ACUTE RESPIRATORY DISTRESS SYNDROME

(ARDS)
Modifiable factor

I. Injury or
exudative
phase

Non-modifiable factors

Sepsis
Aspiration of gastric content
Burns
Inhalation of toxic chemicals (smoke)

Damaged alveolar cells

Lung Injury

- Age: Above 65 years old

- Gender: Male
Vascular narrowing
& obstruction

Bronchoconstriction

Surfactant production

Release of vasoactive substance

(Histamine, serotonin, bradykinin)

Alveolar compliance & recoil

Alveolar capillary membrane

II. Reparative
or

Atelectasis

Lung compliance

Hyaline membrane
Formation

Outward migration of blood

cells & fluid from capillaries

Impaired
Gas
Exchange
Impaired
Gas
Exchange

Pulmonary edema

ARDS

III. Fibrotic or

Pulmonary

(Acute Respiratiory Distress Syndrome)

Chronic
phase

Hypertension

Early S/S:

Complications

-Restlessness
-Dyspnea

Proliferative
phase

permeability

-Nosocomial pneumonia

Chest X-ray
Chest CT scan
Bronchoscopy

- Barotrauma

Late S/S
-Severe DOB (i.e labored, rapid breathing
-SOB
Pulmonary artery
catheterization

ACUTE RESPIRATORY DISTRESS SYNDROME

(ARDS)
-Low blood pressure
-Confusion

-Renal failure

-Tachycardia

Other complications are:

-Cyanosis

-Extreme tiredness

- O2 toxicity

-Thin frothy sputum

-Change in pt. behavior

-Stress ulcer

-Abnormal breath sounds

-Tracheal ulceration
- Pulmonary embolism

Mood swings
Disorientation
Change in LOC

PaCO2 with respiratory

alkalosis

-Cough
ABG analysis

-Fever

Nursing intervention

Medical management

NCP

-Supplemental O2

-Intubation procedure

-Ineffective breathing pattern r/t dec. lung compliance,

-Fluid therapy

-Mechanical ventilator

dec. energy as characterized by dyspnea, abnormal

-Positioning strategies

-Tracheostomy

Turn the pt. from supine

to prone
Another position is lateral
rotation therapy

-Oxygenation
- PEEP

ABG, cyanosis, & use of accessory muscles.

- Impaired gas exchange r/t diffusion defect as
characterized hypoxia (restlessness, irritability, & fear
of suffocation) hypercapnia &tachycardia.
- Risk for dec. cardiac output r/t positive pressure

ACUTE RESPIRATORY DISTRESS SYNDROME

(ARDS)
ventilation.
-Ineffective protection r/t positive pressure ventilation,
dec. pulmonary compliance & inc. secretion as
characterized by crepitus, altered chest excursion,
abnormal ABG & restlessness.

Medications
-Antibiotics
-Anti-inflammatory drugs (such as
corticosteroids)
-Diuretics (

-Drugs to raise BP
-Anti anxiety
-Muscle relaxant
-Inhaled drugs (Bronchodilators)

-Impaired physical mobility r/tmonitoring devices,

mechanical ventilation, & medications as
characterized by imposed restrictions of movement,
dec. muscle strength & limited ROM.
-Risk for impaired skin integrity r/t prolonged bed rest,
prolonged intubation, & immobility.
-Knowledge deficit r/t health condition, new equipment
& hosp. as characterized by inc. frequency of question
posted by pt. & SO.

ACUTE RESPIRATORY DISTRESS SYNDROME

(ARDS)
Reference:
Legend:
Medical management
Modifiable fx
Non-modifiable fx.

Medications

Signs and symptoms

Nursing Intervention
Diagnostic test

NCP

1.Bernard GR, Artigas A, Brigham KL, Carlet J, Falke

K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R.
The American-European Consensus Conference on
ARDS. Denitions, mechanisms, relevant outcomes,
and clinical trial coordination. Am J Respir Crit Care
Med 1994;149:818824.
2. Rubenfeld GD, Caldwell E, Peabody E, Weaver J,
Martin DP, Neff M, Stern EJ, Hudson LD. Incidence
and outcomes of acute lung injury. N Engl J Med
2005;353:16851693.
3. The Acute Respiratory Distress Syndrome Network.
Ventilation with lower tidal volumes as compared with
traditional tidal volumes for acute lung injury and the
acute respiratory distress syndrome. N Engl J Med
2000;342:13011308.