Lesson 4

ACUTE RESPIRATORY DISTRESS SYNDROME

CONTENTS

I. Introduction
II. Assessment
a. Risk Factors/Etiology
b. Clinical Manifestations
c. Diagnostic Examination/ Laboratory Tests
III. Treatment
IV. Nursing Intervention/Goals
V. Self Test / Self Directed Learning / Critical Thinking Drill
VI. References/Further Readings

I. Introduction
 ARDS, also referred to as shock lung or white lung, or non-cardiogenic pulmonary edema is a
condition characterized by increased capillary permeability in the alveolar capillary membrane,
resulting in fluid leaking into the interstitial spaces and the alveoli and a decrease in pulmonary
compliance.
 Increasing CO2 are generally not a primary problem in clients with ARDS; the problem exists
with the diffusion of O2 and availability of the O2 to the circulating hemoglobin.

II. Assessment
A. Risk Factors / Etiology: damage or trauma to the lung tissue, with indirect damage occurring in
other parts of the body
1. Aspiration
2. Pulmonary infection
3. Inhalation of toxic gases
4. Hypoalbuminemia (nephrotic syndrome, liver disease)
5. Chest trauma
6. Embolism: fat, air, amniotic fluid
7. Shock (from any cause)
8. Sepsis
B. Clinical Manifestations
1. Tachypnea and dyspnea
2. Increasing hypoxia that does not respond to increased levels of O2
3. Refractory hypoxemia
4. Tachycardia
5. Crackles

C. Diagnostic Exams
1. Chest X-ray: diffuse alveolar infiltration bilaterally
2. ABGs: decrease in PaO2 with increased levels of O2

III. Treatment
A. Maintain oxygenation
1. Endotracheal intubation
2. Mechanical ventilation
B. Positive end-expiratory pressure (PEEP): used to decrease the effects of shunting and to
improve pulmonary compliance
C. Treatment of underlying condition
D. Supportive medications
1. Prophylactic medications
2. Diuretics
3. Sedatives
4. Bronchodilators
5. Neuromuscular blocking agents
6. Steroids (may be used in course)
E. Nutritional Support

IV. Nursing Intervention

Goal No. 1: To maintain airway patency and improve ventilation.

a. Frequent assessment for increasing respiratory difficulty; anticipate intubation or
tracheostomy
b. Endotracheal (ET) tube or tracheostomy suctioning
c. Evaluate ABG results
d. Sedate as necessary for client to tolerate the ventilator
e. Maintain hemoglobin levels and PaO2 saturation levels
 Goal No. 2: To maintain fluid intake
a. Fluid balance maintained with IV hydration, oral intake may be restricted
b. Check serum electrolyte levels
c. Strict intake and output

Goal No. 3: To assess and maintain cardiac output

a. Assess for dysrhythmias
b. Evaluate cardiac output in related to fluid intake
c. Correlate vital signs with other assessment changes

Goal No. 4: To provide emotional support to client and family.

a. Careful repeated explanation of procedures to client and to family.
b. Calm and gentle approach to decrease anxiety
c. Assist client to maintain communication
d. If ET tube or tracheostomy is in place, explain to family and client that speech is only
temporary interrupted

V. Self Test / Critical Thinking Drill

SELF TEST QUESTIONS

1. The nurse is caring for a patient with suspected acute respiratory distress syndrome with PO2 of 53.
The patient is placed on oxygen via face mask and the PO2 remains the same. What does the nurse
recognize as a key characteristic of ARDS?
a. Unresponsive hypoxemia
b. Diminished alveolar dilation
c. Tachypnea
d. Increased PO2
2. You’re providing care to a patient who is being treated for aspiration pneumonia. The patient is on a
100% non-rebreather mask. Which finding below is a HALLMARK sign and symptom that the patient is
developing acute respiratory distress syndrome (ARDS)?
a. The patient is experiencing bradypnea.
b. The patient is tired and confused.
c. The patient’s PaO2 remains at 45 mmHg.
d. The patient’s blood pressure is 180/96.
3. You’re teaching a class on critical care concepts to a group of new nurses. You’re discussing the topic
of acute respiratory distress syndrome (ARDS). At the beginning of the lecture, you assess the new nurses
understanding about this condition. Which statement by a new nurse demonstrates he understands the
condition?
a. “This condition develops because the exocrine glands start to work incorrectly leading to thick,
copious mucous to collect in the alveoli sacs.”
b. “ARDS is a pulmonary disease that gradually causes chronic obstruction of airflow from the
lungs.”
c. “Acute respiratory distress syndrome
CRITICAL THINKING DRILL
occurs due to the collapsing of a lung
Case Study: Acute Respiratory Distress
because air has accumulated in the
Syndrome
pleural space.”
Anne, 71 year old and single, is admitted to the
d. “This condition develops because unit with the diagnosis of ARDS. She was
alveolar capillary membrane permeability receiving treatment at home for viral pneumonia
has changed leading to fluid collecting in and had appeared to be improving until
yesterday.
the alveoli sacs.”
4. A nurse is assessing a female client with 1. The nurse is assessing Anne for clinical
manifestations associated to ARDS. What
multiple trauma who is at risk for developing acute symptoms does the nurse know positively
respiratory distress syndrome. The nurse assesses correlate with ARDS?
for which earliest sign of ARDS? _______________________________________
a. Bilateral wheezing _______________________________________
b. Inspiratory crackles 2. The nurse is performing a neurologic
c. Intercostal retractions assessment for Anne. What symptoms observed
d. Increased respiratory rate by the nurse indicate that Anne is developing
cerebral hypoxia?
5. A firefighter who was involved in extinguishing
_______________________________________
a house fire is being treated for smoke inhalation.
_______________________________________
He develops severe hypoxia 48 hours after the
3. The nurse observes that Anne is due to receive
incident, requiring intubation and mechanical
oxygen inhalation therapy. What type of oxygen
ventilation. Which of the following conditions has administration should be given and at what
he most likely developed? L/min?
a. Acute respiratory distress syndrome _______________________________________
b. Atelectasis _______________________________________
c. Bronchitis
d. Pneumonia