ARDS in relation to COVID-19 and Influenza Wright 1

Acute Respiratory Distress Syndrome in Relationship to Corona Virus Disease and Influenza
Bianca Wright
Jackson College Nursing Program
Pathophysiology Winter 2020
ARDS in relation to COVID-19 and Influenza Wright 2

Acute Respiratory Distress Syndrome in Relationship to Corona Virus Disease and Influenza

Introduction

During this worldwide pandemic, an overwhelming number of people have been forced

to stay in their homes to self-isolate and social distance themselves from those around them.

According to the New York Times, Corona virus disease has killed more people in New York

than in Italy, which was considered the hardest-hit country in Europe. “The new figures, released

by the city’s Health Department, drove up the number of people killed in New York City to more

than 10,000, and appeared to increase the overall United States death count by 17 percent to

more than 26,000” (New York Times, 2020). While the number of sick has continued to rise; we

have been able to observe diagnostic and therapeutic procedures to better assess and monitor for

symptoms of the COVID-19 virus. Not only does COVID-19 increase possible chances of

developing a respiratory infection, influenza has been causing even more mortality then one may

know. Severe acute respiratory distress syndrome is a sudden, progressive form of acute

respiratory failure in which the alveolar-capillary membrane becomes damaged and more

permeable to intravascular fluid (medsurg). Acute respiratory distress syndrome, or ARDS, is a

type of respiratory failure that can develop after a diagnosis of COVID-19 or influenza. A

possible explanation for such severe hypoxemia in positive COVID-19 patients occur with the

loss of lung perfusion regulation and hypoxic vasoconstriction. The relationship of COVID-19

and influenza can progress to severe respiratory failure requiring extensive medication

intervention, such as the need for mechanical ventilation. ARDS, ultimately, leads to fibrosis of

the lungs and life-long respiratory complications resulting to decreased quality of life.

Pathophysiology
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The pathophysiology of acute respiratory distress syndrome involves the increase in the

permeability of the alveolar-capillary barrier. This can result from many different phenomena

including aspiration, drugs and toxins, infections, trauma, and disseminated intravascular

coagulation disorders such as blood transfusions. Direct causes of ARDS can include pneumonia,

influenza, and COVID-19. Symptoms that may appear include diffuse crackles in the lungs,

dyspnea, cyanosis, tachypnea, tachycardia, and diaphoresis (medsurg). These signs and

symptoms are similar to COVID-19. According to WebMD, “signs and symptoms related to

COVID-19 are fever, dry cough, and fatigue. With advanced symptoms of trouble breathing or

shortness of breath, ongoing chest pain or pressure, new confusion, or unable to wake up fully”

(Webmd). Patients with COVID-19 and/or influenza that could develop in ARDS could possibly

need mechanical ventilating with positive expiratory pressure. There are three phases of ARDS

which include exudative phase, proliferate phase, and the fibrotic phase. Each present with

different symptoms that follow a trend and without proper interventions could increase the risk

of death. Due to viruses rapidly maturing and increased evolution, this makes it very difficult to

contain a correct and unchangeable vaccination to kill off these viruses. The vaccines that are

being made available during “flu season” are hopeful attempts to decrease the cases of the

influenza and increase the immunity people have towards the virus.

Long-term Consequences and Risks to The Patient

Therefore, because COVID-19 is a novel, meaning a new virus anyone can contract it,

the CDC recommends ‘people 65 years and older with severe underlying medication conditions

should take special precautions because they are at higher risk of developing serious COVID-19

illness’ (CDC). COVID-19 and acute respiratory distress syndrome have similar course of

disease like decrease lung capacity effecting perfusion oxygen throughout the tissues. A
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relationship with patients and their increased numbers of comorbidities, like lung disease, has

numbers increasing. Due to the aging process and the decreases elasticity of the lung, a disease

like COVID-19 is detrimental to older people. When patients test positive, they can develop

pneumonia and when the virus makes the way to the lungs, the air sacs within the lungs fill up

with fluid, which impairs the lungs’ ability to transfer oxygen and results in difficulty breathing.

In majority of the severe cases ventilator support may be required to ensure the patient is

receiving sufficient oxygen circulation within the body. Studies have shown that patients who

have tested positive for COVID-19 can develop pneumonia making an increased risk to

progressing into acute respiratory distress syndrome which may be fatal in some patients.

Nursing Interventions

Patients with ARDS’s will require intense medical and nursing interventions to increase

their chances of survival. Patient’s will receive oxygen administration to correct hypoxemia, with

either a face mask or nasal cannula depending on the severity of hypoxemia that is associated

with their symptoms. Due to the severity of the hypoxemia, endotracheal intubation may be

performed by a doctor and positive pressure ventilation will be needed to provide additional

respiratory support.

Recommendations to place the patient into a prone position can also increase respiratory

efforts. This allows other vital organs to change position and lie against the chest wall giving the

lungs a chance to rest and expand. Turning the patient can also decrease the amount of stagnant

fluid being left in the lungs. Enteral or parenteral nutrition may need to be started to meet the

high energy requirements of patients. Performing daily weights as well as monitoring intake and

output will be helpful in monitoring the patient’s fluid balance. The goals of these nursing

interventions are to improve gas exchange and increase the oxygen profusions throughout the
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body. Evaluation of treatments are performed multiple times throughout their stay is needed to

evaluate their need for the ventilator and if they can be taken off (medsurg).

Conclusion

In conclusion, ARDS is a type of respiratory failure that can be caused by an indirect

source of a direct source. The high mortality rates, even after medication intervention are in

relation to COVID-19 and influenza. While most people who contract COVID-19 and influenza

have mild symptoms and recover, others may need critical interventions and may even die. The

most effective way to prevent the spread of viruses and to decrease the risk of ARDS is to initiate

precautions with proper hand washing and encourage others to perform their social distancing to

reduce the risk of exposing your self to others and to prevent the risk of spreading a virus that

one may have built an immunity too.

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Resources

Goodman, J. D., & Rashbaum, W. K. (2020, April 14). N.Y.C. Death Toll Soars Past 10,000 in

Revised Virus Count. Retrieved from https://www.nytimes.com/2020/04/14/nyregion/new-york-

coronavirus-deaths.html

Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L. (2014). Medical-Surgical Nursing:

Assessment and Management of Clinical Problems, 9th Edition

Situation Summary. (2020, March 26). Retrieved from https://www.cdc.gov/coronavirus/2019-

ncov/cases-updates/summary.html

Smith, M. W. (2020, April 14). Coronavirus and COVID-19: What You Should Know. Retrieved

from https://www.webmd.com/lung/coronavirus#1-3