Acute Respiratory Distress Syndrome (ARDS) for Progressive Care Certified Nurse (PCCN)
Included In This Lesson
Outline
Acute Respiratory Distress Syndrome (ARDS)
Definition/Etiology:
- Definition
- Most severe form of acute lung injury with a very high mortality rate. (30 -50%)
- Characterized as noncardiogenic pulmonary edema and malfunction of the alveolar/capillary membrane.
- Etiology – anything that activates the immune system
- Primary Causes
- Sepsis – Systemic Inflammation
- Secondary Causes
- Covid-19
- Pneumonia A
- Acute Pancreatitis
- Drug Overdose
- Near Drowning
- Primary Causes
Pathophysiology:
- Inflammatory mediators not only go to the injured area of the body but to the alveoli and lung capillaries.
- Fluids shift from capillaries and flood alveoli -cannot make surfactant.
- Lack of surfactant = Lungs cannot expand
- Alveoli shrivel – becoming unusable
- Leads to atelectasis
- Three Phases BUT PCCN nurses focus on later stages/decompensated patients – early stages are rarely “caught”.
Noticing: Assessment & Recognizing Cues:
- FAST ONSET
- Subjective Cues
- Fatigue
- Dyspnea/Increased work of breathing
- Decreased LOC
- Objective Cues
- Vitals
- Increased HR, decreased 02 Sat
- Refractory Hypoxemia
- Lung sounds
- Diminished lung expansion
- Wet Sounds
- Productive Cough
- Pink Frothy Sputum
- Vitals
Interpreting: Analyzing & Planning:
- Labs
- CBC – R/O Sepsis
- BNP: rule out cardiac causes
- ABGs
- P/F Ratio (PaO2 / FiO2)
- <200
- Refractory Hypoxemia
- Arterial 02 doesn’t respond to applied Oxygen
- Pa02 below 55 mm Hg
- P/F Ratio (PaO2 / FiO2)
- Diagnostics
- Chest X-ray → diffuse bilateral infiltrates
- “White Out”
- ECG – Tachycardias r/t hypoxia
- Chest X-ray → diffuse bilateral infiltrates
Responding: Patient Interventions & Taking Action:
- ABCs + underlying cause
- BiPap at minimum with probable VENT
- Why? NEED PEEP? Pressure to keep open alveoli back up.
- Pharmacological Interventions
- Depends on underlying cause
- Sepsis?
- Fluids + ABx + Pressors
- Steroids
- Paralytics & sedation for mechanical ventilation
- Non-Pharmacological
- Prone positioning -Lets gas exchange happen where lung tissue is still good (Superior Anterior lobes)
- Adjunct Medical Therapy
- Respiratory Therapist
- Pulmonologist
Reflecting: Evaluating Patient Outcomes:
- Airway Breathing
- Oral Care & HOB – prevent VAP
- Improved P/F Ratio
- Improved Pa02 on blood gasses
- Improved CXR
- Wean from BiPap or Vent
- Circulation
- MAP > 65 (Perfusion)
Linchpins (Key Points):
- Notice – Refractory Hypoxemia
- Interpret – Blood Gases, P/F Ratio & CXR
- Respond – Proning & BiPaP/Vent
- Reflect – Pa02 improves WHILE weaning
Transcript
References:
- AACN, and Tonja Hartjes. AACN Core Curriculum for Progressive and Critical Care Nursing. Available from:Pageburstls, (8th Edition). Elsevier Health Sciences (US), [Insert Year of Publication].
- Dennison, R. D., & Farrell, K. (2015]). Pass PCCN! Elsevier Health Sciences (US).
- Kupchik, N. (2020). Ace The Pccn! you can do it!: Studyguide. Nicole Kupchik Consulting, Inc.
NCLEX
Concepts Covered:
- Circulatory System
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Hematology
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Newborn Complications
- Lower GI Disorders
- Multisystem
- Neurological
- Nervous System
- Central Nervous System Disorders – Brain
- Renal
- Respiratory
- Urinary System
- Respiratory System
- Noninfectious Respiratory Disorder
- Test Taking Strategies
- Note Taking
- Basics of NCLEX
- Prefixes
- Suffixes
- Medication Administration
- Gastrointestinal Disorders
- Respiratory Disorders
- Pregnancy Risks
- Labor Complications
- Hematologic Disorders
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- Delegation
- Perioperative Nursing Roles
- EENT Disorders
- Basics of Chemistry
- Adult
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- Emergency Care of the Respiratory Patient
- Respiratory Emergencies
- Studying
- Substance Abuse Disorders
- Disorders of the Adrenal Gland
- Behavior
- Documentation and Communication
- Preoperative Nursing
- Endocrine System
- Legal and Ethical Issues
- Communication
- Understanding Society
- Immunological Disorders
- Infectious Disease Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Fetal Development
- Terminology
- Anxiety Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Tissues and Glands
- Vascular Disorders
- Renal Disorders
- Eating Disorders
- Prenatal Concepts
- Microbiology
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Depressive Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Peripheral Nervous System Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Integumentary Disorders
- Newborn Care
- Basics of Mathematics
- Statistics
- Labor and Delivery
- Proteins
- Emergency Care of the Trauma Patient
- Hematologic System
- Hematologic Disorders
- Developmental Considerations
- Skeletal System
- Digestive System
- Urinary Disorders
- Postpartum Care
- Basic
- Musculoskeletal Disorders
- Bipolar Disorders
- Metabolism
- Cardiovascular Disorders
- Concepts of Population Health
- Musculoskeletal Disorders
- EENT Disorders
- Postpartum Complications
- Basics of Human Biology
- Postoperative Nursing
- Neurological Emergencies
- Prioritization
- Disorders of Thermoregulation
- Writing
- Community Health Overview
- Dosage Calculations
- Neurological Trauma
- Concepts of Mental Health
- Health & Stress
- Endocrine and Metabolic Disorders
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Concepts of Pharmacology
- Integumentary Important Points
- Emotions and Motivation
- Renal and Urinary Disorders
- Developmental Theories
- Reproductive System
- Adulthood Growth and Development
- Psychological Emergencies
- Growth & Development
- Basics of Sociology
- Somatoform Disorders
- Reading
- Intelligence and Language
- Oncologic Disorders
- Med Term Basic
- Med Term Whole
- Central Nervous System Disorders – Spinal Cord
- Muscular System
- Neonatal
- Learning Pharmacology
- Pediatric
- Psychological Disorders
- State of Consciousness
- Sensory System