Acute Respiratory Distress Syndrome (ARDS)•Severe form of acute lung injury that damages alveoli because of inflammation•Characterized by sudden, progressive pulmonary edema, increasing bilateral lung infiltrates visible on chest x-ray, hypoxemia unresponsive to supplemental oxygen regardless of PEEP and absence of left arterial pressure and most have decreased lung compliance.•Symptoms•Rapid onset of severe dyspnea•Hypoxemiathat does not respond to supplemental oxygen therapyARDS is noncardiac in nature. It affects both lungs and hypoxia is refractory to O2. To differentiate from a cardiac issue we look at the BNP. If >100 it is not cardiac. Important for tx purposes. Goal is to keep Pa02 60 or higher and SaO2 <90 with the lowest use of FiO2. A normal PH is also part of the POC.
ARDS Risk Factors •Aspiration (drowning, gastric secretions)•Drug ingestion and overdose •Hematologic disorders (DIC, massive transfusions)•Prolonged inhalation of high concentration O2, smoke or corrosive substances •Localized infection (bacterial, fungal, viral pneumonia)•Metabolic disorders (pancreatitis, uremia)•Shock (any cause)•Traumas (pulmonary contusion, mult. Fx, head injury)•Major surgery •Fat or air embolism •Sepsis The major cause of death with ARDS is non-pulmonary MODS often with sepsis
ARDS Medical and Pharmacological Management•Treat underlying condition•Intubation, mechanical ventilation with PEEP to keep alveoli open•Nutritional support, enteral feedings preferred or TPN•IV fluids•Inotropic or vasopressors•Possible corticosteroids•Neuromuscular blocking agents•Sedatives•Analgesics•Inhaled nitric oxideNitric oxide (NO ) is used for infants with pulmonary hypertension or respiratory failure and children and adults with ARDS. It is used along with a ventilator. It is a vasodilator and reduces pulmonary artery pressure and vasodilates the blood vessels in the ventilated region. This improves arterial oxygenation and improved V/Q mismatch. It will affect blood pressure, monitor MAP frequently. Neuromuscular blocking agents use for early severe ARDS for 48 hours has shown improved mortality. It is shown to decrease inflammation and oxygen consumption and help facilitate ventilator synchrony.
Question •How would you distinguish dyspnea from ARDS versus dyspnea that is cardiac in nature?
LINKS•Acute Respiratory Distress Syndrome: Diagnosis Basics•FLU and ARDS article
Caring for the Patient with Chronic and Degenerative Neurological DisordersChapter 23Bethany Tucker MS, RN, CNE
Objectives•Analyze the presenting signs and symptoms for (amyotrophic lateral sclerosis) ALS•Create a comprehensive plan of care for patients with ALS•Develop an inclusive discharge teaching plan for patients with ALS•Determine health promotion needs and gerontological implications for patients with ALS