Clinical Nursing: Diagnosis and Treatment of Acute Respiratory Distress Syndrome

Running head: CLINICAL NURSING 1
Clinical Nursing
Name
Institution

CLINICAL NURSING 2
1. Section One
1.1. Patient Background
Brad, a 56-year-old, Caucasian male was brought into the emergency department
(ED) by ambulance to Sir Charles Gairdner Hospital (SCGH) at 1600 following a call
from his carer, who is accompanying him while his wife is not present. His carer
handed over that Brad’s wife told her that Brad had been feeling extra tired lately and
had been coughing for a while during his week on respite if he had a fever to give
him 1g of Paracetamol. On the start of the shift the carer said Brad woke up
complaining more than usual of fatigue, during her shift the carer noticed that he was
breathing harder than usual, she asked Brad several times how he was feeling he
would only say he was tired and that he wanted to stay in bed. On the 1500 vital
signs, she noticed his temperature was slightly elevated at 37.8, so she gave him 1g
of Paracetamol. Half an hour later she noticed that Brad was struggling to breath
more than before and with shortness of breath, shaking and complaining of cold. She
took his temperature again, and it was 39.1 which is when she called the ambulance.
1.2. Reason for Admission
Brad was admitted to ED, these are his vital signs on admission: Respiratory rate 28,
Oxygen saturation (SpO2) 88% on room air, heart rate 109, blood pressure 88/62,
temperature 39.5 degree Celsius.
Brad was using accessory muscles, had shortness of breath, indicating dyspnoea
(Homnick, 2012). Tachycardia and hypoxemia are also noted as per his vital signs
as well as hypotension, fever, and tachypnoea.
1.3. Past Medical/Surgical History
After Brad’s admission, a consultant started to collect the patient’s past medical
history with the assistance of the patient’s wife. It was found that Brad suffers from
Multiple Systems Atrophy (MSA) and was diagnosed with it four years ago. That
information is important as dysphagia is a significant issue with the disease and can
lead to silent aspiration causing pneumonia (Lee et al., 2018). Dysphagia is a
difficulty in swallowing and can affect the direction and speed that the food bolus is
going (Chilukuri, Odufalu, & Hachem, 2018). When adequate measures are not in
place food particles can travel to the lungs and cause complications like pneumonia.

CLINICAL NURSING 3
Pneumonia if left untreated can lead to acute respiratory distress syndrome (ARDS)
and is the leading cause for it (Monahan, 2013).
Brad’s wife also informed the consultant that Brad goes to respite once a month and
that they were trying a new clinic since moving from Melbourne, but that Brad
complained that the staff at the clinic were feeding him too fast upon his return from
the clinic and since then has been feeling unwell.
Also due to MSA Brad has an Indwelling catheter inserted and has had multiple
urinary tract infections in the past, one that progressed to general sepsis.
With this information in hands, the consultant believes that Brad may be suffering
from ARDS secondary to aspiration pneumonia caused in the respite clinic.
1.4. Aetiology and brief pathophysiology
Acute respiratory distress syndrome is experienced when fluids build up in the alveoli
in the lungs. As a result, less oxygen reaches the lungs thus the organs of the body
are deprived of oxygen affecting how they function. Some of the main causes of
ARDS include sepsis, severe pneumonia, injuries to the head or chest, inhaling
harmful substances, and pancreatitis among others (Matthay, Ware & Zimmerman,
2012). The major cause of ARDS is sepsis which occurs when there is a widespread
infection of the bloodstream. It is also important to note that inhaling high
concentrations of chemical fumes or smoke may lead to acute respiratory distress
syndrome. Another potential cause of ARDS is an injury to the head or chest that
may directly injure the lungs. Severe pneumonia also causes ARDS because it
severely attacks the lungs (Pierrakos, Karanikolas, Scolletta, Karamouzos &
Velissaris, 2012). It is important to note that aspirations can cause pneumonia. It is a
complication that occurs when one inhales food into their lungs thus leading to a lung
infection that may cause pneumonia (DiBardino & Wunderink, 2015). It is
characterized by shortness of breath, cough, and fatigue as stated in Brad’s case. It
can thus be stated that Brad potentially developed pneumonia which was left
untreated thus leading to the development of ARDS.
ARDS characterized by low blood pressure, shortness of breath, confusion, and
rapid breathing that is usually laboured (Pierrakos et al., 2012). From the scenario,
Brad is experiencing shortness of breath accompanied by laboured breathing. His