patient started to be febrile and
complaints of mild SOB and fatigue
Assessment:
Upon Auscultation bilateral basal
crepitations heard
Vitals signs:
Temp – 38.2C, SpO2- 96% with O2
mask 10lits
Investigations and Management;
X-ray, septic work up
Furosemide, Antibiotics and O2
DAY 4

7. Case scenario
Assessment
Patient still having spike of fever,
struggling to even get out of bed and
have extreme fatigue. Patient got shifted
to CCU as a case of suspected sepsis
&requiring high o2 support.
BP-90/50mmhg, HR-116bpm, RR-
30/min,spo2 94% with BIPAP
Upon arrival to CCU patient was
connected to cardiac monitor and
NRBM, full set of vitals signs taken and
head to toe assessment done. Upon
auscultation rhonchi throughout his lung
fields and occasional wheezes heard.
Now patient is on BIPAP.
Chest x-ray repeated showed patches.
DAY 5

8. Case scenario
Patient struggled to oxygenate,
family agreed for intubation.
Electively intubated.
Chest x-ray: Bilateral infiltration
PF ratio: 90
ABG: PH 7.25, p02 80 mmhg, pco2:
52mmhg, fio2 100%,Hco3 28meq/L
HR 125bpm,BP 80/53mmhg,RR
34/min, spo2 94%
Ventilator mode: SIMV TV 450ml,
fio2 100%, PEEP 5, PS 12, Rate 16
Medication: Fentanyl, midazolam,
furosemide, nor adrenaline.
DAY 6

9. Let's Discuss
What do you think
about the progression
of patient condition?
What is your opinion
about the Noninvasive
ventilation initiation for
the patient?.
Do you feel that there
was a proper
involvement of the
MDT, weaning team?
What is your reflection
on the Nursing
practices?
Do you feel that this
ARDS could have been
prevented?
Do you have
suggestion for
improvement and how
we can avoid such
events in the future?

10. Action plan
Description
Analysis
Conclusion
Reflect on the scenario.
• Improper treatment.
• Management delayed.
• Developed respiratory
arrest and went into
sepsis.
• Difficult weaning and went
to ARDS.
• Delayed and inappropriate
management.
• Noncompliance in nursing care.
• Ineffective involvement of MDT.
• Ventilator alarms ignored.
• In effective communication to
patient and family.
• Identified a gap in the
respiratory management in the
unit.
• Noted delayed referrals
process.
• Knowledge deficit among
nurses related to ventilator
settings.
• Arrival of new ventilator
enhanced this .
• Noncompliance to Policy.
• Follow up plan
• Notify the physician.
• Education sessions.
• Involvement of HAI team
for policy reinforcement
and compliance
monitoring.
• Policy awareness
• IFI

11. Do you aware these terms?
ARDS or NCPE
DEFINITION

12. In simple terms
ARDS is 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.

13. ARDS – The Berlin Definition (Ranieri et al, 2012)
RESPIRATORY THERAPY EDUCATION AND COMPETENCY PROGRAM
BERLIN DEFINITION

14. ARDS – The Berlin Definition (Ranieri et al, 2012)
RESPIRATORY THERAPY EDUCATION AND COMPETENCY PROGRAM
BERLIN DEFINITION

15. ARDS – The Berlin Definition (Ranieri et al, 2012)
RESPIRATORY THERAPY EDUCATION AND COMPETENCY PROGRAM
BERLIN DEFINITION

16. ARDS – The Berlin Definition (Ranieri et al, 2012)
RESPIRATORY THERAPY EDUCATION AND COMPETENCY PROGRAM
BERLIN DEFINITION

17. E.G. If our healthy patients pao2 is 100 when
breathing on room air with a Fio2 of 0.21, then
normal P/F ratio will be 100/0.21= 500
PF ratio

18. Did you know to calculate?
1. pa02 60 mmhg
Fio2 100%
2. pa02 80mmhg
Fio2 25%
PF ratio

20. Patho
RESPIRATORY THERAPY EDUCATION AND COMPETENCY PROGRAM
Theoretical:

21. Influx of protein rich edema fuid and inflammatory cells into air
filled spaces. Dysfunction of surfactant. Loss of lung tissue
Increased permeability of alveolarcapillary membrane
Damage to alveolar capillary membrane
Activation inflammatory cells and mediators (serotonin,
histamine and bradykinin)
Insult(direct/indiect)

22. • Direct lung injury
Pneumonia
Aspiration Pneumonia
Less Common Causes
Pulmonary Contusion
Fat emboli near Drowning
Near Drowning
Inhalation injury
Reperfusion pulmonary
edema
• Indirect lung injury
Sepsis
Severe trauma with shock,
multiple transfusions
Less Common Causes
Cardiopulmonary Bypass
Drug over dose
Acute Pancreatitis
Etiology

23. How to differentiate Pulmonary edema

24.  Fluid management
 Hemodynamic management
Dietary management
 Prone positioning
Pharmacological
• Steroids
• Neuromuscular agents
• Sedation
ECMO
Management of ARDS

25. F ………… Feeding
A ………… Analgesia
S ………… Sedation
T ………… Thrombo prophylaxis
H ……….... Head-of-bed elevation
U ………… Ulcer prophylaxis
G ………… Glucose control
FASTHUG
MANAGEMENT OF ARDS
RESPIRATORY THERAPY EDUCATION AND COMPETENCY PROGRAM

26. B………… Bowel movement
L ………… Lines
S ………… Skin care
BLS
NON - VENTILATORY MANAGEMENT OF ARDS –
NURSES
RESPIRATORY THERAPY EDUCATION AND COMPETENCY PROGRAM

27. Follow Up Plans
• Notify with managers deficit in our units
• Compliance in Nursing Care.
• Involve MDT early.
• Special attention to Ventilator alarms.
• Policy awareness to all staff.
• Conduct a training session on ventilator
parameters.
• IFI

29. References
• Adeani,I.Febriani,R. (2020).Using GIBBS Reflective cycle in making reflections of literature analysis. Research gate.
Volume6(2):139-148. Available from:
https://www.researchgate.net/publication/343599316_Using_GIBBS'_reflective_cycle_in_making_reflections_of_literary_an
alysis. [Accessed On 17 December 2022].
• Heart Hospital nursing educators and experienced colleagues in CCU.
• Ajibowo, A . Kolawole, O. Sadia, H.Amedu,O.Chaudary,H.Hussaini,H.Hambolu,E.Khan,T.Kauser,H.Khan,A. ( 2022) A
Comprehensive Review of the Management of Acute Respiratory Distress Syndrome. Cureus 14(10): e30669.Available from:
https://www.cureus.com/articles/105730-a-comprehensive-review-of-the-management-of-acute-respiratory-distress-
syndrome [Accessed On 19 December 2022].
• HMC Intranet Clinical guidelines. Prone Positioning in Severe Acute Respiratory Distress Syndrome (ARDS) in Intensive Care
Unit (ICU)CG1014.Available from:
https://itawasol.hamad.qa/EN/SiteSearch/Pages/results.aspx?k=PRONING#k=PRONE:~:text=https%3A//itawasol.hamad.qa/K
nowledgeCenterDocuments/Clinical%20Guidelines/Hamad%20General%20Hospital/CG%2010146%20Prone%20Positioning%
20in%20Severe%20Acute%20Respiratory%20Distress%20Syndrome%20(ARDS)%20in%20Intensive%20Care%20Unit%20(ICU).
pdf [Accessed On 18 December 2022].
• HMC Intranet Clinical Policy. Care Of mechanically Ventilated Patients. CL6011.Available from:
https://itawasol.hamad.qa/EN/How%20We%20Work/HMC-Policies/CP/Manuals/Pages/Clinical-Policy-Manual-(CL).aspx
[Accessed On 18 December 2022].