ARDS MANAGEMENT

1. Nurse patient in ICU as ARDS is a potentially life threatening complication and requires high quality one-on-one nursing care 2. Position client in a Semi or High Fowlers position (unless contraindicated) for maximum lung expansion 3. Assess respiration rate, rhythm and depth, presence of nasal flaring, use of accessory muscle of respiration as these are key indicators of clients inability to self-ventilate 4. Assess for signs such as cyanosis in lips, poor capillary refill, changes in level of consciousness as these would indicate a decrease in tissue perfusion 5. Auscultate for adventitious breath sounds such as crackles and rhonchi as they indicated the presence of fluid in air spaces and inability of lungs to adequately ventilate 6. Place client on pulse oximeter to monitor oxygenation saturation 7. Administer 100% humidified oxygen via a facemask to maintain PaO2 of 60mmHg and SaO2 of greater than 90% 8. Monitor CBC with emphasis on Hb as decreased Hb indicates need for blood replacement to prevent fatigue that will impact clients ability to self ventilate 9. Administer dopamine as prescribed to prevent hypovolemic shock 10.Assess client for low fluid levels in blood blood pressure, pulse, Monitor V/S with emphasis of blood pressure and pulse as an decrease in bp could indicate dopamine side effect along with headache 11.Administer bronchodilators such as Ventolin and epinephrine to increase the diameter of the airways an improved in air entry, exit 12.Administer corticosteroids such as methylprednisone to reduce and control inflammation 13.??Administer diuretics such as Lasix to help reduce pulmonary edema 14.Monitor electrolytes to assess serum levels and institute measures to correct imbalances which may be caused diuretic therapy

15.Place client on cardiac monitoring to monitor for any dysrhythmias 16.Maintain strict I/O monitoring as patient is at risk for hypovolemia due to movement of fluids from vascular to interstitial spaces of lungs 17.Assess ABGs PaO2 and PaCO2 and pH to monitor the adequacy of alveoli ventilation and gas exchange functions 18.Assist with moving client to mechanical ventilation if Pa02 is less than 60 mmHg and PaC02 is greater than 50 mmHg, pH is greater 7.30 19.Suction client as necessary to remove secretions and keep airway clear 20.Take patients weight daily to determine fluid and nutrition status 21.Ensure nutritive needs are met as indicated to maintain energy and muscle functions 22.Assist with obtaining chest x-rays of client to determine extent of lung involvement as the condition is made worse by increase alveoli damage 23.Stay with the patient and provide nursing care with a confident attitude at all times as nurses presence and attitude helps to allay clients anxiety which may intensify condition 24.Use aseptic techniques where necessary eg during suctioning to prevent cross contamination 25.Appropriate chest physiotherapy to loosen secretions and prevent stasis of fluid which is a medium for bacteria growth