Acute Respiratory Distress Syndrome

-CHIEF

COMPLAINT

-HISTORY

-PHYSICAL

EXAMINATION

difficulty of breathing and orthopnea shortness of breath

 In

taking client's history, the demographic data are also included such as the : -name -age - gender -location -birthday -birthplace -citizenship -educational attainment -work -activities of daily living

use the COLDSPA mnemonic as a guideline for information to collect. C-haracter O-nset L-ocation D-uration S-everity P-attern A-ssociated factors
We

 Do

you ever experience difficulty breathing? Describe the difficulty. Do you experience any other symptoms when you have difficulty breathing?

 Do

you have difficulty breathing when you are resting or do any specific activities cause the difficulty? you have difficulty breathing when you sleep? Do you use more than one pillow or elevate the head of the bed when you sleep?

Do

Have

you had prior respiratory problem? you ever had any thoracic surgery, biopsy, or trauma?

Have

 Have

you been tested for or diagnosed with allergies?

Have

you ever had a chest x-ray, tuberculosis (TB) skin test, or influenza immunization? Have you had any other pulmonary studies in the past?

 Is

there a history of lung disease in your family? Did any family members in your home smoke when you were growing up? Is there a history of other pulmonary illness/disorders in the family, e.g., asthma?

 Are

you exposed to any other environmental conditions that affect your breathing? Where do you work? Are you around smokers?

Do

you have difficulty performing your usual daily activities? Describe any difficulties.

 What

kind of stress are you experiencing at this time? How does it affect your breathing?

Are

you currently taking medications for breathing problems or other medications (prescription or OTC) that affect your breathing? Do you use any other treatments at home for your respiratory problems?

ASSESS

THE RESPIRATORY RATE

INSPECT

FOR INTERCOSTAL RETRACTION OR BULGING OF ABNORMAL

AUSCULTATION

SOUNDS

Other names:
Adult hyaline membrane disease Increased-permeability pulmonary edema Noncardiac pulmonary edema

 Diagnostic

tests are used to find the cause of your symptoms. You may have ARDS or another condition that causes similar symptoms.

 An

arterial blood gas test. This blood test shows the oxygen level in your blood. A low level of oxygen in the blood may be a sign of ARDS. Normal values: pH 7.35 - 7.45 PaCO2 35 45 mmHg PaO2 80 100 mmHg HCO3 22-26 mEq/L

Chest


x-ray

This test is used to take pictures of the structures in your chest, such as your heart, lungs, and blood vessels. It can show whether you have extra fluid in your lungs.

Nursing care:

You may be asked to remove some or all of your clothes and to wear a gown during the exam. You may also be asked to remove jewelry, dentures, eye glasses and any metal objects or clothing that might interfere with the x-ray images.

Blood

tests, such as a complete blood count, blood chemistries, and blood cultures. These tests help find the cause of ARDS, such as an infection.

Normal values:
RBC - Red blood cells Range 4.20 5.70 HGB - Hemoglobin Range 13.2 - 16.9 HCT - Hematocrit Range 38.5 49.0% Platelets Count Range 140,000 390,000 (mm3) WBC - White Blood Cell (leukocytes)Range 3,900 10,000 (mm3)

Chest

computed tomography scan,

or chest CT scan. This test uses a computer to create detailed pictures of your lungs. It may show lung problems, such as fluid in the lungs, signs of pneumonia, or a lung tumor.

Heart
that

tests

look for signs of heart failure. Heart failure is a condition in which the heart can't pump enough blood to meet the body's needs. This condition can cause fluid to build up in your lungs.

Shows

decreased lung compliance with reduced vital capacity, minute volume, and functional vital capacity

Shows

normal pressures in ARDS, helping ARDS from cardiogenic pulmonary edema

Is

characterized by noncardiac pulmonary edema and progressive refractory hypoxemia. form of acute respiratory

Severe

failure

It

is declining, remains around 30% - 40%

Shock Inhalation Infections Drug

Injuries

overdose Trauma

And

other disease such as pancreatitis, open heart surgery with cardiopulmonary bypass and etc.

Dyspnea Tachypnea Anxiety

This three are the early manifestation that occur usually 24-48 hrs after the initial insult

Increasing respiratory rate Intercostal retraction Use of accessory muscles in respiration Cyanosis ( not improve by O2 therapy) Breath sounds are clear but crackles and rhonchi develop later

Mental

status changes such as: agitation confusion lethargy

Primary insult Chemical mediator released Damaged to alveolar- capillary membrane Interstitial edema Alveolar edema Damaged to surfactant producing cell

Decrease lung compliance, atelectasis, hyaline membrane formation Impaired gas exchanged Increased work of breathing Respiratory failure

No specific therapy for acute respiratory distress syndrome (ARDS) exists. Treatment of the underlying condition is essential, along with supportive care and appropriate ventilator and fluid management.

Separating

out initial resuscitation, as used for early goal directed therapy, and maintenance fluid therapy is important.

full face mask is attached

Example:  non

invasive positive pressure ventilation [NIPPV]

Contraindications: diminished level of consciousness or other causes of decreased airway protection reflexes inadequate cough vomiting or upper gastrointestinal bleeding inability to properly fit the mask poor patient cooperation hemodynamic instability

The

goals of mechanical ventilation in ARDS are to maintain oxygenation while avoiding oxygen toxicity and complications of mechanical ventilation.

Protective

ventilation

strategy
the use of low tidal volumes improves survival rate TV 12ml/kg IP 50cmH2O vs. 6:30 MR 39.8-31%
-by

PEEP positive end-expiratory pressure PCV pressured controlled ventilation Prone position it is safe, tested to improve oxygenation

 If

mechanical ventilation is prolonged, tracheostomy is eventually required

 If

too distress, usually the physician ordered as NPO to avoid aspiration nutrtion via NGT

Enteral

 Patients

with ARDS are at bed rest (CBR s BRPs) Frequent position change Elevation of HOD to 45-90 degrees angle

 NONE!

Palliative........ Corticosteroids usually given in sepsis does not prevent ARDS

Agent Prostaglandin E1

Rationale A direct pulmonary vasodilator, inhibitor of platelet aggregation, and inhibitor of neutrophil adhesion Inhibitor of thomboxane synthase and thus acts as a pulmonary vasodilator and inhibitor of platelet aggregation

Effects Mortality unaltered More rapid improvement in oxygenation

Dazoxiben

Mortality unaltered

Ketoconazole

Ketoconazole Inhibitor of thomboxane synthase and 5-lipoxygenase, thus reducing production of leukotrienes, neutrophil chemokines

Mortality unaltered

N-acetyl cysteine

Antioxidant that reduces Mortality unaltered damage by reactive Improved oxygenation oxygen species and compliance Inhibitor of phosphatidic Mortality unaltered acid which increases cytokine production and activates neutrophils

Lisofylline

 Physical

Limited work
Social

Support of family
Emotional

Acceptance
Spiritual

Confession and Faith Environmental Lifestyle