Case Study 31 Acute Respiratory Distress Syndrome<\/p>\n
G.S., a 56-year-old secretary, was involved in a motor vehicle accident; a car drifted left of the centerline and struck G.S. head-on, pinning her behind the steering wheel. She was intubated immediately after extrication and flown to your trauma center. Her injuries were found to be extensive: bilateral flail chest, right hemothorax and pneumothorax, fractured spleen, multiple small liver lacerations, open fractures of both legs, and probable cardiac contusion. She was taken to the operating room (OR) for repair of her injuries. In the OR she received 36 units of packed red blood cells (RBCs), 20 units of platelets, He was taken to the operating room (OR) so that his injuries could be fixed. She got 36 units of packed red blood cells (RBCs) and 20 units of platelets in the operating room. 12 units of fresh frozen plasma, and 18 L of lactated Ringer’s solution. G.S. was admitted to the intensive care unit (ICu) postoperatively, where she developed acute respiratory distress syndrome (ARDS).<\/p>\n
1.\tWhat is ARDS?<\/p>\n
2.\tWhat are the risk factors for developing ARDS? Which does G.S. have?<\/p>\n
CaSE StuDy ProGrESS
\nG.S. was in the ICu for 4 weeks, and her ARDS is almost resolved. She is being transferred to your unit. The ICu nurse gives you the following report: \u201cShe is awake, alert, and oriented to person and place. Both legs remain casted from hip to toe. She can wiggle her toes on both feet. Heart tones are clear, last vital signs were 138\/90, 88, 26, 99.3\u00b0 F (37.4\u00b0 C); bilateral radial pulses 3\uf02b. All of her surgical incisions are healed. She has bilateral chest tubes to water suction with closed drainage, both dressings are dry and intact. She has a duodenal feeding tube, a Foley catheter to down drain, and a left double-lumen peripherally inserted central catheter (PICC) line. Her morning labs are still pending.\u201d<\/p>\n
3.\tWhat additional information do you need from the ICU nurse?<\/p>\n
CaSE StuDy ProGrESS
\nYou complete your assessment of G.S. You note she is dyspneic and has fine crackles throughout all lung fields posteriorly and in both lower lobes anteriorly, and coarse crackles over the large airways. She has oxygen on at 2 L per nasal cannula and her Spo2 is 94%. You finish your Assessment of G.S. You notice that she is short of breath and that she has fine crackles in all back lung fields and in both front lower lobes, as well as coarse crackles over the large airways. Her Spo2 is 94% and she is getting 2 L of oxygen through a nasal cannula.
\n4.\tWhat is the significance of the fine and coarse crackles?<\/p>\n
5.\tThe nurse from the previous shift charted the following statement: \u201cFine and coarse crackles that clear with vigorous coughing.\u201d Based on your knowledge of pathophysiology, determine the accuracy of this statement.<\/p>\n
6.\tIt is time to administer scheduled furosemide (Lasix) 60 mg intravenous push (IVP). What effect, if any, should furosemide have on G.S.’s breath sounds?<\/p>\n
7.\tWhat action do you need to take before giving the furosemide?<\/p>\n
8.\tWhich laboratory values concern you, and why?<\/p>\n
9.\tGiven G.S.\u2019s laboratory values, what action do you need to take and why?<\/p>\n
CaSE StuDy ProGrESS
\nThe physician wants you to administer the furosemide and prescribes the following.<\/p>\n
10.\tWhy did the physician order a magnesium level?<\/p>\n
11.\tG.S. has one available port to use on the PICC line. Outline a plan for administering the potassium chloride and the calcium gluconate.<\/p>\n
12.\tWhat interventions do you need to perform to safely administer intravenous (IV) potassium chloride? Select all that apply.
\na.\tPlace G.S. on continuous electrocardiogram (ECG) monitoring.
\nb.\tAdminister the infusion using an intravenous pump.
\nc.\tAssess the patency of the PICC line before initiating the infusion.
\nd.\tAdminister the potassium infusion over a time period of at least 2 hours.
\ne.\tInvert the potassium-containing IV bag several times before and during the infusion.<\/p>\n
13.\tYou go to prepare G.S.’s furosemide dose and find only one 20-mg vial in the medication- dispensing system. The floor stock is empty. The pharmacist tells you that it will be at least an hour before he can send the drug to you. What are your options?<\/p>\n
14.\tWhile you are administering the furosemide, G.S. says, \u201cThis is so weird. A couple times this morning, I felt like my heart flipped upside down in my chest, but now I feel like there’s a bird flopping around in there.\u201d What are the first two actions you should take next?<\/p>\n
15.\tG.S.’s pulse is 66 beats\/min and irregular. Her blood pressure is 92\/70 and respirations are 26. She admits to being \u201ca little lightheaded\u201d but denies having pain or nausea. Your co-worker connects G.S. to the code cart monitor for a \u201cquick look.\u201d Interpret what you see.<\/p>\n
16.\tWhy is G.S. likely experiencing a dysrhythmia?<\/p>\n
17.\tWhat will your next actions be?<\/p>\n
18.\tYou increase her oxygen to 6 L and the physician orders a stat set of ABGs. How would you interpret G.S.’s ABGs?<\/p>\n
19.\tWhat are your nursing priorities at this time?<\/p>\n
20.\tDescribe four interventions you will perform over the next few hours based on this priority.<\/p>\n
21.\tYou notice that G.S. looks frightened and is lying stiff as a board. How would you respond to this situation?<\/p>\n
CaSE StuDy outCoME
\nG.S.’s pulmonary status does not improve after administration of the furosemide and she continues to have frequent ventricular dysrhythmias despite the administration of the electrolytes. The physician transfers G.S. back to the ICu, where she is found to have a pulmonary embolus. unfortunately, 1 week later she throws another embolus and all a<\/p>\n","protected":false},"excerpt":{"rendered":"
Case Study 31 Acute Respiratory Distress Syndrome G.S., a 56-year-old secretary, was involved in a motor vehicle accident; a car drifted left of the centerline\u2026<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1463,7667,7669,7657,7663,7662,2751,7665,7664,1468,7666,7659,7660,7661,7658,1465],"tags":[687,116,117,121,125,8905,114,8902,8906,118,8908,8,115,62,8903,71,33,36,119,4,124,122,8904,7,77,50,105,123,8907],"class_list":["post-96413","post","type-post","status-publish","format-standard","hentry","category-best-nursing-paper-writing-service","category-buy-bsn-nursing-papers-online","category-buy-dnp-nursing-papers-online","category-healthcare-management-assignment-help-from-experts","category-help-my-assignment","category-ireland-assignment-help","category-online-healthcare-assignment-help","category-online-nursing-essay","category-online-nursing-paper-writers","category-online-nursing-papers","category-online-public-healthcare-assignment-help","category-online-tutors-helps","category-sample-assignment","category-top-essay-writing","category-urgent-assignment-helper","category-write-my-nursing-paper","tag-assignment-help-website","tag-best-essay-writing-service","tag-best-nursing-essay-writing-service","tag-best-nursing-essay-writing-services","tag-biology-essay-writing-service","tag-book-essay-title-generator","tag-healthcare-essay-writing-service","tag-help-me-write-my-essay","tag-help-write-my-essay","tag-medical-assignment-writing-services","tag-medical-essay-assignment-writi","tag-medical-essay-writing-service","tag-medical-essay-writing-service-online","tag-medical-paper-writing-service","tag-need-help-writing-an-essay","tag-nursing-answers","tag-nursing-essay-help","tag-nursing-essay-writing-examples","tag-nursing-essay-writing-services","tag-nursing-paper-writing-services-reviews","tag-nursing-writing-acers","tag-nursing-writing-helps","tag-online-essay-help-chat","tag-online-nursing-essay-writing-service","tag-pay-for-nursing-essay","tag-please-write-my-essay","tag-professional-medical-writing-services","tag-reliable-online-nursing-assignment-help","tag-write-my-essay-for-me"],"_links":{"self":[{"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/posts\/96413","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/comments?post=96413"}],"version-history":[{"count":0,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/posts\/96413\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/media?parent=96413"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/categories?post=96413"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/tags?post=96413"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}