ACUTE RESPIRATORY DISTRESS (ARDs)
Lecture Notes February 26, 2001
Review Nursing Care Plan Page: 1902-1903 and 1949 1951
N Sudden progressive pulmonary disorder
1. Acute lung inflammation
2. diffuse alveola capillary injuries characterized as severe dyspnea, hypoic PaCo2 <50 or 60
N Mortality rate is high
N Young adults 40% die
N Elderly 60% die
Cause of ARDs:
N Insult bacterial infection (i.e., pneumonia, septicemia)
N Medical conditions; trauma cases, burns, shock
N Noxious events; exposure to smoke
Leads to ARDs directly:
N Viral, bacterial, fungal pneumonia
N Lung contusion
N Fat embolus
N Aspiration (forign material, drawning)
N Massive smoke inhalation
N Inhaled toxic
N Prolonged exposure to high concentration of oxygen
Direct pulmonary Trauma:
N Multisystem trauma
Early Signs & Symptoms of ARDs:
N Rapid shallow breathing
N Air hunger
N Cyanosis (nail membranes)
N Respiratory alkalosis FIRST
N Marked dyspnea
N Hypoxemia Pa02 <60 mm Hg when on 60% oxygen, lung sounds clear to fine crackles
Late Signs & Symptoms of ARDs:
N Decreased lung compliance
N Defuse bilateral infiltrates Xray
N Metabolic acidosis or Respiratory acidosis
Diagnosis by respiratory assessment of lung sounds
ABGs need to be evaluated
i. Endotracheal tube, (can get sores in mouth, can use for 10 to 14 days only)
ii. Tracheostomy Tube, (neet a tube of the same size taped to HOB and trach dilator.
i. Adequate ventilation
ii. Precise concentration of F;oxygen RA=21%
iii. Adequate title volume
iv. Decrease work of breathing
Shiley Trach: disposible inner canula
Fenestrated trach: used for long term & pt can talk
If on a ventilator you should give ativan push to help with anxiety.
N Mechanical ventilation with PEEP
N Neuromuscular blocking agents
§ Pavulon (paralyzed patient)
Other treatments for ARDS:
N Treat cause
N Shock: HTN or Cardiac
§ Increased cardiac output and increased BP, multiple lines
§ Dopamine and dobutamine for increased BP (SBP <100)
§ Sputum specimen with suction
§ Treat with antibiotics until culture returns (broad spectrum Abx)
§ May use antiinflammatories (i.e., methylprednisone)
N Monitor for complications: (Cardiac dysrhythmias)
§ Due to hypoxemia
§ Renal failure
§ Thrombocytopenia with infection process
§ Stress ulcers
§ May develop mult. Lines
§ Arterial, swan for cardiac output
N Complications of positive pressure ventilation
§ Decreased cardiac output
§ Decreased blood flow to splanchnic area (3rd spacing, high pressure)
· Ischemic gastric mucosa (cause of stress ulcer, pepsid, zantac, histamine blackers)
· Decreased renal blood flow d/t decreased CO, will increase peripheral edema, decrease urine output and fluid retention (diuretics: Lasix or Bumex)
· Respiratory alkalosis: Title volume delivered is too high, Respiration rate is too high. May lead to seizure or alkalosis development.
N Reasons for Mechanical Ventilation
1. Permanent d/t quads, Lou Gehrigs Disease, MS, neuromuscular conditions.
2. Correct hyopoxemia
N Three types of Positive Pressure Ventilators:
1. Volume Cycled ventilator: used in acute problems (ie, spinal cord injury or COPD. Inspiration occurs until a preset volume of air is delivered.
2. Pressure Cycled Ventilator: Used in home with long term patients. Inspiration ends when preset pressure is reached. 20 50 cm of water pressure.
3. Time Cycled Ventilator: How many breaths/minute used with kids and infants. Inspiration ends with a preset time of enterval.
N Mods of Ventilation:
1. Control mode CMV needed with neuroblocking agent. Ventilator does all the work.
2. Assist/Control Machine assist patient. Patient triggers and then machine takes over.
3. Intermittent Mandatory Ventilator (IMV) Trying to ween off ventilator. Machine lets patient breath on own.
4. Synchronized Intermittent mandatory Ventilator (SIMV) The machine breaths are synchronized with the patients breaths.
5. Pressure Support Ventilator (PSV) Used for weening when close to coming of ventilator. Patient breaths spontaneously. NOTE: LOOKING @ PRESET PRESSURE
6. Positive End Expiratory Pressure (PEEP) preset amount of pressure left in the lungs @ the end of exhale to keep aveola open. Like a balloon not totally deflated. Oxygen defuses easier into capillaries. Its a positive pressure 5-20cc/water a setting on ventilator.
7. C-PAP Similar to PEEP, a continuous positive airway pressure.