RESPIRATORY

DISTRESS
SYNDROME

Aliana Dewi
Medical Surgical Nursing
Departement

ACUTE RESPIRATORY
DISTRESS SYNDROME

Definition
Is a sudden and progressive form of
acute respiratory failure in which the
alveolar capillary membrane becomes
damages and more permeable to
intravascular fluid.

ETIOLOGY

Direct lung injury

Aspiration of gastric contents or other

substances
Near drowning
Inhalation of toxics substances
Viral/bacterial pneumonia
Chest trauma
Embolism
Oxygen toxicity
Radiation pneumonitis

Indirect lung injury

Sepsis
Severe pancreatitis
Multiple blood transfusion
Multiple trauma
Severe head injury
Shock states
Nonpulmonary systemic disease
Cardiopulmonary by pass
Anaphylaxis
Narcotic drug abuse

PATHOPHYSIOLOGY

Due to stimulation of the inflamatory and

immune system.
> cause an atraction of neutrophils to the
pulmonary interstitium
> The neutrophils cause a release of
biochemical, humoral and cellular mediator
> produce changes in the lung :
increase pulmonary capillary membrane
permeability
destruction of elastin and collagen
Formation of pulmonary microemboli
Pulmonary artery vasocontriction

THREE PHASE

INJURY or EXUDATIVE PHASE

occurs approxymately 1 to 7 days

(usually 24 to 48 hours)
Interstitial and alveolar edema and
atelectasis
Severe V/Q mismatch and shunting of
pulmonary capillary blood
Diffusion limitation
Less compliant because of decrease
surfactan, pulmonary edema and
atelectasis

REPARATIVE or PROLIFERATIVE
PHASE

Begins 1 to 2 weeks after the initial lung

injury.
An influx of granulocytes, monocytes and
lymphocytes and fibroblast proliferation
as part of the inflamatory response.
Increased pulmonary vascular resistance
and pulmonary hypertension
Lung compliance continues to decrease
hypoxemia

Fibrotic phase

2 to 3 weeks after the initial lung injury

Also called the chronic or late phase of
ARDS
Completely remodeled by sparsely
collagen and fibrous tissues
There is diffuse scarring and fibrosis
Hypoxia continues

CLINICAL
MANIFESTATION
For several hours to 1 to 2 days the
patient may not experience
respiratory symptoms or may exhibit
only dyspnea, tachypnea, cough, and
restlessness.
ABGs usually indicate mild hypoxemia
and respiratory alkalosis

As ARDS progreses
Respiratory discomfort > the work
of breathing is increases
Tachypnea and intercostal and
suprasternal retraction
Tachycardia, diaphoresis, changes in
sensorium with decreased mentation,
cyanosis and pallor
Crackles and rhonchi

Chest x-ray demonstrates diffuse

and extensive bilateral interstitial
and alveolar infiltrates.
Pleural effusions may also be present

COMPLICATIONS
Nosocomial Pneumonia
Barotrauma
Stress ulcers
Renal failure

NURSING ASSESSMENT

Subjective data :

o Important health information

- past health history
- medications
- surgery or other treatments
o Functional health patterns
- health perception-health management
- Nutritional-metabolic
- activity-exercises
- sleep-rest
- cognitive-perceptual
- coping-stress tolerance


o
o

Objective Data :
General
- restlessness, agitation
Integumentary
- pale, cool, clammy skin or warm flushed
skin, peripheral and central cyanosis
Respiratory
- shallow, increased respirations
progressing to decreased rate, use of
accessory muscles, stridor, friction rub

Cardiovascular
- tachycardia progressing to
bradycardia, arrythmias, extra heart
sounds
Gastro intestinal
- abdomial distension with tympani
Neurologic
- somnolence, confusion, slurred
speech, tremors, seizures, coma

NURSING DIAGNOSIS

Ineffective airway clearance related to

excessive secretion, decrease level of
consciousness
Ineffective breathing pattern related to
neuromuscular impairment of respirations,
pain, anxiety, decrease of consciousness,
respiratory muscle fatigue and
bronchospasme
Impaired gas exchange related to alveolar
hypoventilation
Altered nutrition: less than body
requirements related to poor appetite,
shorthness of breath.

PLANNING

The overal goal :

PaO2 within limits of normal for age or

baseline values
SaO2 greater than 90%
Patent airway
Clear lungs on auscultation

RESPIRATORY THERAPY

Oxygen administration

Primary goal : to correct hypoxemia

O2 administered via mask with high flow
system

Mechanical ventilation
Apply PEEP

EVALUATION

The expected outcomes for the

patient with ARDS are similar those
for a patient with respiratory failure
in NCP.