Respiratory Failure & ARDS

ARDS
ARDS, is a condition that causes fluid to leak into your lungs, blocking oxygen
from getting to your organs.
It is serious, sometimes life-threatening, and can get worse quickly. But its
generally treatable and most people can recover from it. Fast diagnosis and
treatment are important -- your organs need enough oxygen to work right and
keep you going.

What Happens When You Have ARDS?

Fluid leaks from small blood vessels and builds up in the tiny air sacs in
your lungs. Your lungs are then unable to fill up with enough air.
Because of this, the blood traveling to your lungs cant pick up the amount of
oxygen it needs to carry to the rest of your body. That can lead to organs such as
your kidneys or brain not working as they should or shutting down.
Some of the causes of ARDS may include:
Sepsis: This is when you get an infection in your bloodstream, and your immune
system goes into overdrive, causing inflammation and, eventually, blood clots.
Accidents: Injuries from a car wreck or a fall can damage your lungs or that part
of your brain that handles breathing.
Breathing in harmful substances: Dense smoke or chemical fumes can trigger
ARDS.
Some of the other possible causes of ARDS include:

Pneumonia
Bleeding that requires a blood transfusion
Inflammation of the pancreas
Overdosing on cocaine and other drugs

Symptoms
ARDS makes it hard to breathe and puts great strain on the lungs. So symptoms
include shortness of breath, often severe. Other signs of ARDS include:
 Low blood pressure
Unusually fast breathing
Confusion and exhaustion
Blue-tinted lips or nails from lack of oxygen in the blood
Dizziness
Lots of sweating

Diagnosis and Tests

No one test can identify a case of ARDS.
To make a diagnosis, doctors will probably begin by asking about medical history. Then likely
do a physical exam and listen to breathing and heartbeat. May also look for:

Signs of extra fluid in your body

Bluish color on your lips or skin

There are various tests:

Scans:
- Chest X-ray
- CT Scan
Blood tests:
- O2 level
- Infection
- Anemia
Heart tests:
- Heart problems

Treatment
Treatment aims to get oxygen levels in your blood back up to where they should be, so your
organs get what they need through: air mask and later go to a breathing tube and ventilator (a
machine that helps you breathe), depending on exactly what you need.
Other treatments might include:

Nutrition and medicine through IV fluids

Medicine to prevent bleeding and blood clots
Medicine to keep you calm and comfortable
 Respiratory Failure
Respiratory System major task:

Facilitate gas exchange of oxygen & carbon dioxide

Could be CHRONIC or ACUTE

2 TYPES OF RESPIRATORY FAILURE

1. HYPOXEMIC (also known as OXYGENATION FAILURE)

- Diffusion is compromised

4 MAJOR PHYSIOLOGIC EVENTS:

1. Ventilation / Perfusion mismatch (known as V/Q mismatch)

Ventilation amount of gas that reaches the alveoli.

Q Perfusion amount of blood perfusing the lungs (represented by the

blood vessel near the alveoli)

- NORMALLY, the amt of gas that reaches the alveoli is EQUAL with the
volume of the blood perfusing the lungs
- CONDITIONS that causes V/Q mismatch are asthma, COPD ,
Pneumonia, etc. )

Ex: PNEUMONIA

It causes secretions of fluid in the alveoli (therefore compromising the air

entering the lungs) = decreasing the amt of O2 going inside the alveoli
HOWEVER the amt of blood perfusing the lungs remains UNCHANGED.

2. Perfusion Problems

- The amt gas going inside the alveoli is NOT AFFECTED, the problem is the
blood vessel in the lungs, there is not enough blood perfusing the lungs
meaning NO enough blood will receive the O2.
- SHUNTING exaggerated V/Q mismatch
 There is gas exchange in both the alveoli and the BV of the lungs, blood
exits without the so called diffusion process; usually secondary to
certain diseases such as ARDS.

3. Diffusion Limitation
- Due to the thickening of the alveolar membrane
- There is GAS EXCHANGE but LIMITTED
- CLASSIC SIGN: Hypoxemia during exercise but not at rest

4. Alveolar Hypoventilation
- Mechanism of HYPERCAPNIC resp. failure
- Eventually lead to hypoxemia

2. HYPERCAPNIC
- Ventilatory SUPPLY & DEMAND

Ventilatory SUPPLY maximum ventilation wherein the body can sustain

w/out developing resp. muscle fatigue

Ventilatory DEMAND the amt of ventilation needed to keep the PC02

within normal limits

= NORMALLY, Resp. SUPPLY is always GREATER than the Resp DEMAND

- 16-20 bpm @ rest

- 40-50 bpm @ work of during exercise

- BUT WE NEVER GET OUT OF SUPPLY!

The problem occurs when the pt developed OBSTRUCTIVE DISEAQSES

- The body breathes double time in attempt to release the ;excess CO2
- EXCEEDING resp. supply causes resp fatigue w/c will eventually lead to
RESPIRATORY FAILURE
SIGNS & SYMPTOMS

Manifestations depend on the onset and the pts ability to compensate.

EARLY MANIFESTATIONS:

- Mental status changes

- Tachycardia
- Tachypnea
- Mild HTN

SPECIFIC MANIFESTATIONS:

HYPOXIA HYPERCAPNIA

P - paradoxical breathing P purse lip

R - retractions M morning headache

C- cyanosis (late) R - rapid/ shallow breathing
E expiration prolong
T- tripod positioning
N- nasal flaring

T - tachypnea

DIAGNOSIS:

- PE/PA
- ABG
- Pulse oximetry
- Chest X-ray
- CBC
- Serum electrolytes
- UA
- Culture
 - ECG
- V/Q scan
- CT scan
- Hemodynamics

NURSING IMPLICATION:

Assessment:

-VS

- ABG

- Capnography

- PFT

- Chest X-ray

- Sputum Culture

- Hemodynamics

INTERVENTION:

-Physical

- Chemical

- Supportive

PHYSICAL:

-Positioning

- Suctioning

- Chest tube
CHEMICAL:

- Oxygenation
- Bronchodilators
- Mucolytics
- Corticosteroid
- Diuretics
- Antibiotics
- Pain mgt
- Anxiolytics

Supportive:

- Hydration
- -Nutrition ( high calorie due to hypermetabolism)
- Check the Hgb
- Coughing/Chest physio
- OTHERS incentive spirometry, bed rest, early ambulation)