Nursing Diagnosis for ARDS (Acute Respiratory Distress Syndrome)
Acute Respiratory Distress Syndrome (ARDS) is a critical respiratory condition characterized by sudden and severe inflammation in the lungs that leads to hypoxemia, impaired gas exchange, and respiratory failure. ARDS is considered a medical emergency and often requires mechanical ventilation, intensive monitoring, and multidisciplinary interventions in the Intensive Care Unit (ICU).
Understanding the nursing diagnoses related to ARDS is essential for developing comprehensive nursing care plans that address both physiological and psychosocial patient needs. This article explores ARDS pathophysiology, common nursing diagnoses, clinical manifestations, nursing goals, interventions, and references used in evidence-based care.
Understanding Acute Respiratory Distress Syndrome (ARDS)
ARDS results from direct or indirect lung injury. Common triggers include pneumonia, sepsis, trauma, aspiration, and inhalation injuries. The disorder is marked by damage to the alveolar-capillary membrane, leading to fluid accumulation in the alveoli, reduced lung compliance, and impaired oxygenation.
Studies estimate that ARDS affects approximately 10% of ICU admissions worldwide, and mortality rates range between 34% and 46%, depending on severity. Severe ARDS carries the highest risk of death and long-term disability, including prolonged muscle weakness, cognitive impairment, and reduced quality of life.
Pathophysiology of ARDS
The pathophysiology of ARDS involves three primary phases:
1. Exudative Phase
Occurs within the first week of injury. There is leakage of protein-rich fluid into the alveoli, formation of hyaline membranes, and decreased lung compliance. Patients often require high oxygen supplementation and ventilatory support.
2. Proliferative Phase
Between 7 to 21 days after onset. The body attempts to repair damaged lung tissue, but respiratory distress may persist if alveolar damage remains significant.
3. Fibrotic Phase
Characterized by lung scarring and irreversible changes. Lung compliance continues to deteriorate, causing persistent oxygenation problems and prolonged ventilator dependency.
Understanding these phases helps nurses anticipate complications and modify interventions accordingly.
Why Nursing Diagnoses are Crucial in ARDS
Nurses are responsible for continuous monitoring of respiratory status, airway patency, mechanical ventilation parameters, fluid balance, nutritional intake, mobility, skin integrity, and psychological well-being. Nursing diagnoses allow nurses to:
- Identify patient-specific problems
- Prioritize urgent issues (e.g., oxygenation)
- Develop measurable and goal-oriented care plans
- Implement targeted interventions
- Evaluate outcomes and adjust care priorities
Common Nursing Diagnoses for ARDS
The following are the most frequently used NANDA-I based nursing diagnoses for ARDS patients:
- Ineffective Breathing Pattern
- Impaired Gas Exchange
- Ineffective Airway Clearance
- Excess Fluid Volume
- Imbalanced Nutrition: Less Than Body Requirements
- Activity Intolerance
- Impaired Physical Mobility
- Risk for Pressure Injury / Impaired Skin Integrity
- Sleep Pattern Disturbance
- Anxiety or Ineffective Coping
- Impaired Verbal Communication (especially in ventilated patients)
Detailed Explanation of Key Nursing Diagnoses
1. Ineffective Breathing Pattern
Definition: Inspiration and/or expiration that does not provide adequate ventilation.
Related Factors: decreased lung compliance, respiratory muscle fatigue, hypoxemia, mechanical ventilation dependence.
Clinical Indicators: dyspnea, tachypnea, accessory muscle use, cyanosis, altered respiratory rhythm.
Nursing Interventions:
- Monitor respiratory rate, oxygen saturation, and work of breathing
- Position patient in semi-Fowler or high-Fowler
- Collaborate with respiratory therapist to optimize ventilator settings
- Administer prescribed bronchodilators or sedation if indicated
2. Impaired Gas Exchange
Definition: Decreased oxygenation and/or elimination of carbon dioxide at the alveolar level.
Clinical Indicators: hypoxemia, confusion, restlessness, cyanosis, abnormal ABG results.
Nursing Interventions:
- Monitor ABG values regularly
- Assess lung auscultation sounds
- Implement prone positioning as ordered to improve ventilation-perfusion ratio
- Evaluate effects of positive-end expiratory pressure (PEEP)
3. Ineffective Airway Clearance
Definition: Inability to clear secretions or obstructions from the airway.
Nursing Interventions:
- Perform suctioning based on clinical need
- Encourage coughing and deep breathing if conscious
- Ensure humidification of inspired gases
- Maintain airway patency, especially in intubated patients
4. Excess Fluid Volume
ARDS often causes fluid leakage into lung tissue. If unmanaged, pulmonary edema worsens respiratory function.
- Monitor intake and output
- Assess for edema and weight gain
- Educate family on fluid restrictions when prescribed
5. Impaired Physical Mobility and Pressure Injury Risk
Prolonged immobility, mechanical ventilation, and sedation predispose patients to muscle atrophy and skin breakdown.
- Reposition every two hours
- Use pressure-relieving surfaces
- Encourage passive or active range-of-motion exercises
Example of Nursing Care Plan for ARDS
- Problem: Impaired Gas Exchange
- Goal: Improve oxygen saturation levels to ≥ 92%
- Interventions:
- Monitor ABG and SpO2
- Collaborate on mechanical ventilation adjustments
- Implement prone positioning if ordered
- Expected Outcome: Patient demonstrates improved oxygenation with reduced dyspnea
Conclusion
ARDS is a life-threatening syndrome requiring comprehensive, evidence-based nursing interventions. Identifying accurate nursing diagnoses ensures early recognition of complications, improves patient outcomes, and enhances care coordination. Nurses must focus not only on respiratory issues such as gas exchange and airway clearance but also on nutritional needs, mobility limitations, psychological support, and prevention of secondary complications.
Holistic nursing care tailored to ARDS patients contributes significantly to survival, quality of life, and long-term rehabilitation outcomes.
References / Sources
- American Thoracic Society. Clinical Guidelines for ARDS Management.
- NANDA International. Nursing Diagnoses Definitions and Classification.
- StatPearls Publishing. Acute Respiratory Distress Syndrome Review.
- JAMA Network. Global Epidemiology and Mortality of ARDS Study.
- World Health Organization. Critical Care Management Guidelines.
- Bezmialem Science Journal. Nursing Care of ARDS Patients.
