Acute Respiratory Distress Syndrome Nursing Management and Interventions

ARDS is a breathing failure that turns critical fast. A patient who is already very ill or badly injured suddenly cannot oxygenate, and the priority is supporting gas exchange while you treat what caused it.

Definition

Acute respiratory distress syndrome (ARDS) is a life-threatening lung condition, a form of breathing failure in very ill or severely injured people. It is not a specific disease. It starts with swelling of lung tissue and fluid building up in the tiny air sacs that move oxygen into the bloodstream, which drives blood oxygen down. It resembles infant respiratory distress syndrome, but the causes and treatments differ. ARDS can develop in anyone over the age of 1 year. Also called adult respiratory distress syndrome or respiratory distress syndrome.

Causes

Direct injury to the lungs: chest trauma such as a heavy blow, breathing vomit, breathing smoke, chemicals, or salt water, and burns.

Indirect injury to the lungs: severe infection, massive blood transfusion, pneumonia, severe inflammation of the pancreas (pancreatitis), overdoses of alcohol or certain drugs (aspirin, cocaine, opioids, phenothiazines, tricyclic antidepressants), and lung or bone marrow transplantation. Within a few days of a lung transplant the recipient is prone to ARDS.

Risk Factors

ARDS usually develops in people already hospitalized and being treated for one of the injuries above, though only a small number of them actually develop it. No one can predict who will, but cigarette smokers, those with chronic lung disease, and those over age 65 are more at risk.

Symptoms

Shortness of breath, fast labored breathing, bluish skin or fingernail color, and rapid pulse.

Diagnosis

Suspect ARDS when a patient with severe infection or injury develops breathing problems, a chest x-ray shows fluid in the air sacs of both lungs, blood tests show low blood oxygen, and other causes of breathing trouble have been ruled out. Workup includes blood pressure check; blood tests for oxygen levels, signs of infection, and BNP (brain natriuretic peptide, a marker of heart failure); chest x-ray; analysis of coughed-up matter; sometimes an echocardiogram (heart ultrasound) to rule out congestive heart failure; pulmonary artery catheterization to aid the workup; and bronchoscopy to analyze the airways, where lab examination may show certain viruses or cancer cells. Open lung biopsy is reserved for cases that are hard to diagnose.

Nursing Diagnoses

• Ineffective airway clearance
• Ineffective breathing pattern
• Impaired gas exchange
• Anxiety

Treatment

Treat the underlying cause or injury and support the patient until the lungs heal. Support means mechanical ventilation through a tube placed in the mouth or nose or through an opening in the neck, monitoring blood chemistry and fluid levels, and sedation, which most ARDS patients need to tolerate these treatments.