ARDS ppt

PPT on Acute respiratory distress syndrome.

1. ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) 1 Mr sanjay . M. Peerapur , Principal, KLES Institute of Nursing Sciences, Hubli

2. INTRODUCTION TO RESPIRATORY SYSTEM 2 Mr sanjay . M. Peerapur , Principal, KLES Institute of Nursing Sciences, Hubli

3. INTRODUCTION TO RESPIRATORY SYSTEM contd ………… Mr sanjay . M. Peerapur , Principal, KLES Institute of Nursing Sciences, Hubli 3

4. INTRODUCTION TO RESPIRATORY SYSTEM contd ………… 4 Mr sanjay . M. Peerapur , Principal, KLES Institute of Nursing Sciences, Hubli

5. INTRODUCTION TO RESPIRATORY SYSTEM contd ………… Mr sanjay . M. Peerapur , Principal, KLES Institute of Nursing Sciences, Hubli 5

6. RESPIRATORY DISTRESS SYNDROME (ARDS) Acute respiratory distress syndrome (ARDS) is a life-threatening lung condition that prevents enough oxygen from getting into the blood. Acute respiratory distress syndrome was first described in 1967 by Ashbaugh and colleagues. ARDS is also referred with variety of terms like Stiff Lung Shock lung Wet lung Post traumatic lung Adult respiratory distress syndrome Adult hyaline membrane disease Capillary leak syndrome & Congestive atelectasis . 6 Mr sanjay . M. Peerapur , Principal, KLES Institute of Nursing Sciences, Hubli

7. DEFINITION Acute respiratory distress syndrome (ARDS) is a sudden and progressive form of acute respiratory failure in which the alveolar capillary membrane becomes damaged and more permeable to intravascular fluid resulting in severe dyspnea , hypoxemia and diffuse pulmonary infiltrates. Mr sanjay . M. Peerapur , Principal, KLES Institute of Nursing Sciences, Hubli 7

8. STAGES OF ODEMA FORMATION IN ACUTE RESPIRATORY DISTRESS SYNDROME Mr sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli 8

9. ETIOLOGY & RISK FACTORS Direct Lung Injury Common causes Aspiration of gastric contents or other substances. Viral/bacterial pneumonia Less Common causes Chest trauma Embolism: fat, air, amniotic fluid Inhalation of toxic substances Near-drowning O2 toxicity Radiation pneumonitis Mr sanjay . M. Peerapur , Principal, KLES Institute of Nursing Sciences, Hubli 9

10. ETIOLOGY & RISK FACTORS contd ……. Indirect Lung Injury Common causes Sepsis Severe traumatic injury Less common causes Acute pancreatitis Anaphylaxis Prolonged Cardiopulmonary bypass surgery Disseminated intravascular coagulation Multiple blood transfusions Narcotic drug overdose (e.g., heroin) Nonpulmonary systemic diseases Severe head injury Shock Massive blood transfusion. Mr sanjay . M. Peerapur , Principal, KLES Institute of Nursing Sciences, Hubli 10

11. SCHEMATIC REPRESENTATION OF PATHOPHYSIOLOGY OF ARDS Mr sanjay . M. Peerapur , Principal, KLES Institute of Nursing Sciences, Hubli 11 Lung injury Release of Vasoactive substances (serotonin, histamine, bradykinin ) Damaged Type II alveolar cell Surfactant production Alveolocapillary membrane permeability Vascular narrowing & obstruction Alveolar Compliance and recoil Bronchoconstriction Outward migration of blood cells & fluids from capillaries Atelectasis Pulmonary Edema Hyaline membrane formation Lung compliance Impairment in gas exchange ARDS Pulmonary hypertension

12. CLINICAL MANIFESTATIONS Early signs/symptoms Restlessness Dyspnea Low blood pressure Confusion Extreme tiredness Change in patient’s behavior Mood swing Disorientation Change in LOC If pneumonia is causing ARDS then client may have Cough Fever Mr sanjay . M. Peerapur , Principal, KLES Institute of Nursing Sciences, Hubli 12

13. CLINICAL MANIFESTATIONS CONTD………… Late signs & symptoms Severe difficulty in breathing i.e., labored, rapid breathing. Shortness of breath. Tachycardia Cyanosis (blue skin, lips and nails) Think frothy sputum Metabolic acidosis Abnormal breath sounds, like crackles PaCo 2 with respiratory alkalosis. PaO 2 Mr sanjay . M. Peerapur , Principal, KLES Institute of Nursing Sciences, Hubli 13

14. DIAGNOSITC EVALUATION History of above symptoms On physical examination Auscultation reveals abnormal breath sounds The first tests done are : Arterial blood gas analysis Bood tests Chest x-ray Bronchoscopy Sputum cultures and analysis Other tests are : Chest CT Scan Echocardiogram Mr sanjay . M. Peerapur , Principal, KLES Institute of Nursing Sciences, Hubli 14

15. COMPLICATIONS Common complications are; Nosocomial pneumonia: Barotrauma Renal failure Other complications are : O 2 toxicity, stress ulcers, Tracheal ulceration, Blood clots leading to deep vein thrombosis & pulmonary embolism. Mr sanjay . M. Peerapur , Principal, KLES Institute of Nursing Sciences, Hubli 15

16. MEDICAL MANAGEMENT Persons with ARDS are hospitalized and require treatment in an intensive care unit. No specific therapy for ARDS exists. Supportive measures : Supplemental oxygen Mechanical respirator Positioning strategies Turn the patient from supine to prone. Another position is lateral rotation therapy Fluid therapy Mr sanjay . M. Peerapur , Principal, KLES Institute of Nursing Sciences, Hubli 16

17. TURNING PATIENT PRONE ON VOLLMAN PRONE POSITIONER Mr sanjay . M. Peerapur , Principal, KLES Institute of Nursing Sciences, Hubli 17

18. PATIENT LYING PRONE ON VOLLMAN PRONE POSITIONER Mr sanjay . M. Peerapur , Principal, KLES Institute of Nursing Sciences, Hubli 18

19. LATERAL ROTATION THERAPY BED Mr sanjay . M. Peerapur , Principal, KLES Institute of Nursing Sciences, Hubli 19

20. MEDICAL MANAGEMENT contd ……. Medications : Antibiotics Anti-inflammatory drugs; such as corticosteroids Diuretics Drugs to raise blood pressure Anti-anxiety Muscle relaxers Inhaled drugs (Bronchodilators) Mr sanjay . M. Peerapur , Principal, KLES Institute of Nursing Sciences, Hubli 20

21. NURSING DIAGNOSIS Ineffective breathing pattern related to decreased lung compliance, decreased energy as characterized by dyspnea , abnormal ABGs, cyanoisis & use of accessory muscles. Impaired gas exchange related to diffusion defect as characterized by hypoxia (restlessness, irritability & fear of suffocation), hypercapnia , tachycardia & cyanosis. Risk for decreased Cardiac output related to positive pressure ventilation Ineffective protection related to positive pressure ventilation, decreased pulmonary compliance & increased secretions as characterized by crepitus , altered chest excursion, abnormal ABGs & restlessness. Mr sanjay . M. Peerapur , Principal, KLES Institute of Nursing Sciences, Hubli 21

22. NURSING DIAGNOSIS CONTD…….. Impaired physical mobility related to monitoring devices, mechanical ventilation & medications as characterized by imposed restrictions of movement, decreased muscle strength & limited range of motion. Risk for impaired skin integrity related to prolonged bed rest, prolonged intubation & immobility. Knowledge deficit related to health condition, new equipment & hospitalization as characterized by increased frequency of questions posed by patient and significant others. Mr sanjay . M. Peerapur , Principal, KLES Institute of Nursing Sciences, Hubli 22