Discharge And Home Healthcare Guidelines

PREVENTION. Focus teaching on the problems associated with intoxication and strategies to avoid further intoxication. Encourage the patient to adapt proper nutrition.

REFERRALS. Refer the patient to appropriate substance abuse support groups such as Alcoholics Anonymous (AA).

Acute Respiratory Distress Syndrome

DRG Category: 087

Mean LOS: 5.5 days

Description: MEDICAL: Pulmonary Edema and

Respiratory Failure DRG Category: 475 Mean LOS: 9.5 days Description: MEDICAL: Respiratory System Diagnosis with Ventilator Support DRG Category: 483 Mean LOS: 41.9 days Description: SURGICAL: Tracheostomy Except for Face, Mouth, and Neck Diagnoses

The term adult respiratory distress syndrome (ARDS) was first coined by Ashbaugh and Petty in 1971. Previously, terms such as stiff lung, wet lung, shock lung, adult hyaline-membrane disease, and others were used to describe this syndrome that occurs after catastrophic events such as major surgical procedures, serious injuries, or other critical illnesses. In 1992, the American-European Consensus Conference on ARDS recommended changing the name back to what Ashbaugh and Petty originally named it in 1967, acute respiratory distress syndrome, because this condition affects children, teenagers, and adults.

ARDS is defined as noncardiogenic pulmonary edema that occurs despite low to normal pressures in the pulmonary capillaries. Many theories and hypotheses are currently under investigation. Patients with ARDS are characterized as having high-permeability pulmonary edema (HPPE) in contrast to cardiogenic pulmonary edema. In ARDS, the alveolar-capillary membrane is damaged, and both fluid and protein leak into the interstitial space and alveoli. Recent research has focused on possible mediators of the membrane damage, such as neutrophils, tumor necrosis factor (TNF), bacterial toxins, and oxygen free radicals, among others. The onset of symptoms generally occurs within 24 to 72 hours of the original injury or illness.

As ARDS progresses, patients exhibit decreased lung volumes and markedly decreased lung compliance. Type II pneumocytes, the cells responsible for surfactant production, are damaged. This deficiency is thought to be partly responsible for the alveolar collapse and the decrease in lung volumes that occur. In addition, fibroblasts proliferate in the alveolar wall, migrate into the intra-alveolar fluid, and ultimately convert the exudate (fluid with high concentration of protein and cellular debris) into fibrous tissue. Refractory hypoxemia occurs as the lungs are perfused but not ventilated (a condition called capillary shunting) owing to the damage to the alveoli and developing fibrosis. As ARDS progresses, respiratory failure and cardiopulmonary arrest can develop.

Various conditions can predispose a patient to ARDS, but they usually represent a sudden, catastrophic situation. These conditions can be classified into two categories: direct lung injury and indirect lung injury. Direct injury occurs from situations such as gastric aspiration, near drowning, chemical inhalation, and oxygen toxicity. Indirect injury occurs from mediators released during sepsis, multiple trauma, thermal injury, hypoperfusion or hemorrhagic shock, disseminated intravascular coagulation, drug overdose, and massive blood transfusions. The most common risk factor for ARDS is sepsis from an abdominal source. Approximately 150,000 new cases of ARDS occur each year. Mortality rates vary and have been estimated to be between 40% and 50%, but older patients and patients with severe infections have a higher rate. Survivors generally have almost normal lung function a year after the acute illness.

Alcohol No More

Alcohol No More

Do you love a drink from time to time? A lot of us do, often when socializing with acquaintances and loved ones. Drinking may be beneficial or harmful, depending upon your age and health status, and, naturally, how much you drink.

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