Prepared by: Carrie Ann S.

Fernandez

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Characterized by noncardiac pulmonary edema and progressive hypoxemia. It is recognized as a severe form of acute respiratory failure is a serious reaction to various forms of injuries or acute infection to the lung. RDS is a severe lung syndrome (not a disease) caused by a variety of direct and indirect issues. It is characterized by inflammation of the lung parenchyma leading to impaired gas exchange with concomitant systemic release of inflammatory mediators causing inflammation, hypoxemia and frequently resulting in multiple organ failure. This condition is often fatal, usually requiring mechanical ventilation and admission to an intensive care unit.

RDS has been known by various names such as: - Shock lung - Wet lung -Vietnam lung -Adult hyaline membrane disease -Neonatal respiratory distress syndrome -Infant respiratory distress syndrome -Surfactant deficiency

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Shock Inhalation injuries Infections Drug overdose Trauma

Direct Lung Injury Conditions that can directly injure the lungs include: Pneumonia Breathing in harmful fumes or smoke. Inhaling vomited stomach contents from the mouth. Using a ventilator Nearly drowning 2. Indirect Lung Injury Conditions that can indirectly injure the lungs include: Sepsis. Severe bleeding An injury to the chest or head, such as a severe blow. Pancreatitis Fat embolism
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Dyspnea Tachypnea Anxiety Intercostal retraction Use of accessory muscles Cyanosis develop Crackles(rales) and ronchi may develop later Mental status changes(agitation, confusion, and lethargy)

Impaired gas exchange related to increased alveolar-capillary permeability, interstitial edema, and decreased lung compliance Other Diagnoses that may occur in Nursing Care Plans For ARDS Ineffective airway clearance Ineffective breathing pattern Activity intolerance Anxiety (specify level: mild, moderate, severe, panic) Risk for aspiration

Diagnostic Tests o Arterial Blood Gas o Chest X-ray o Pulmonary function test o Pulmonary artery pressure monitoring o Blood tests, including CBC and blood chemistries o Bronchoscopy o Sputum cultures and analysis

Primary insult

Chemical mediators release

Damage to alveolar-capillary membrane Interstitial edema Alveolar edema Dilution of surfactant Damaged surfactant producing cells Decreased surfactant production

Decreased lung compliance,atelectasis,hyaline membrane formation Increased work of breathing Respiratory failure Impaired gas exchange

Medical Management

Identify and treat the underlying condition insure early detection; use aggressive supportive treatment; prevent infection ( intubation and mechanical ventilation). As disease progresses, use positive and expiratory pressure PEEP ( neuromuscular blocking agent such as pancuronium (pavulon and vecuronium) (norcuron) maybe used to paralyzed patient for easier ventilation. Monitor arterial blood gas values , pulse symmetry , and pulmonary function testing. Provide circulatory support; treat hypovolemia carefully ; avoid overload Provide adequate fluid management ; administer intravenous solutions Provide nutritional support; (35 to 45 kilocalories per kilogram daily) Pharmacologic therapy may include human recombinant interleukin-1 receptor antagonist, neutrophil inhibitors, pulmonary- specific vasodilators, surfactant replacement therapy, antisepsis agents, antioxidant therapy, and corticosteroids (late in the course of ARDS).

-No definitive drug for RDS, number of medication may be used - Surfactant therapy - Corticosteroids -Inhaled nitric oxide -Vecuronium (Norcuron)

Identify and treat cause of the Acute respiratory distress syndrome through assessment. Administer oxygen as prescribed. Position client in high fowlers position. Restrict fluid intake as prescribed. Provide respiratory treatment as prescribed. Administer diuretics, anticoagulants or corticosteroids as prescribed.