Signs and Symptoms
As patients develop dyspnea and have changes in their chest x-ray, they could be diagnosed with pneumonia or heart failure with fluid in the lungs. However, these patients do not respond to typical treatment and continue to be more dyspneic and remain acutely ill. The patient with ARDS experiences shortness of breath, dyspnea, and cough. Some may be febrile, with associated tachycardia and tachypnea. As patients develop a cough, it will likely be productive and lead to fatigue. Some patients will complain of chest pain that may be more noticeable upon inhalation. The patient may experience hypoxemia and some degree of cyanosis. The nurse should monitor for changes in mental status such as confusion, drowsiness, restlessness, and other indicators of hypoxemia. The nurse should assess and follow vital signs regularly. Ongoing evaluation of body temperature may be useful as patients who are febrile early in the development of ARDS often have a lower mortality rate as compared to those patients who have average or subnormal temperatures early in the disorder (Grossman & Porth, 2014; Ignatavicius et al.; NHLBI, 2019).
While doing a physical assessment on this patient, the nurse would not only want to auscultate for lung sounds but to observe for sternal retractions or any signs of an increased effort to breathe. It is important to note that the nurse will not necessarily hear abnormal lung sounds because the inflammatory process is creating excess fluid in the interstitial space but not in the airways. The nurse will assess and continue to monitor the oxygen saturation of the patient and carefully document the saturation level when the supplemental oxygen was initiated as well as the response. This should also be done if the level or type of oxygen device is changed. The nurse should also continue to closely monitor the respiratory effort being made by the patient as well as changes in vital signs (Grossman & Porth, 2014; Ignatavicius et al., 2018; Wilkinson et al., 2016).