A nurse is planning care for a client who has acute respiratory distress syndrome (ARDS)

A nurse is planning care for a client who has acute respiratory distress syndrome (ARDS). Which of the following interventions should the nurse include in the plan?

A.
Administer low-flow oxygen continuously via nasal cannula.

B.
Offer high-protein and high-carbohydrate foods frequently.

C.
Place in a prone position.

D.
Encourage oral intake of at least 3,000 mL of fluids per day.

The correct answer and Explanation is :

The correct answer is C. Place in a prone position.

Explanation

Acute Respiratory Distress Syndrome (ARDS) is a severe condition characterized by widespread inflammation in the lungs, leading to impaired gas exchange and respiratory failure. Managing ARDS requires a multidisciplinary approach with a focus on improving oxygenation and ventilation. Here’s why placing the patient in a prone position is the preferred intervention among the options:

1. Prone Positioning: In ARDS, the distribution of lung perfusion and ventilation can be uneven, often due to gravity affecting the dependent areas of the lungs. Prone positioning helps redistribute ventilation and perfusion more evenly, improving oxygenation. This position can also alleviate pressure on the lungs and improve recruitment of collapsed alveoli. Clinical studies have shown that prone positioning can improve oxygenation and reduce mortality in patients with moderate to severe ARDS.
2. Low-flow Oxygen via Nasal Cannula: In ARDS, the severity of hypoxemia often necessitates higher levels of oxygenation than what a nasal cannula can provide. Patients typically require mechanical ventilation or high-flow oxygen therapy to manage their condition effectively.
3. High-Protein and High-Carbohydrate Foods: While nutritional support is important in ARDS management, high-protein and high-carbohydrate foods are more relevant for overall nutritional status rather than acute management. ARDS patients might have specific dietary needs based on their overall condition and energy expenditure, but this is not a primary intervention for the acute respiratory phase.
4. Encouraging Oral Intake of Fluids: Fluid management in ARDS is crucial, but excessive fluid intake can lead to fluid overload and worsening of pulmonary edema. Fluid balance is carefully managed based on the patient’s hemodynamic status and response to treatment, rather than a fixed target of 3,000 mL per day.

In summary, prone positioning directly addresses the impaired gas exchange and can lead to significant improvements in oxygenation and overall respiratory function in ARDS patients, making it the most appropriate intervention among the choices provided.