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to ventilated areas

Independent

To augment gas exchange, the patient needs endotracheal suctioning periodically. Prior to suc-tioning, hyperventilate and hyperoxygenate the patient to prevent the ill effects of suctioning, such as cardiac dysrhythmias or hypotension. Turn the patient as often as possible, even every

44 Adrenal Insufficiency (Addison's Disease)

hour, to increase ventilation and perfusion to all areas of the lung. If the patient has particularly poor gas exchange, consider a rocking bed that constantly changes the patient's position. If the patient's condition allows, even if the patient is intubated and on a ventilator, get the patient out of bed for brief periods. Evaluate the patient's condition to determine if soft restraints are appropriate. Although restraints are frustrating for the patient, they may be necessary to reduce the risk of self-extubation.

If the patient requires medications for skeletal muscle paralysis, provide complete care and make sure the medical management includes sedation. Use artificial tears to moisten the patient's eyes because the patient loses the blink reflex. Provide passive range-of-motion exercises every 8 hours to prevent contractures. Reposition the patient at least every 2 hours for comfort and adequate gas exchange, and to prevent skin breakdown. Provide complete hygiene, including mouth care, as needed. Assist the patient to conserve oxygen and limit oxygen consumption by spacing all activities, limiting interruptions to enhance rest, and providing a quiet environment.

The patient and family may be fearful and anxious. Acknowledge their fear without providing false reassurance. Explain the critical care environment and technology but emphasize the importance of the patient's humanness over and above the technology. Maintain open communication among all involved. Answer all questions and provide methods for the patient and family to communicate, such as a magic slate or point board.

• Respiratory status of the patient: respiratory rate, breath sounds, and the use of accessory muscles; arterial blood gas (ABG) levels; pulse oximeter and chest x-ray results

• Response to treatment, mechanical ventilation, immobility, and bedrest

• Presence of any complications (depends on the precipitating condition leading to ARDS)

PREVENTION. Prompt attention for any infections may decrease the incidence of sepsis, which can lead to ARDS.

COMPLICATIONS. If patients survive ARDS, few residual effects are seen. Complications are directed to any other conditions the patient may have.

^Addison's disease, primary adrenal insufficiency, occurs rarely. The adrenal glands consist of the medulla and the cortex. The medulla is responsible for the secretion of the catecholamines epinephrine and norepinephrine; the cortex is responsible for the secretion of glu-cocorticoids, mineralocorticoids, and androgen. The principal glucocorticoid, cortisol, helps regulate blood pressure, metabolism, anti-inflammatory response, and emotional behavior. The principal mineralocorticoid, aldosterone, is important for regulating sodium levels. Adrenal insufficiency is characterized by the decreased production of cortisol, aldosterone,

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