(^88) Medical-Surgical Nursing Demystified
circulation (hypoxemia). Oxygen saturation decreases. Respiratoryacidosis develops,
and the patient appears to have respiratory distress.
This is most commonly due to shock, sepsis, or as a result of trauma or inhala-
tion injury. Patients may have no history of pulmonary disorders, also known as
Adult Respiratory Distress Syndrome.
PROGNOSIS
Early recognition and treatment is critical. Even with intensive treatment, ARDS
has a mortality rate of 50 to 60 percent. Some patients will progress into a more
chronic type of ARDS which has permanent lung changes. These patients may
require long-term mechanical ventilation.
HALLMARK SIGNS AND SYMPTOMS
- Hypoxemia—insufficient level of oxygen in the blood, despite supplemental
oxygen at 100 percent. - Difficulty breathing (dyspnea)—increased need for oxygen to meet body’s
demand. The need for oxygen will increase as fluid builds up in the lungs
and compliance worsens. - Pulmonary edema—fluid build-up in the lungs.
- Breathing rate greater than 20 breaths per minute (tachypnea)—breathing
becomes faster in an attempt to get oxygen into the body. - Decreased breath sounds—harder to hear through fluid in alveoli; no air
movement in collapsed alveoli. - Anxiety—secondary to not getting enough oxygen.
- Rales (crackles) heard in the lungs—air moving through fluid in alveoli and
small airways on inspiration and expiration (not heard initially). - Wheezing (rhonchi)—inflammation develops or mucous is created. This
narrows the airways, creating a sound as the air travels through the narrowed
airway. - Restlessness—due to decreased oxygen levels.
- Cyanosis—due to lack of oxygenation.
- Accessory muscle use for respirations—look for retractions between ribs
(intercostal) and below the sternum (substernal).