Page 84 - Critical Care Nursing Demystified

Chapter 2 CARE OF THE PATIENT WITH CRITICAL RESPIRATORY NEEDS 69

Monitor the effect of medication on the patient to determine when to with-
draw therapy.
Teach patient relaxation techniques to decrease the work of breathing.
Teach how to cough effectively to prevent atelectasis.

Evaluate the effectiveness of rapid-acting medications.
Reassure patient during times of respiratory distress.

Acute Lung Injury (ALI)

See Chapter 6 (Care of the Traumatized Patient).

Acute Respiratory Distress Syndrome (ARDS)

What Went Wrong?
ARDS is a condition that generally comes after acute direct or indirect lung
injury. Direct lung injury occurs when the lung tissue itself is affected and can
include aspiration, pneumonia, fat embolism, near drowning, oxygen toxicity,
pulmonary contusion, and toxic inhalation. Indirect lung injury is a result of
sequelae from other insults in the body. These types of lung injury include Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
anaphylaxis, disseminated intravascular coagulation, embolism, excessive
blood transfusions, hypotension from cardiac arrest or shock/sepsis, drug
overdose, long bone or pelvic fractures, and pancreatitis.
ARDS is characterized by worsening respiratory failure despite aggressive oxygen
therapy. The release of inflammatory mediators allows fluid to translocate into the
lungs, causing a noncardiogenic pulmonary edema. Increased fluid causes the lungs
to become stiff and noncompliant, making the work of breathing more difficult for
the patient. Pulmonary edema interferes with allowing carbon dioxide to be excreted
(hypercarbia) and oxygen to be absorbed (hypoxemia). Increased capillary pressure
can cause pulmonary hypertension leading to atelectasis and a reduction in function-
ing lung volumes. Ultimately this leads to blood leaving the lungs with a decrease in
oxygen that is pumped by the left side of the heart to the tissues (shunting).

Prognosis
Around 150,000 cases occur each year and around half occur within the first
24 hours of hospital admission after a direct or indirect lung assault. Chronic
health conditions can predispose a patient to develop ARDS like chronic lung
disease and alcoholism. Inflammatory responses that are activated do not spare
other organs, and multiple organ dysfunction can result from hypoxemia.