ACUTE

RESPIRATORY
DISTRESS
SYNDROME
(ARDS)
Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli 1
INTRODUCTION TO RESPIRATORY SYSTEM

Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli 2

INTRODUCTION TO RESPIRATORY SYSTEM
contd…………

Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli 3

INTRODUCTION TO RESPIRATORY SYSTEM
contd…………

4
Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli
INTRODUCTION TO RESPIRATORY SYSTEM
contd…………

Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli 5

 RESPIRATORY DISTRESS
•SYNDROME (ARDS)
Acute respiratory distress syndrome (ARDS) is a life-threatening
lung condition that prevents enough oxygen from getting into the
blood.
• Acute respiratory distress syndrome was first described in 1967
by Ashbaugh and colleagues.
• ARDS is also referred with variety of terms like
• Stiff Lung
• Shock lung
• Wet lung
• Post traumatic lung
• Adult respiratory distress syndrome
• Adult hyaline membrane disease
• Capillary leak syndrome &
• Congestive atelectasis.
Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli 6
 DEFINITION

• Acute respiratory distress syndrome (ARDS) is a

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.

Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli 7

STAGES OF ODEMA FORMATION IN ACUTE
RESPIRATORY DISTRESS SYNDROME

Mr sanjay. M. Peerapur, Principal, KLES

8
Institute of Nursing Sciences, Hubli
 ETIOLOGY & RISK FACTORS
• Direct Lung Injury
– Common causes
• Aspiration of gastric contents or other substances.
• Viral/bacterial pneumonia
– Less Common causes
• Chest trauma
• Embolism: fat, air, amniotic fluid
• Inhalation of toxic substances
• Near-drowning
• O2 toxicity
• Radiation pneumonitis
Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli 9
ETIOLOGY & RISK FACTORS contd…….
• Indirect Lung Injury
– Common causes
• Sepsis
• Severe
traumatic
injury
– Less common
causes
• Acute
pancreatitis
• Anaphylaxis
• Prolonged
Cardiopulm
onary
bypass
surgery
• Disseminate 10
SCHEMATIC REPRESENTATION OF PATHOPHYSIOLOGY OF ARDS
Lung injury

Damaged Type II alveolar cell Release of Vasoactive substances

(serotonin, histamine, bradykinin)
Surfactant production
Alveolocapillary Vascular
membrane narrowing &
Alveolar
permeability obstruction
Compliance and recoil
Bronchoconstriction

Outward migration
Atelectasis
of blood cells &
fluids from capillaries
Hyaline membrane
formation Pulmonary Edema

Lung
compliance
I
m
p
a Pulmonary
i ARDS hypertensio
r Principal, KLES Institute of Nursing Sciences, Hubli
Mr sanjay. M. Peerapur,
n 11
m
 CLINICAL MANIFESTATIONS
• Early signs/symptoms
– 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
• Fever
Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli 12
CLINICAL MANIFESTATIONS CONTD…………

Late signs & symptoms

– Severe difficulty in breathing i.e., labored, rapid
breathing.
– Shortness of breath.
– Tachycardia
– Cyanosis (blue skin, lips and nails)
– Think frothy sputum
– Metabolic acidosis
– Abnormal breath sounds, like crackles
– PaCo2 with respiratory alkalosis.
– PaO2
13
Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli
 DIAGNOSITC EVALUATION
• History of above symptoms
• On physical examination
– Auscultation reveals abnormal breath sounds
• The first tests done are :
– Arterial blood gas analysis
– Bood tests
– Chest x-ray
– Bronchoscopy
– Sputum cultures and analysis
• Other tests are :
– Chest CT Scan
– Echocardiogram
Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli 14
 COMPLICATIONS
• Common complications are;
– Nosocomial pneumonia:
– Barotrauma
– Renal failure
• Other complications are :
– O2 toxicity,
– stress ulcers,
– Tracheal ulceration,
– Blood clots leading to deep vein thrombosis &
– pulmonary embolism.
Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli 15
 MEDICAL MANAGEMENT
• Persons with ARDS are hospitalized and require
treatment in an intensive care unit.
• No specific therapy for ARDS exists.
• Supportive measures :
– Supplemental oxygen
– Mechanical respirator
– Positioning strategies
• Turn the patient from supine to prone.
• Another position is lateral rotation
therapy
• Fluid therapy
Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli 16
TURNING PATIENT PRONE ON VOLLMAN PRONE POSITIONER

17
Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli
PATIENT LYING PRONE ON VOLLMAN PRONE POSITIONER

18
Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli
LATERAL ROTATION THERAPY BED

19
Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli
MEDICAL MANAGEMENT contd…….
• Medications :
– Antibiotics
– Anti-inflammatory drugs; such as corticosteroids
– Diuretics
– Drugs to raise blood pressure
– Anti-anxiety
– Muscle relaxers
– Inhaled drugs (Bronchodilators)

Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli 20

 NURSING DIAGNOSIS
1. Ineffective 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 protection related to positive pressure
ventilation, decreased pulmonary compliance &
increased secretions as characterized by crepitus,
altered chest excursion, abnormal ABGs &
restlessness.
Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli 21
 NURSING DIAGNOSIS CONTD……..

5. Impaired physical mobility related to monitoring

devices, mechanical ventilation & medications as
characterized by imposed restrictions of
movement, decreased muscle strength & limited
range of motion.
6. Risk for impaired skin integrity related to
prolonged bed rest, prolonged intubation &
immobility.
7. Knowledge deficit related to health condition,
new equipment & hospitalization as characterized
by increased frequency of questions posed by
patient and significant others.
Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli 22