Bc pts who aspirate gastric contents great

Bc pts who aspirate gastric contents= great risk=closely A- & monitor those on tube feedings
& w/problems impair swallowing & gag reflexes
 Carefully observe pts who are being Txed for any health problems associated w/ARDS
6. A- & Clinical Manifestations
 A- the breathing of any pt w/a condition that  the risk of ARDS
o No abnormal lung sounds are present on auscultation bc the edema of ARDS occurs first
in the interstitial spaces & not in the airways
o Might usually have diminished lung sounds
o  work of breathing? Hyperpnea, grunting respirations, cyanosis, pallor, & retraction
intercostally or substernally
 Document sweating, respiratory effert, & change in mental status
 Monitor VS at least hrly to A- for hypotension, tachycardia, & dysrhythmias

7. Dx A-
 The Dx of ARDS is est. by a  Pao2 value thru ABG measurements .
o Pt has a progressive need for higher levels of O2 Due to the shunting of blood
o Pt doesn’t respond to  concentrations of O2 (- refractory hypoxemia = Can’t get pt off
100% O
2
but you still have to tx them w/100% O
2
=the only way to tx them initially) &
often needs intubation & mechanical ventilation
 Sputum cultures obtained by the HCP thru bronchoscopy & by transtracheal aspiration are
used to determine if a lung infection also is present
 The chest x-ray usually shows diffused haziness or a “whited-out” (ground-glass) appearance
of the lung
 ECG rules out cardiac problems & usually reveals no specific changes
 Pulmonary artery (Swan-Ganz) catheter placement & hemodynamic monitoring is a Dx tool
o Put these in pt’s a lot that have vol. issues particularly w/pulmonary edema or issues
w/their lungs being wet
o In Pt w/ARDS, pulmonary capillary wedge pressure (PCWP) is usually  to normal
(Normal range=4-12)
 PCWP differs in ARDS pt from one w/cardiac-induced pulmonary edema (cardio-
induced=PCWP is  18 mm Hg)
o Wedge=in PA=tells the vol. that exist in lungs
o Wedge floats from right side of  to left side into PA where it is “wedged” into place by a
balloon that’s blown up until normal PCWP is reached (4-12) =After wedging=expect vol.
on left side of  or to lungs=higher bc there is too much vol. & they aren’t moving it=that
means wet lungs
 HF pt=PCWP= bc they have too much vol. from cardiac system=after wedge=
PCWP bc too much vol.=its sitting in lungs from the lack of vol. mvmt or overload of vol.
mvmt
 ARDS pt=will be normal bc they don’t have cardiac involvement= lungs are just wet
bc the lungs & alveoli are bad
1. ARDS pt= lungs are wet w/a different type of fluid (it’s interstitial fluid that we
are measuring w/cardiac output for CHF; an ARDS lung has protein=vol. is in the
lungs but it is not necessarily systemic like we see w/CHF=when wedged & 
PCWP, the vol. that exist in the lungs w/somebody w/CHF is going to be =ARDS