Acute Respiratory Distress Syndrome (ARDS)

  1. General information
    1. A form of pulmonary insufficiency more commonly encountered in adults with no previous lung disorders than in those with existing lung disease.
    2. Initial damage to the alveolar-capillary membrane with subsequent leakage of fluid into the interstitial spaces and alveoli, resulting in pulmonary edema and impaired gas exchange.
    3. There is cell damage, decreased surfactant production, and atelectasis, which in turn produce hypoxemia, decreased compliance, and increased work of breathing.
    4. Predisposing conditions include shock, trauma, infection, fluid overload, aspiration, oxygen toxicity, smoke inhalation, pneumonia, DIC, drug allergies, drug overdoses, neurologic injuries, fat emboli.
    5. Has also been called shock lung.
  2. Assessment findings
    1. Dyspnea, cough, tachypnea with intercostal/suprasternal retraction, scattered to diffuse rales/rhonchi
    2. Changes in orientation, tachycardia, cyanosis (rare)
    3. Diagnostic tests
      1. pCO2 and pO2 decreased
      2. Hypoxemia
      3. Hgb and hct possibly decreased
      4. pCO2 increased in terminal stages
  3. Nursing interventions
    1. Promote optimal ventilatory status.
      1. Perform ongoing assessment of lungs with auscultation every 1-2 hours.
      2. Elevate head and chest.
      3. Administer/monitor mechanical ventilation with PEEP.
      4. Assist with chest physical therapy as ordered.
      5. Encourage coughing and deep breathing every hour.
      6. Monitor ABGs and report significant changes.
    2. Promote rest by spacing activities and treatments.
    3. Maintain fluid and electrolyte balance.


Middle Child said...

When someone for example a high level Quadriplegic is given a Pleurodesis for moderate pleural fluid (not cancer or anything serious) and the pleurodesis fails and he begins to go into respiratory arrest and devlops ARDS...what would be the chances of halting this progression were those observing him willing to concede that the Pleurodesis had failed? The time inbetween his beginning to have problems with gas exchange and his first respiratory arrest was about 2 this time the symptoms were ignored. Can ARDS be avoid by early intervention