ARDS ppt

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ACUTE RESPIRATORY DISTRESS SYNDROME

(ARDS)

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

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INTRODUCTION TO RESPIRATORY SYSTEM


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INTRODUCTION TO RESPIRATORY SYSTEM contd…………


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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

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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.



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STAGES OF ODEMA FORMATION IN ACUTE RESPIRATORY DISTRESS SYNDROME

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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


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ETIOLOGY & RISK FACTORS contd…….• Indirect Lung Injury

– Common causes• Sepsis• Severe traumatic injury

– Less common causes• Acute pancreatitis• Anaphylaxis• Prolonged Cardiopulmonary bypass surgery• Disseminated intravascular coagulation• Multiple blood transfusions• Narcotic drug overdose (e.g., heroin)• Nonpulmonary systemic diseases• Severe head injury• Shock• Massive blood transfusion.


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SCHEMATIC REPRESENTATION OF PATHOPHYSIOLOGY OF ARDS


Lung injury

Release of Vasoactive substances (serotonin, histamine,

bradykinin)

Damaged Type II alveolar cell

Surfactant production

Alveolocapillary membrane

permeability

Vascular narrowing & obstruction

AlveolarCompliance and recoil

Bronchoconstriction

Outward migration of blood cells &

fluids from capillaries

Atelectasis

Pulmonary EdemaHyaline membrane

formation

Lung compliance

Impairment in gas exchange

ARDSPulmonary

hypertension

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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


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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.

– PaO2Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli

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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


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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.


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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


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TURNING PATIENT PRONE ON VOLLMAN PRONE POSITIONER


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PATIENT LYING PRONE ON VOLLMAN PRONE POSITIONER


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LATERAL ROTATION THERAPY BED


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MEDICAL MANAGEMENT contd…….• Medications :– Antibiotics– Anti-inflammatory drugs; such as corticosteroids– Diuretics– Drugs to raise blood pressure– Anti-anxiety– Muscle relaxers– Inhaled drugs (Bronchodilators)


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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.


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

ARDS ppt

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