Critical care nursing for Acute

Respiratory Distress Syndrome (ARDS)

Ance M.Siallagan, S.Kep.,Ns,M.Kep

 Etiology
• Aspiration (gastric secretions, drowning, hydrocarbons)
• Drug ingestion and overdose
• Hematologic disorders (disseminated intravascular coagulopathy [DIC],
massive transfusions, cardiopulmonary bypass)
• Prolonged inhalation of high concentrations of oxygen,smoke, or
corrosive substances
• Localized infection (bacterial, fungal, viral pneumonia)
• Metabolic disorders (pancreatitis, uremia)
• Shock (any cause)
• Trauma (pulmonary contusion, multiple fractures, head injury)
• Major surgery
• Fat or air embolism
• Systemic sepsis
 Clinical Manifestations
• Arterial hypoxemia
• Findings on chest x-ray are similar to those seen with
cardiogenic pulmonary edema and are visible as
bilateral infiltrates that quickly worsen.
• The acute lung injury then progresses to fibrosing
alveolitis with persistent, severe hypoxemia.
• The patient also has increased alveolar dead space
(ventilation to alveoli, but poor perfusion) and
decreased pulmonary compliance (“stiff lungs,” which
are difficult to ventilate).
 Assessment and Diagnostic Findings

• intercostal retractions and crackles

• plasma brain natriuretic peptide (BNP) levels,
echocardiography
• Transthoracic echocardiography
• Pulmonary artery catheterization is the
definitive method to distinguish between
hemodynamic(heart failure) and permeability
pulmonary edema
 Medical Management
• intubation and mechanical ventilation
• circulatory support, adequate fluid volume
• Supplemental oxygen
• surfactant replacement therapy, pulmonary
antihypertensive agents, and antisepsis
agents.
• nutritional support require 35-45 kcal/kg/day
 Nursing management
1. Positioning to improve ventilation and
perfusion in the lungs and enhance secretion
drainage.
2. Oxygenation in patients with ARDS is
sometimes improved in the prone position.
 Ventilator Considerations
3. sedation may be required to decrease the
patient’s oxygen consumption, allow the
ventilator to provide full support of
ventilation, and decrease the patient’s
anxiety.
– Sedatives that may be used are lorazepam
(Ativan), midazolam (Versed), dexmedetomidine
(Precedex), propofol (Diprivan), and short-acting
barbiturates.
4. The nurse must reassure the patient that the
paralysis is a result of the medication and is
temporary.
5. Paralysis should be used for the shortest
possible time and never without adequate
sedation and pain management.
6. The nurse must be sure the patient does not
become disconnected from the ventilator, because
respiratory muscles are paralyzed and the patient
will be apneic
7. Eye care is important as well, because the patient
cannot blink, increasing the risk of corneal
abrasions.
8. Neuromuscular blockers predispose the patient to
deep venous thrombi, muscle atrophy, and skin
breakdown.
9. The nurse must anticipate the patient’s needs
regarding pain and comfort.
10.The nurse checks the patient’s position to
ensure it is comfortable and in normal
alignment and talks to, and not about, the
patient while in the patient’s presence.
11.it is important for the nurse to describe the
purpose and effects of the paralytic agents to
the patient’s family.
12.Frequent assessment of the patient’s status is
necessary to evaluate the effectiveness of
treatment
Thank you