Med-Surg Respiratory System, part 12: ARDS and ARF
by Cathy Parkes August 27, 2021 Updated: January 17, 2022 6 min read
In this article, we’ll explain acute respiratory distress syndrome, ARDS, and acute respiratory failure, also known as ARF.
The Med-Surg Nursing video series follows along with our Medical-Surgical Nursing Flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.
Acute Respiratory Distress Syndrome (ARDS)
ARDS (acute respiratory distress syndrome) is respiratory failure that occurs due to non-cardiac pulmonary edema (excess fluid in the lungs).
While pulmonary edema may be a result of left-sided heart failure, with ARDS this is not the case. Acute respiratory distress syndrome occurs when there is either a direct injury to the lungs or an indirect injury to the lungs that results in systemic inflammation. This inflammatory response leads to alveolar permeability — fluid entering the alveoli and collecting in the lungs — as well as inflammation, and, ultimately, lung collapse.
The risk factors associated with ARDS include sepsis, shock, trauma, pneumonia, pancreatitis (inflammation of the pancreas), and the inhalation of chemicals or water, such as a near-drowning event. Any of these will trigger systemic inflammation, which in turn will allow for the accumulation of fluid in the alveoli.
Signs and symptoms
The signs and symptoms of ARDS include dyspnea (shortness of breath), rapid and shallow breathing, substernal retractions (when the belly pulls below the breastbone), tachycardia, cyanosis or pallor, and crackles — when listening to the patient’s lungs, they have a crackling sound due to fluid collection.
Labs and diagnostics
ABGs and chest X-rays are used to help diagnose ARDS. A chest X-ray will reveal bilateral infiltrates — when a substance denser than air (e.g., pus, blood, or protein) accumulates in the lungs.
Learn more about oxygen and other important nursing practices and skills with Level Up RN’s Fundamentals of Nursing flashcards. Learn more about ABG interpretation in our Arterial Blood Gas Interpretation Flashcards for Nursing Students.
In terms of nursing care, it is important to maintain a patent (unobstructed) airway for the patient while closely monitoring their cardiac status. It may also be important to provide mechanical ventilation care.
Acute Respiratory Failure (ARF)
ARF (acute respiratory failure) is the inability of the lungs to maintain arterial oxygenation or to eliminate carbon dioxide from the body (or both), resulting in tissue hypoxia, that is, the tissues are not getting sufficient oxygen.
The risk factors associated with ARF include atelectasis (a partial or complete collapse of the lung), as well as COPD, cystic fibrosis, heart failure, pneumonia, pneumothorax, and pulmonary embolism.
Signs and symptoms
The most obvious symptom of ARF is respiratory distress. Other signs and symptoms include tachycardia, arrhythmia/dysrhythmia (irregular heartbeat), and signs of hypoxia. If the patient exhibits restlessness, that is likely an early sign of hypoxia; later signs of hypoxia can include decreased level of consciousness.
Labs and diagnostics
Treatment for ARF begins with oxygen therapy. Mechanical ventilation may be necessary as well. Chest physiotherapy is an option, as well as BiPAP and CPAP.
Medications may also be helpful and these include bronchodilators, corticosteroids, antibiotics, inotropic agents such as digoxin, and vasopressors (medicines that constrict (narrow) blood vessels, increasing blood pressure) and diuretics.
You can learn more about these medicines and their administration in our Pharmacology Flashcards.
In terms of nursing care, it is important to maintain the patient's airway — a patent airway is the number one priority.
Effective positioning of the patient is key as well. If the patient is lying on their back, make sure the head of the bed is angled up at least 30 degrees. It’s possible that the patient must be repositioned so that their good lung is down, also known as “side-lying,” a positioning used for unilateral lung disorder. During the COVID-19 pandemic, patients were often put in the prone position, that is face down, which allows for more effective oxygenation.
For non-intubated patients, encourage coughing and deep breathing, as well as increased fluid intake.
Hi. I'm Cathy with Level Up RN. In this video, we are going to talk about acute respiratory distress syndrome, which is ARDS, and acute respiratory failure, or ARF. So ARDS is respiratory failure that occurs due to non-cardiac pulmonary edema. So you may be familiar with the fact that left-sided heart failure can result in pulmonary edema. That is not what's happening here with ARDS. With ARDS, we have either direct injury to the lungs or indirect injury to the lungs that results in systemic inflammation, which increases the permeability of the alveoli and lets fluid enter the alveoli and collect in the lungs. So risk factors associated with ARDS include sepsis, shock, trauma, pneumonia, pancreatitis, inhalation of chemicals or water, such as a near-drowning event. So one of these things will trigger that systemic inflammation, which in turn will allow for that accumulation of fluid in the alveoli. So signs and symptoms of ARDS includes dyspnea, rapid and shallow breathing, substernal retractions, tachycardia, cyanosis or pallor, and then when you listen to your patient's lungs, you will hear crackles because of that fluid collection.
In terms of diagnosis, we can use ABGs as well as a chest X-ray to help diagnose ARDS. With that chest X-ray, we will see bilateral infiltrates. And then treatment includes correcting the underlying cause as well as the administration of oxygen, and then mechanical ventilation may be necessary as well. In terms of nursing care, we're going to want to maintain a patent airway for the patient. We're going to closely monitor their cardiac status, and we're going to provide mechanical ventilation care, which we will talk more about in the following video.
All right. Let's now talk about acute respiratory failure, or ARF. So ARF is the inability of the lungs to maintain arterial oxygenation or to eliminate carbon dioxide from the body such that we end up with tissue hypoxia. So our tissues are not getting sufficient oxygen. Risk factors associated with ARF include atelectasis, as well as COPD, cystic fibrosis, heart failure, pneumonia, a pneumothorax, and a pulmonary embolism. So signs and symptoms, you could probably guess it, respiratory distress is definitely going to be a key symptom as well as tachycardia, dysrhythmia, and then signs of hypoxia. So like we talked about in one of the first videos in the respiratory system, with early signs of hypoxia, the patient may exhibit things like restlessness. Late signs can include decreased level of consciousness.
In terms of treatment for ARF, oxygen therapy is definitely going to be one treatment. Mechanical ventilation may be necessary as well. Chest physiotherapy is an option, as well as BiPAP and CPAP. So medications that may also be helpful include bronchodilators, corticosteroids, antibiotics, inotropic agents such as digoxin, and vasopressors and diuretics. So in terms of nursing care, you always want to maintain the patient's airway. So we want a patent airway; that's your number one priority. You want to really promote effective positioning of the patient as well. So when the patient is on their back, you want to make sure the head of the bed is up at least 30 degrees. However, we may need to position the patient so that their good lung is down. So with the COVID-19 pandemic, you likely saw a lot of patients being in the prone position, so face down. It actually allows for more effective oxygenation. For non-intubated patients, we can encourage coughing and deep breathing, as well as increased fluid intake. And then we want to closely monitor our patient's ABGs, their Is & Os, their fluid and electrolytes, and their cardiac status as well.
Okay. In my next video, we are going to talk about mechanical ventilation, which, as I mentioned in this video, is a treatment that we can use for both ARDS as well as ARF. So definitely listen to that video. And if you haven't already done so, be sure to subscribe to our channel. And if this video is helpful, be sure to hit that like button and leave me a comment. Thank you so much for watching.
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