Case Presentation On

Acute respiratory
distress syndrome
Presented by
Takshu M. Meshram
Basic bsc nursing
2nd year
MGCON Wardha
 Demographic Data :-
Name of the patient : Mr Akshay bhange
age / Sex: . 34 years / male
address: Wardha
religion : Hindu
Marital status : married
education: graduate
occupation: works in a industry
date of admission: 13 February 2021
diagnosis: acute respiratory distress
syndrome
PRESENTING COMPLAINTS :
Mr. Akshay Bhange admitted in
lifecare hospital on dated 13th
February 2021 with the chief
complaint of Difficulty in breathing ,
cough, fatigue , disinterest in any
activity.
 Date :13th
Physical examination :- February
Vital signs In Patient Normal Time : 3 PM
Remark
Range
01.

Temperature 38 C 37.5 C Normal

Pulse 104 beat /min 60-100 beat Tachyacardia

/min
Respiration 28breath /min 12 -26 Tachypnoea
breath /min
Blood 90/60 mmHg 120/80 mmHg Low blood
pressure
Pressure (hypotention)
 CHEST -
Palpation : No any axillary lymph node enlargement
or any masses
Percussion-Pleural effusion is present
Auscultation -Sound is present (Muffled sound)
  INVESTIGATION
• Complete blood count
• Increased WBC count
• Chest X-ray :- Bilateral, scattered interstitial
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infiltrates compatible with an Ards pattern

01

• Arterial Blood Gas Analysis - ABGA reveal

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the hypoxemia. Oxygen saturation is 86%

• Echo cardiogram
• Bronchoscopy
 DRUG STUDY
•
1.Methylprednisolone
Trade Name -Medrol
:-
• Route -Oral
• Dose and frequency -16 to 64 my /day once daily or in
divided doses
• Action - It decreases immune system response to the
disease to reduce symptoms of allergic reaction
• Side effects - Nausea, vomating, headache, dizziness,
increased thirst ,increased sweating
• Nursing Responsibility - monitor vital signs ,assess for side
effects and report ,obtain history of patient to determine any
allergies to drugs
 2. Dopamine -
• Trade name - Intropin or Dopastat
• Route - IV infusion through injection
• Dose and frequency - injectable 40mg or 80mg /ml
• Infusion solution in D5 80mg /100ml
• Action - At higher doses dopamine causes
vasoconstriction which increases BP. Dopamine produces
positive intropic effects on myocardium resulting in
maintaining heart rate
• Side effects - vomating nausea, chest pain, high BP,
Increased heart rate
 3.Dobutamine
• Trade Name -Dobutrex
• Route - Intravenous infusion
• Dose and frequency - 5mg/kg/min
• Action - Dobutamine stimulate intropic effect on the
heart through binding and activating beta-1 receptor.
It increases contractility which leads to end systolic
volume, to decrease and hence increase in stroke
volume. The larger stroke volume leads to an increase
in cardiac output and respiratory functioning.
• Side effects - nausea, vomating ,chest pain,
troubled breathing
 DISEASE CONDITION
Acute respiratory Distress Syndrome
(ARDS) is a sudden and progressive form
of acute respiratory failure In which the
alleviolar capillary membrane becomes
damaged and more permeable to
intravascular fluid resulting in severe
dyspnoea hypoxemia and diffuse
pulmonary infiltrates.
 Etiology and risk factors

Book picture Patient picture

Environmental Present
factors
Personal habit Present
Family history Absent
Direct lung injury Absent
Pathophysiology
Direct or indirect lung injury
Immune response is triggered
Systematic inflammatory response
Increasing
Acute respiratory failure hypoxemia

Acute respiratory distress syndrome

 Clinical manifestation :-
Book picture Patient Picture
Shortness of breath Present
Low blood pressure Present
Hypoxemia Present
Chest discomfort or pain Absent

Confusion Absent
Cough Present
 Medical Management :-
Book picture Patient picture
Corticosteroids - Given
Methylprednisolone
Intropic agent -Dobutamine Given
Vasodialator -nitric oxide Not given
Vasoconstriction - Given
Dopamine
Diuretics - Not given
  Nursing Management :-
• Assess the patient respiratory status and vital signs
frequently
• Change position of the client to enhance secreations
drainage. Provide prone position
• Administer oxygen therapy as a supplemental oxygen.
• Assess the colour and consistency of sputum. Collect
sputum and send it to laboratory for sputum culture
and analysis
• Encourage breathing exercises, coughing exercise ,lip
pursed breathing .
NURSING
CARE
PLAN
 Nursing Diagnosis
1. Ineffective breathing pattern related to accumulation of
fluid in the alveoli
2. Ineffective airway clearance related to accumulation of
fluid in alveoli as evidenced by cough with or without
sputum
3. Decreased cardiac output related to disease condition
4. Activity intolerance related to inadequate tissue
oxygenation and dyspnoea as evidenced by inability to
meet basic needs
5. Knowledge deficient related to health condition as
 1. Ineffective breathing pattern related to
accumulation of fluid in the alveoli

• Assess the general condition and vital signs to know

baseline data
• Provide prone position and change positions
frequently to improve gas exchange and to facilitate
secreations drainage
• Administer oxygen to provide adequate o2 to the bod
• Teach deep breathing exercises to releave from
discomfort
• Administer medication as prescribed by physician
2. Ineffective airway clearance related to accumulation
of fluid in alveoli as evidenced by cough with or
without sputum

• Assess cough pattern, consistency and amount of

secretions and breath sound to obtain baseline data
• Give client 8 to 10 glasses of warm water to facilitate
coughing out sputum
• Provide steam inhalation twice daily to make
secreations loosen and easier to cough out
• Teach and encourage to use diaphragmatic breathing
exercises and coughing exercise to improve
ventilation
3. Decreased cardiac output
related to disease condition
• Assess heart rate, sound and monitor blood
pressure to evaluate cardiac output
• Note skin colour, peripheral pulse, and capillary
refill to check signs of hypoxemia
• Record urine output and determine how often
patient urinates because renal system
counterbalance low BP by retaining water
• Provide medication as prescribed by physician to
regulate heart functioning.
Health Education
• Diet
• Exercise
• Personal hygiene
• Rest and sleep
• Medication
• Lifestyle modification
• Follow up