Significance of ARDS

Acute respiratory distress syndrome is a condition that affects critically ill patients and progresses rapidly. The complication occurs as fluid builds up in the lungs’ tiny and elastic air sacs. This fluid prevents the lungs from being filled with enough air, making breathing difficult; thus, only a small amount of oxygen enters the circulatory system (Chris, 1). As a result, body organs lack the oxygen they need to operate. The key symptom (severe shortness of breath) will appear anywhere from a few hours to a few days after the infection.
Pathophysiologic changes associated with ARDS

ARDS may injure the alveoli. The gas passes by alveoli, which are made up of fragile epithelial cells across which gas exchange takes place. Epithelial cells in the alveoli normally forms a barrier preventing the entry any fluid. In persons with ARDS, this barrier is broken and it allows the flooding of the alveolar space and makes difficult for oxygen diffusion to body tissues (Chris, 2).
Surfacant produced by type 2 alveolar cells prevents alveoli from collapsing. These cells are likely to cause alveoli collapse due to diminished production of surfacant. Decreases surfacant production is caused by flooding through the broken type 1 cell barrier.
ARDS also causes injury to the alveolar capillaries. In cases where the injury is directly below alveolar capillaries, chemical mediators released by the immune system rush to the injury site thus causing damage and inflammation to the cells lining the capillaries.
Pathophysiologic phases of ARDS
Classical phases of ARDS include
• Injury
• Exudative where the alveolar capillary is disrupted with inflammatory cell infiltrate and high protein exudates forming hyaline membranes.
• Poliferative ARDS is when there is proliferation of abnormal type 2 alveoli and inflammatory cells.
• Fibrotic where there is infiltration with fribroblasts thus replacing alveolar ducts with fibrosis.
ARDS Diagnosis
There are no specific tests to identify the condition. Its diagnosis is based on physical examination, oxygen levels and chest X-rays. Diagnosis is done in the following ways;
Imaging
In this case, there is use of chest X-ray and computerized tomography (CT). Chest X-ray reveals the part of the lungs and the extent of fluid. CT scan is a combination of images taken in different directions in cross-sectional views of the organs (Kenneth, 2).
Lab tests
Blood sample from an artery in the wrist can be used to measure oxygen level. The blood tests can also be used to check other signs of infections such as anaemia. Secretions from the airway are used to ascertain the medical condition.
Heart tests
Signs and symptoms are similar to those of certain heart problems, Therefore a doctor can recommend tests such as electrocardiogram, a painless test that tracks electrical activities of the heart.
Medical complications seen with ARDS
ARDS put individuals at risk of infections especially after lying down for a long period of time in the hospital. Some of these infections include pneumonia. The condition can lead to collapsed lung or pneumothorax. This is a condition in which gas or air collects in spaces surrounding the lungs. This causes lung collapse and subsequent lung scarring (Melisa, 4). Lung scarring is a disease that causes lung to be stiff and presents with difficulty in expanding. Lying for so long in the hospital can lead to blood clot within the body.
Laboratory findings
Laboratory test for ARDS uses blood from the artery in the wrist to measure oxygen level. Other types of blood tests are used to check oxygen level in the blood and signs of infection including disease like anaemia (Suzanne & Elizabeth, 1). If the doctors suspects lung infection, lung secretions are tested to identify the cause of infection.
Radiologic changes seen with ARDS
The radiographic abnormalities of ARDS show leakage of fluid with high protein contents into the air sacs due to alveolar epithelial injury or due to diffuse alveolar image. Chest radiograph vary in ARDS findings. The most common chest radiograph. Pleural effusions and septal lines are uncommon. However, they are seen in patients with congestive heart failure. Chest radiograph findings include diffuse or normal alveolar, they are often bilateral and obsecular pulmonary vascular markings (Joshua & Gillian, 3). In fibrotic phase, chest cardiographs show interstitial appearance not necessarily due to fibrosis. This is because condition resolves in many patients who survive.
Changes in pulmonary function studies with ARDS
As seen by other studies, survivors have abnormal tests of pulmonary function. This include mild restriction, impaired gas transfer, reduced arterial oxygen pressure, Obstruction of airflow is also present in cases of the disease (Melissa, 2). Obstruction of airflow may develop during recovery while other indicators of the pulmonary function continue to improve.
Signs and symptoms of hypoxia
Central nervous system; there is change in mental status and loss of consciousness.
Pulmonary; the patient has noisy breathing. There are audible noises with breathing. The patient breathes with a wheezing sound or crackles. Secretions by the lungs can block the airway (Glynda & Jodie, 2).
Treatment goal for ARDS
One of the main goals of treating ARDS is to provide oxygen to the lungs and other body organs. Some of the organs that need oxygen include heart, brain and kidney. Doctors ensure that they adjust the ventilator during the treatment process to supply the right amount of needed oxygen. Proper oxygen supply also prevents injury of the lungs from the ventilator pressure. Oxygen is usually given through the nasal prongs or masks fitted in the mouth or nose. However, if there is difficulty in breathing, breathing tube can be used.
Principal treatments for ARDS
ARDS is treated through various ways. One of the principal treatments for ARDS is oxygen therapy. Oxygen is provided to the lungs and other body organs (Eloise et al., 3). Oxygen tubes are inserted into nasal prongs after being given injection to relax and sleep. Breathing tube is connected to the machine that supports breathing. The doctor adjusts the ventilator in helping the lungs to get enough oxygen.
Nonventilatory pulmonary support
One type of nonventilatory support is supportive care. It helps the patients to be relieved from the symptoms, prevent complications, and improve the quality of life. The medicines used help the individual to relax. At the same time, there is ongoing monitoring of the lungs. Nutritional support is given to patients with malnutrition. Extra feeding can be done through a feeding tube. Due to the fact that use of ventilator increases chance of getting other infections, the doctors will always provide antibiotics (Eloise et al., 4).
Pharmacologic interventions in ARDS
Surfacant replacement therapy: this intervention is theoretical and improves oxygenation but brings no improvement in mortality (Thompson, 1). Glucocorticoids improve the ventilator free days but fail to improve mortality. It also increases weakness. Ketoconazole is antifungal drug that inhibits thromboxane synthase and 5-lypooxygenase.
Hemodynamic monitoring play in management of ARDS
Hemodynamic monitoring provides important diagnostic and therapeutic information. It facilitates early differentiation between cardiogenic and non cardiogenic pulmonary edema. Therapy response can be monitored in order to optimize cardiopulmonary function (Boysen, 2). Through this kind of monitoring, more intelligent therapeutic approaches can be individualized.
Appropriate nursing diagnoses with ARDS
The most appropriate tests for ARDS include:
Arterial blood gas test shows oxygen level in the blood. A low level of oxygen in blood can be a sign of ARDS. Blood tests can also be done such as complete blood count, blood chemistrines, and blood cultures. These tests help identify the cause of ARDS and other infections (Eloise et al., 2). X-rays can be used to take picture of the structure in the chest. The organs captured include the heart, blood vessels and lungs.
Nurses overall goal in caring for ARDS patients
Nurses overall goal in the caring process is to relive symptoms and prevent further complications of the disease. In doing this, they improve the quality of life. The nurses use supportive approaches in handling the disease (Eloise et al., 3). Some of the examples include giving medicines to relax the body, lung monitoring, nutritional support and treatment of infection.

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