Acute Respiratory Distress Syndrome (ARDS) is a life-threatening condition that requires rapid assessment, close monitoring, and skilled nursing care. For every nurse working in ICU, emergency, or step-down units—and for every registered nurse (RN nurse) preparing for the NCLEX—understanding ARDS is essential.
This article simplifies ARDS pathophysiology, treatment, and nursing responsibilities to help nurses provide safe, evidence-based care.
What Is ARDS?
ARDS is a severe form of acute lung injury characterized by widespread inflammation and increased alveolar-capillary permeability. As a result, fluid leaks into the alveoli, causing impaired gas exchange and refractory hypoxemia.
Common causes include:
- Sepsis
- Pneumonia
- Aspiration
- Severe trauma
- COVID-19 and other viral infections
📌 NCLEX focus: ARDS is non-cardiogenic pulmonary edema, meaning it is not caused by heart failure.
Pathophysiology of ARDS (Simplified)
In ARDS:
- Inflammation damages alveolar membranes
- Fluid enters alveoli
- Surfactant is lost
- Alveoli collapse
- Oxygenation drops despite oxygen therapy
Therefore, patients often require mechanical ventilation and intensive nursing interventions.
Key Signs and Symptoms Nurses Must Recognize
A registered nurse should suspect ARDS when a patient shows:
- Severe dyspnea
- Tachypnea
- Refractory hypoxemia
- Crackles on auscultation
- Decreased lung compliance
- Cyanosis (late sign)
Early recognition by the RN nurse improves survival.
Diagnostic Criteria (Berlin Definition – NCLEX Relevant)
ARDS is diagnosed based on:
- Acute onset (within 1 week of insult)
- Bilateral infiltrates on chest X-ray
- PaO₂/FiO₂ ratio ≤ 300
- Respiratory failure not explained by cardiac causes
📌 These criteria frequently appear in NCLEX questions and critical care nursing bundle materials.
Nursing Priorities in ARDS Care
1. Oxygenation and Ventilation
Most patients require mechanical ventilation.
Nursing responsibilities include:
- Monitoring SpO₂ and ABGs
- Ensuring low tidal volume ventilation (lung-protective strategy)
- Maintaining appropriate PEEP levels
📌 NCLEX tip: High PEEP helps keep alveoli open but increases risk for barotrauma.
2. Positioning: Prone Therapy
Prone positioning improves oxygenation by:
- Redistributing ventilation
- Improving alveolar recruitment
RN nurse responsibilities
- Ensure airway security
- Protect pressure points
- Monitor hemodynamics
Proning is a high-yield topic in nursing exams.
3. Fluid Management
Fluid balance is critical in ARDS.
- Avoid fluid overload
- Monitor I&O closely
- Assess daily weights
📌 Nursing principle: Conservative fluid strategy improves lung function.
4. Sedation and Comfort
Patients may require:
- Sedation
- Neuromuscular blockers (short term)
Nurse responsibilities
- Assess sedation levels
- Prevent delirium
- Perform daily sedation interruptions when ordered
These concepts are emphasized in ICU nursing bundles.
5. Preventing Complications
ARDS patients are at high risk for:
- Ventilator-associated pneumonia (VAP)
- Pressure injuries
- DVT
- ICU delirium
Registered nurse interventions
- Elevate HOB 30–45°
- Oral care with chlorhexidine
- Turn and reposition frequently
- Apply DVT prophylaxis as ordered
Medications Commonly Used in ARDS
While no cure exists, supportive medications include:
- Sedatives (propofol, midazolam)
- Analgesics (fentanyl)
- Vasopressors (if septic shock present)
📌 NCLEX note: Corticosteroids may be used selectively but are not universally indicated.
NCLEX-Style Nursing Concepts to Remember
- ARDS ≠ heart failure
- Oxygenation is the top priority
- Low tidal volume ventilation reduces mortality
- PEEP improves oxygenation but increases barotrauma risk
- Prone positioning improves gas exchange
These points are repeatedly tested on the NCLEX and reinforced in every comprehensive nursing bundle.
Role of the Registered Nurse in ARDS Outcomes
The RN nurse plays a central role by:
- Detecting early deterioration
- Interpreting ABGs
- Managing ventilators safely
- Advocating for lung-protective strategies
Strong nursing assessment skills directly improve survival in ARDS patients.
Final Takeaway for Nurses
Caring for patients with ARDS is challenging but manageable with strong fundamentals. By understanding pathophysiology, prioritizing oxygenation, and applying evidence-based nursing interventions, every registered nurse can provide safe, effective care and feel confident answering NCLEX questions on this topic.