Page 85 - Critical Care Nursing Demystified

70 CRITICAL CARE NURSING DeMYSTIFIED

A patient who survives ARDS usually has residual lung damage that can lead
to disability in activities.

Hallmark Signs and Symptoms
Changes in the level of responsiveness; restlessness and disorientation
Increasing dyspnea
Progressive lung sound changes from crackles to gurgles to bronchial breath
sounds
Tachypnea and increase in accessory muscle use to breathe

Elevated central venous pressures but low to normal pulmonary capillary
wedge pressures

Interpreting Test Results

Initially, respiratory alkalosis may occur as carbon dioxide has no problems
diffusing.

Worsening hypoxemia despite increasing the patient’s oxygenation.
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Chest x-rays show bilateral patchy infiltrates that have “ground glass appear-
ance.”
A hallmark is the changing of lungs from the normal black color to complete
whiteout bilaterally.
PFTs decrease.
Peak inspiratory pressures rise on the ventilator, indicating decreased
compliance.

Treatment
The best treatment is to initiate PEEP after mechanical ventilation.

Administration of broad-spectrum antibiotic if ARDS is due to sepsis.
Administration of corticosteroids is controversial but helpful in many cases.
Administration of Nipride to help decrease pulmonary hypertension.
Administration of continuous sedation to assist with ventilatory synchrony.
Therapeutic paralysis may be required.
Nutritional support with 35 to 45 kcal/kg per day.

Comfort and pain control.