Acute Respiratory Distress Syndrome (ARDS) - Pathophysiology, Management, and pH Changes

This article discusses the pathophysiology of Acute Respiratory Distress Syndrome (ARDS), its management using the 5Ps, and the pH changes observed in ARDS patients. The patient's case study is used to explain the pathophysiology of ARDS. The 5Ps of managing ARDS patients are discussed in detail. The article also explains the pH changes observed in ARDS patients.

Running head: ARDS
ARDS
Name of the student:
Name of the university:
Author note:

1
ARDS
Question 1:
Acute respiratory distress syndrome called the ARDS is a kind of severe lung condition
that occurs when the fluid is seen to fill up the air sacs in the lungs. When there remains too
much fluid in the lungs, it is mainly seen to lower the amount of the oxygen and increase of the
amount of carbon dioxide in the blood stream. It can lead to organ failure by preventing the
organs to get enough oxygen required for their functioning. Inflammation may result from sepsis
due to viral pneumonia where respiratory viruses may cause dysfunctioning of the endothelial
cells along with fluid leakage from the capillaries as well as impairment of the drainage of fluid
from the lungs. A respiratory burst may result in the immune cells in this stage. In the second
stage, dys-functioning of the endothelial cells results in the cells as well as the inflammatory
exudates in entering the portions of the alveoli. There will be increase in the pulmonary edema
that in turn results in increasing the thickness as well as the breadth of the layers that separate
the blood which is present in the capillary from the different types of regions of the space in the
air sacs. This is seen to be increasing the distance that the amount of the oxygen has to undertake
diffusion diffuse for reaching the blood. As a result, there is impairment of gas exchange causing
hypoxia, increased work of breathing. This also results in scarring of air spaces within the lungs.
Accumulation of fluid in the lungs along with the decreasing of the surfactant production type 2
pneumocytes results in collapsing of the air sacs or complete filled with fluid resulting in loss of
aeration and further right to left shunt in ARDs. In the patient as well, it is seen that he was
suffering from viral pneumonia and he was having respiratory difficulty. This is obvious from
his high respiratory rate of about 26 breaths per minute. Moreover, it is also seen in his chest
radiograph that he was having mild alveolar infiltrates. Therefore, this pathophysiology can be
applied to this patient.

2
ARDS
Question 2:
Managing patients with ARDs require the nurses to follow the 5Ps. The first one is perfusion
where the nurses should aim to maximize the perfusion in the pulmonary capillary system. For
this, the nurse needs to increase the fluid volume without overloading the patient. Crystalloids or
colloids can help in replacing the fluids that have leaked from capillaries. The next “p” is patient
positioning which affects perfusion. Immobility is one of the major causes of pulmonary
complications and can greatly influence perfusion. Three positioning therapies can be used to
creases complications like kinetic theory, prone positioning and continuous lateral rotational
therapy. The next P is protective lung ventilation for open collapsed alveoli. This is done to
support organ function by providing adequate ventilation as well as the oxygenation at the same
time of decreasing the work of the patient in breathing. Next step is the protocol weaning as it
helps in reducing the time as well as the cost of care at the same time of improving the outcomes
for the ARDS patients. The last P would be the preventing of complications like the VILI,
pressure ulcers, deep vein thrombosis (DVT), and decreased nutritional status.
Question 3:
The value of pH has been seen to increase in the case of the patient. It is about 7.55 when the
normal range is about 7.35 to 7.45. Acute respiratory distress syndrome patients are seen to
suffer from the acute persistent hypercapnia. The later is mainly seen to trigger the metabolic
acid-base adaptation within the body. There results in the increase in the standard base excess of
the hypercapnic patients. This is mainly seen to be involving the decrease in the serum
lactate as well as unmeasured anions. These increase the inorganic apparent strong ion

3
ARDS
difference mainly through the procedures of the slight increase of the magnesium,
serum sodium, potassium and calcium. Serum chloride is not reduced. Therefore, pH
is seen to increase. Moreover, respiratory alkalosis had also taken place due to
lowered amount of oxygen due to hypoxia and therefore lowering of the value of
PaCO2 had taken place.