NCM 112 LEC | MEDICAL - SURGICAL NURSING by: tinyya~

Respiratory Distress Syndrome (RDS)

- Acute Respiratory Distress Syndrome (ARDS) is a sudden & progressive form of acute respiratory
failure in w/c the alveolar capillary membrane becomes damaged & more permeable to intravascular
fluid resulting in severe dyspnea, hypoxemia, & diffuse pulmonary infiltrates.

1) DIRECT LUNG INJURY

- Direct (pulmonary or primary) lung injury results in local damage to the lung epithelium.
- Common causes:
 Aspiration of gastric contents or other substances
 Viral/Bacterial pneumonia
- Less common causes:
 Chest trauma  Near drowning
 Embolism (fat, air, amniotic fluid)  O2 toxicity
 Inhalation of toxic substances  Radiation pneumonitis

2) INDIRECT LUNG INJURY

- Indirect (extrapulmonary or secondary) lung injury occurs in the setting of systemic disorders
that diffusely damage the vascular endothelium.
- Common causes:
 Sepsis
 Severe traumatic injury
- Less common causes:
 Acute pancreatitis  Narcotic drug overdose
 Anaphylaxis  Non pulmonary systemic diseases
 Prolonged cardiopulmonary bypass surgery  Severe head injury
 Disseminated intravascular coagulation  Shock
 Multiple blood transfusion  Massive blood transfusion

Early signs and symptoms:

 Restlessness  Extreme tiredness
 Dyspnea  Change in pt.’s behavior (mood swing, disorientation, change in
 Low blood pressure LOC)
 Confusion  If pneumonia is causing ARDS, then pt. may have cough & fever

Vocabulary:
Radiation pneumonitis – is an inflammation of the lung tissue. Radiation pneumonitis often appears between 6 and 24
weeks after radiation therapy.
Pulmonary embolism (PE) – it occurs when a blood clot gets stuck in an artery in the lung, blocking blood flow to part of
the lung.
NCM 112 LEC | MEDICAL - SURGICAL NURSING by: tinyya~
Late signs and symptoms:
 Severe DOB (labored,  Thick, frothy sputum
rapid breathing)  Metabolic acidosis
 SOB  Abnormal BS like crackles
 Tachycardia  Decreased PaCO2 w/ respiratory alkalosis
 Cyanosis  Decreased PaCO2

 History of above symptoms

 On physical examination
o Auscultation reveals abnormal BS
 The first tests done are:
o Arterial Blood Gas (ABG) Analysis
o Blood tests
o CXR
o Bronchoscopy
o Sputum cultures & analysis
 Other tests are:
o Chest CT scan
o Echocardiogram

 Nosocomial pneumonia – a.k.a. Hospital-Acquired Pneumonia (HAP); it is defined as pneumonia

that occurs 48 hours or more after hospital admission and not incubating at the admission time.
 Barotrauma – it means injury to your body because of changes in barometric (air) or water
pressure.
 Renal failure
 Others:
o O2 toxicity o Blood clots leading to deep thrombosis
o Stress ulcers o Pulmonary embolism
o Tracheal ulceration

 Person w/ ARDS are hospitalized & require treatment in an ICU

 No specific therapy for ARDS exists
 Supportive measures:
o Supplemental O2 o Turn the pt. from supine to prone
o Mechanical respirator o Another position is lateral rotation therapy
o Positioning strategies
 Fluid therapy

Vocabulary:
Radiation pneumonitis – is an inflammation of the lung tissue. Radiation pneumonitis often appears between 6 and 24
weeks after radiation therapy.
Pulmonary embolism (PE) – it occurs when a blood clot gets stuck in an artery in the lung, blocking blood flow to part of
the lung.
NCM 112 LEC | MEDICAL - SURGICAL NURSING by: tinyya~

 Medications:
o Antibiotics – several antibiotics such as macrolides & tetracyclines exert pleiotropic
immunomodulatory effects that might be able to rectify the dysregulated inflammatory
response present in pts. w/ ARDS.
o Anti-inflammatory drugs such as corticosteroids
o Diuretics – are frequently administered to critically ill patients to alleviate pulmonary edema &
may reduce lung injury
o Drugs to raise blood pressure
o Anti-anxiety
o Muscle relaxers
o Inhaled (Bronchodilators)

 The principles of nursing management of pts. w/ pulmonary edema & care of the pt. requiring
mechanical ventilation are appropriate in the care of the pt. w/ ARDS. Placing the pt. in prone position
clearly is within the realm of nursing.
 Evaluation of the pt.’s response to treatment as well as careful monitoring for potential complication is
essential.

 Ineffective Breathing Pattern r/t decreased lung compliance, decreased energy as characterized by
dyspnea, abnormal ABG’s, cyanosis, and use of accessory muscles.
 Impaired Gas Exchange r/t diffusion defects as characterized by hypoxia, hypercapnia, tachycardia, and
cyanosis.
 Risk for Decreased Cardiac Output r/t positive pressure ventilation.
 Ineffective Protection r/t to positive pressure ventilation, decreased pulmonary compliance, and
increased secretions as characterized by crepitus, altered chest excursion, abnormal ABG’s and
restlessness.

Vocabulary:
Radiation pneumonitis – is an inflammation of the lung tissue. Radiation pneumonitis often appears between 6 and 24
weeks after radiation therapy.
Pulmonary embolism (PE) – it occurs when a blood clot gets stuck in an artery in the lung, blocking blood flow to part of
the lung.
NCM 112 LEC | MEDICAL - SURGICAL NURSING by: tinyya~

Atelectasis
- Collapse of a part or the entire lung due to bronchial obstruction.
- May be caused by:
 Intrabronchial obstruction
 Tumors, bronchospasm
 Foreign bodies
 Extrabronchial compression (tumors, enlarged lymph nodes)
 Endobronchial disease (bronchogenic carcinoma, inflammatory structures)

 Signs and symptoms may be absent depending upon the degree of collapse & rapidity with w/c
bronchial obstruction occurs.
 Dyspnea decreased BS on affected side, decreased respiratory excursion, & dullness to flatness upon
percussion over affected area.
 Cyanosis, tachycardia, tachypnea, elevated temp., weakness, pain over affected area.

o Bronchoscopy – may or may not reveal an obstruction

o CXR shows diminished size of affected lung & lack of radiance over atelectatic area
o PO2 decreased

Vocabulary:
Radiation pneumonitis – is an inflammation of the lung tissue. Radiation pneumonitis often appears between 6 and 24
weeks after radiation therapy.
Pulmonary embolism (PE) – it occurs when a blood clot gets stuck in an artery in the lung, blocking blood flow to part of
the lung.