ACUTE RESPIRATORY

DISTRESS SYNDROME
Group 1

De Peralta

Junasa

Alparito

Prado

Lim,
 Case Scenario

 55 y/o male recently diagnosed with influenza A.

Presented to the ER with his wife with worsening SOB,
Fever, productive cough, and new onset of altered mental
status  Current Meds:
 Levophed IV
 O2 sat – 61% with use of accessory muscles
 Propofol IV
 BIPAP used but respiratory status continued to deteriorate
 Protonix IV

 Historty:  Lovenox SQ
 Hypertension – 2009  Azithromycin
 Hyperlipidemia – 2009
 2 alcoholic beverages per week
VS and Labs

 T – 38C
 HR 93
 ABG:
 RR 30
 pH 7.42
 BP 87/50
 PaCO2 41 mmHg
 O2 Sat 85%
 PaO2 34 mmHg
 HCO3 26 mmol/L
 CXR – worsening air space
opacity, pulmonary edema
ARDS

 A severe form of acute lung injury & life-threatening respiratory

condition characterized by sudden and progressive pulmonary edema,
increasing bilateral infiltrates, and hypoxemia unresponsive to O2
supplementation
 Etiology

Main causes
 Sepsis – most common cause,
especially for alcoholics Other Causes
 Pneumonia
 Aspiration  Smoking/inhalation injury
 Severe trauma  CABG
 Massive BT  Thoracic/ Lung surgery
 Stem cell transplant  Acute pancreatitis
 Drugs – alcohol, aspirin, cocaine,  Near drowning
opioids (OVERDOSE)  Severe burns
 Symptomatology

 3 stages: Exudative Stage, Proliferative  Refractory hypoxemia

Stage, Fibrotic Stage  Dyspnea
 Cyanosis
 I. Exudative Stage – from inciting event to 7
 Crackles
days
 1. Actual diffuse alveolar damage
 Tachypnea and Tachycardia

 2. Leads to fluid accumulation wherein all  Use of accessory muscles

symptoms begin  Cough
 3. Stage where alveoli collapse and  Chest pain
surfactant cells are damaged
 Altered mental status
 4. Start of ventilation-perfusion mismatch
Proliferative Stage

 7-10 DAYS AFTER INCITING EVENT

 Body tries to repair structures and some fluid resorption occurs

 Problem is healing of alveolar type 2 cells can lead to metaplasia wherein there is a
production of interstitial myofibroblasts during the healing process
 This thickens the interstitial
 Patients will have some s/s of exudative stage but less severe
Fibrotic Stage

 Not all patients get to this stage

 Patients who get here experience so much damage that there is obliteration of normal
lung architecture making it very difficult for the lung to heal
 Diffuse fibrosis occurs
 Dead space in the lung occurs, prognosis very poor
 Leads to respiratory arrest
Nursing Dx

 Impaired Gas Exchange r/t pulmonary edema

 Ineffective Breathing Pattern r/t decreased lung compliance, pulmonary edema,
decreased surfactant
 Ineffective Airway Clearance
 Ineffective tissue perfusion r/t decreased gas exchange or VQ mismatch