Final answer:
In a patient with sepsis at risk for ARDS, a nurse will monitor for signs of dyspnea, tachypnea, cough, restlessness, and adventitious lung sounds indicative of fluid in the alveoli.
Step-by-step explanation:
When caring for a patient admitted with sepsis who may be at risk for developing acute respiratory distress syndrome (ARDS), a nurse will monitor for several early clinical manifestations. The key symptoms to look for include:
- Dyspnea and tachypnea
- Adventitious lung sounds
- Cough and restlessness
- Respiratory acidosis
- Oliguria
ARDS typically presents with rapid onset of severe shortness of breath (dyspnea) and fast breathing (tachypnea). This can be accompanied by cough, increased work of breathing, and changes in mental status such as restlessness. Lung auscultation may reveal adventitious lung sounds like crackles, indicating fluid in the alveoli. Respiratory acidosis may occur as the impaired gas exchange leads to an accumulation of carbon dioxide in the blood. Although oliguria, a decrease in urine output, isn't a primary respiratory symptom, it can occur in severe cases due to the associated shock and organ failure.