Acute Respiratory Distress

Syndrome

ARDS….
Respiratory Distress R/T
Insult
http://www.rale.ca/Bronchial.htm

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It is an Emergency
➲ Alternative names for it
Non cardiogenic edema
Increased permeability pulmonary
edema
Stiff lung
Shock lung
ARDS
Acute lung injury

NUR2744C R.Jonas,MSN,RN revised Spring2007 2

Characterized by
➲ Diffuse pulmonary microvascular injury
Results in increased capillary permeability
Recall the mechanisms involved in gas
exchange
Recall the presentations last week
– Hypoxemic Resp. Failure
– Hypercapnic Resp. Failure
– Alveolar function

➲ Thus from above results in non

cardiogenic NUR2744C
edema R.Jonas,MSN,RN revised Spring2007 3
Ventilation -Perfusion Studies
➲ Reveal the predominant
pathogenesis of hypoxemia in
ARDS is related to intrapulmonary
shunts.
Recall and review the term VQ Scan
Recall and review the term
intrapulmonary shunts

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Etiology
➲ Sepsis
➲ Multipletrauma
➲ Bowel infarction
➲ Diabetes
➲ Septic Shock
➲ ARDS-either a cause of a sequelae
of SIRS…
➲ Your text-table 66-6
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Pathological Changes
➲ ARDS changes may be due to the
immune reaction or an
inflammatory response.
Insult of these systems affect the
alveoli

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Pathophysiology
➲3 phases
Injury or exudative phase
Reparative or proliferative phase
Fibrotic phase

NUR2744C R.Jonas,MSN,RN revised Spring2007 7

Injury or Exudative Phase
➲ 1-7 days after initial insult
➲ Influx of neutrophils and
macrophages case damage to
endothelium
➲ Alveolar fluid accumulates

NUR2744C R.Jonas,MSN,RN revised Spring2007 8

Reparative or Proliferative phase
➲ 1-2 weeks after initial insult
➲ Influx of granulocytes, monocytes,
and lymphocytes
➲ Attempting to repair damage
➲ Progression may be resolved or
continue to fibrosis

NUR2744C R.Jonas,MSN,RN revised Spring2007 9

Fibrotic Phase
➲ 2-3 weeks after initial insult
➲ Diffuse scarring and fibrosis
➲ Decreased lung compliance
➲ Hypoxemia due to thickened walls
➲ Pulmonary hypertension
➲ Chest x-ray “white out”…

NUR2744C R.Jonas,MSN,RN revised Spring2007 10

Death
➲ Major cause of death in ARDS is
MODS
➲ Lungs fail first
➲ Kidneys
➲ Liver
➲ Heart

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Treatment
➲ Aimed at correcting the underlying
cause
➲ Progression depends on client
Clinical picture is not clear cut

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Nursing Management
➲ Preventive measures
Treat the underlying cause
➲ Adequate oxygenation-Primary
goal correct hypoxemia
Mechanical Ventilation
➲ Fluid balance
➲ Positioning-Debatable-see article_

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Medications
➲ Bronchodilators-Albuterol
➲ Epinephrine
➲ Aminophylline
➲ Diprivan-Propofol
Ramsay scale-My web site

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 Critical Thinking…
➲ Ina client with ARDS, what is the
common early clinical
manifestations that a nurse caring
for the client will observe?
A. Dyspnea and tachypnea
B. Cyanosis and apprehension
C. Hypotension and tachycardia
D. Respiratory distress and frothy
sputum