ARDS

Question 1

What is ARDS?

Answer 1

respiratory failure that occurs when the capillary membranes that surround the alveoli sacs become damaged and leak fluid INTO the alveoli sacs (blood, plasma or fluids) causing inflammation and alveolar collapse.

• sudden rapid onset respiratory distress with systemic inflammation

Question 2

What are the risk factors? and who is at higher risk of ARDS?

Answer 2

Risk Factors:
- long hospital stays
- above 65
- tobacco use
- alcohol consumption
- lung diseases
- immune compromised
- contact with air pollution
- covid
- diabetes, copd, htn
- obese

• those with increased risk: older men, African Americans, anyone with pulmonary infections, or COVID.

Question 3

What is the number one cause of ARDS?

Answer 3

SEPSIS

Question 4

Direct vs. Indirect lung injuries?

Answer 4

Indirect: source not in the lungs such as sepsis, burns, blood transfusions, pancreatitis, drug overdose.

Direct: source is in the lungs such as pneumonia, aspiration, inhalation injury, drowning, emobolism.

Question 5

Signs & Symptoms of ARDS?
Early & Late –> how they correlate with ABGS.

Answer 5

Early: barely noticable
- normal to random crackles in the lungs
- difficulty breathing
ABGS: decrease in C02 & 02, PH increases leading to respiratory alkalosis.

Late: respiratory failure
- refractory hypoxemia
- cyanosis
- mental status changes
- chest retractions
- crackles throughout the lungs
- xray will show “white out” in the lungs, indicating bilateral infiltrates.
ABGS: increase in C02, decrease in 02 & PH leading to respiratory acidosis.

Question 6

What is refractory hypoxemia?

Answer 6

IT IS THE HALLMARK SIGN OF ARDS
- it’s when the patients 02 levels do not improve even with oxygen support.
- will see increasing RR and decreasing C02 and 02 levels showing that oxygen is not helping.

Question 7

What are the phases of ARDS?

Answer 7

1. Exudative
2. Proliferative
3. Fibrotic

Question 8

What happens in the exudative phase?

Answer 8

damage to the capillary membranes, causing protein rich fluid to leak out and into the other spaces of the lungs, leading to pulmonary edema.
- REFRACTORY HYPOXEMIA
- decrease in surfactant; which keeps the alveoli from sticking together during exhale and preventing lung collapse (atelectasis)
- decrease 02 and hypoxemia
- cells create the hyaline membrane that makes the lungs stiff and decreases lung compliance

Question 9

What happens is the proliferative phase?

Answer 9

the body tries to repair the damages structures of the lungs which means that the cells are growing and reproducing rapidly leading to lung tissue that is very dense and fibrotic, further decreasing lung compliance and worsening hypoxemia.
- right sided heart dysfunction
- worsening chest xrays
- pulmonary htn

Question 10

What happens in the fibrotic phase?

Answer 10

fibrosis of the lung tissue, with lots of dead space.

• no gas exchange is happening, lungs do not work due to major damage.
• prolonged ventilator use
• IRRIVERISBLE, most patients do not come back from this phase and lung transplant are typically required.

Question 11

Prevention of ARDS?

Answer 11

• aspiration precautions
• early fluids and antibiotics
  CATCHING THE EARLY WARNING SIGNS IS KEY

Question 12

What nursing care do we do for a patient with ARDS?

Answer 12

• monitor ABGs, CBC, lactic acid, blood and sputum cultures, EKGs.
• ventilator support
• prone the patient
• monitor vitals
• treat anxiety and pain
• re orient
• suctioning