A client with acute respiratory distress syndrome (ARDS) has fine crackles at lung bases and the respirations are shallow at a rate of 28 breaths/minute. The client is restless and anxious. In addition to monitoring the arterial blood gas results, the nurse should anticipate doing which of the following? Select all that apply.

A. ARDS and hypoxemia can lead to multi-organ hypoperfusion, including renal dysfunction. Monitoring BUN and creatinine helps assess for early signs of acute kidney injury, which is important in critically ill patients. B. The client is restless and anxious, which can worsen oxygen consumption and respiratory distress. Sedatives may be prescribed to reduce anxiety and improve oxygenation, especially if non-invasive measures are insufficient. Sedation must be carefully titrated to avoid respiratory depression. C. In ARDS, the head of the bed is usually elevated (30–45°) to improve oxygenation, reduce work of breathing, and prevent aspiration. Lowering the bed would increase risk of hypoxemia and aspiration. D. Oxygen therapy is essential in ARDS to correct hypoxemia. Humidification prevents airway dryness, irritation, and mucus plugging, which are common in patients with shallow, rapid breathing. E. Frequent auscultation helps the nurse monitor for changes in lung sounds, including worsening crackles, wheezing, or absent breath sounds, which may indicate progression of pulmonary edema or complications.