The role of the nurse in the care and treatment of ARDS patients is multi-faceted and typically in an ICU. Nursing assesses the patient by collecting history and physical assessment data initially and ongoing. The nurse must carefully monitor vital signs, respiratory effort, oxygen saturation levels, and diagnostic studies, contacting the provider with remarkable findings. It is also essential that the nurse keeps the family updated within their scope of practice and patient confidentiality, ensuring not to violate HIPPA. The patient’s family may be anxious and apprehensive. Although the nurse will be busy caring for the patient, they must remember to integrate the family into patient care when possible and use open and honest communication (Ignatavicius et al., 2018).
Nursing may also be involved in assisting with diagnostic procedures such as obtaining sputum specimens, collecting urine samples, and assisting with bronchoscopies. The nurse may also need to set up sterile fields for procedures, and monitor the patient following procedures. Nursing will need to watch for anticipated and unexpected events following these procedures. Treatment options include using supplemental oxygen as ordered and observing for the effectiveness of the oxygen. The nurse will need to be prepared to increase oxygen levels per provider order and change oxygen delivery devices based on arterial blood gases and/or oxygen saturation levels. Nursing should be aware of the various types of oxygen devices, flow rates, and the percent of oxygen they can deliver through each device. Oxygen devices include a nasal cannula (see Figure 1 below), simple face mask (see Figure 2 below), partial rebreather, nonrebreather mask (see Figure 3 below), venturi mask (see Figure 4 below), face tent, tracheostomy collar, and a T-piece (a T-shaped tube connected to an endotracheal tube [ETT] to deliver supplemental oxygen when mechanical ventilation is not required) (Ignatavicius et al., 2018; Wilkinson et al., 2016).
Figure 1 – T-Shaped Tube
The ARDS patient may be placed on mechanical ventilation, so nursing must be knowledgeable and prepared to work with mechanical ventilators, intubation, and suctioning of the airway. Nursing must be familiar with different types of respirators and recognize what the standard settings mean, and how to troubleshoot the ventilator. Working with respiratory therapy will be essential to deliver the best care for the patient. It is imperative that the nurse suction as needed using a vigilant sterile technique (Ignatavicius et al., 2018; Wilkinson et al., 2016).
As discussed above, when caring for a patient with ARDS, they may already have an active infection; thus, nursing must correctly use sterile technique when suctioning to decrease the risk of introducing additional organisms. Proper handwashing must always be utilized, and nurses who exhibit any signs of active illness should not be involved with the care of these patients. The concepts of safety and infection control are paramount in caring for these patients (Ignatavicius et al., 2018; Wilkinson et al., 2016).
Medication administration will involve parenteral therapy as well as possible oral administration, depending on the ability of the patient to swallow. Nursing will need to be knowledgeable regarding the mechanism of action, anticipated outcomes, and possible adverse effects. Medication administration will involve the assessment of the patient before administration, evaluation at appropriate times, and clear and concise documentation. Depending on the patient’s condition, they may require supplemental nutrition, so nursing must be aware of how to correctly administer parenteral and/or enteral nutrition, recognizing that this is another potential source of infection (Ignatavicius et al., 2018; Wilkinson et al., 2016).
Nursing must work in collaboration with other specialty areas such as physical therapy, occupational therapy, respiratory therapy, and others in meeting the needs of the ARDS patient. The patient will need to be turned and repositioned frequently; the provider will determine the most appropriate position(s) for the patient but will likely involve being in the prone position for intervals. Some of the other disciplines may be involved in using equipment to assist in positioning the patient in the prone position to ensure safety. The nurse plays a vital role in supporting and providing care for the ARDS patient (Ignatavicius et al., 2018).