Case Study Questions s1

Case Study Questions

Acute Respiratory Distress Syndrome (ARDS)

Patient Profile Mr. J. is a 55-year-old African American man who was admitted 72 hours ago to a general surgical unit after surgery for a bowel obstruction. The surgical procedure involved extensive abdominal surgery to repair a perforated colon, irrigate the abdominal cavity, and provide hemostasis. During surgery his systolic blood pressure dropped to 70 mm Hg. Seven units of packed red blood cells and 4 L of normal saline were administered intravenously to restore blood loss and circulating volume. He is receiving 60% O2 through an aerosol face mask. He is being monitored with a cardiac monitor and pulse oximeter. He has a central intravenous catheter in place and is receiving 0.9% normal saline IV at 125 ml per hour. A urinary catheter is in place.

Subjective Data  Complains of shortness of breath, inability to lie flat, and diffuse abdominal pain

Objective Data Physical Assessment  General: alert, well-nourished man who appears restless and anxious; head of bed elevated 45 degrees; skin cool with moderate diaphoresis  Respiratory: no accessory muscle use, retractions, or paradoxic breathing; respiratory rate 28 breaths/min; SpO2 88%; fine crackles at lung bases. The nurse also assessed the patient’s chest and abdominal wall excursion as well as depth and pattern of respiration.  Cardiovascular: blood pressure 100/60 mm Hg; cardiac monitor shows sinus tachycardia at 120 beats/min, with equal apical-radial pulse; temperature 101° F (38° C) orally.  Gastrointestinal: surgical dressing dry and intact; sharp pain on palpation over incisional area  Urologic: urinary catheter draining concentrated urine, less than 30 mL per hour

Diagnostic Findings

 ABG results: pH 7.35, PaO2 59 mm Hg, PaCO2 27 mm Hg, bicarbonate 16 mEq/L, O2 sat 89%.  Chest x-ray shows new scattered interstitial infiltrates compatible with an ARDS pattern as interpreted by the radiologist.

Critical Thinking Questions 1. How does the pathophysiology of ARDS predispose to the development of refractory hypoxemia? 2. What clinical manifestations does Mr. J. exhibit that support a diagnosis of ARDS? 3. What are the possible causes of ARDS in Mr. J.? 4. What are the possible complications Mr. J. is at risk for developing secondary to ARDS? 5. What respiratory care interventions might be implemented to improve Mr. J’s hypoxemia? 6. Based on the assessment data presented, write one or more appropriate nursing diagnoses. 7. Discuss any collaborative problems that might apply to this patient.