N211: Health Differences Across the Lifespan I ARDS is an unexpected, catastrophic pulmonary complication occurring in a person with no previous pulmonary problems. The mortality rate is high (50%). In ARDS, a common laboratory finding is a lowered PO2. These clients are not responsive to high concentrations of oxygen and often require intubation and mechanical ventilation with positive end expiratory pressure (PEEP). PEEP is the installation and maintenance of small amounts of air into the alveolar sacs to prevent them from collapsing each time the client exhales. The amount of pressure can be set by the ventilator and is usually around 5 to 10cm H2O. In children, respiratory distress will manifest as restlessness, increased respiratory rate, increased pulse rate and diaphoresis. One may also see nasal flaring, retractions, grunting, adventitious breath sounds or absent breath sounds, head bobbing, cyanosis and pallor. A pediatric client will often go into respiratory distress before cardiac failure. Nursing Assessment Shows decreased respiratory excursion, use of accessory muscles, intercostal retractions, difficulty breathing, SOB, dyspnea, hyperpnea, cyanosis, pallor, anxiety, restlessness, tachypnea, orthopnea and fatigue. Hypoxemia with PO2 <50 mmHg with FiO2 > 60%. Diffuse pulmonary infiltrates are seen on chest radiograph as a “white out” appearance. Nursing Diagnosis • Impaired gas exchange related to inadequate respiratory center activity or chest wall movement • Risk for deficient fluid volume related to… • Ineffective breathing pattern related to increased oxygen demand • Risk for injury related to… • Risk for infection related to… Nursing Inte ventions Include position client for maximum lung expansion, monitor client for signs of hypoxemia and oxygen toxicity, monitor breath sounds for pneumothorax, especially when PEEP is used to keep small airways open. Suction client only when secretions are present. Provide emotional support to decrease anxiety and allow ventilator to work the lungs. Monitor client hemodynamically with essential vital signs and cardiac monitor. Monitor arterial blood gases routinely. Monitor vital organ status, central nervous system, level of consciousness, renal system output, and myocardium (apical pulse, blood pressure). Monitor fluid and electrolyte balance and metabolic status through routine blood work. Common medications used include Morphine, Ativan, bronchodilators (Terbutaline, Aminophylline, Albuterol, Atrovent and Alupent). Neuromuscular blocking agents may be used to improve compliance to mechanical ventilation.
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