Posted: October 5th, 2022

G.S., a 56-year-old secretary

Case Examine 31 Acute Respiratory Misery Syndrome

G.S., a 56-year-old secretary, was concerned in a motorcar accident; a automobile drifted left of the centerline and struck G.S. head-on, pinning her behind the steering wheel. She was intubated instantly after extrication and flown to your trauma middle. Her accidents have been discovered to be intensive: bilateral flail chest, proper hemothorax and pneumothorax, fractured spleen, a number of small liver lacerations, open fractures of each legs, and possible cardiac contusion. She was taken to the working room (OR) for restore of her accidents. Within the OR she acquired 36 models of packed purple blood cells (RBCs), 20 models of platelets, He was taken to the working room (OR) in order that his accidents might be fastened. She received 36 models of packed purple blood cells (RBCs) and 20 models of platelets within the working room. 12 models of contemporary frozen plasma, and 18 L of lactated Ringer’s answer. G.S. was admitted to the intensive care unit (ICu) postoperatively, the place she developed acute respiratory misery syndrome (ARDS).

1. What’s ARDS?

2. What are the danger elements for growing ARDS? Which does G.S. have?

CaSE StuDy ProGrESS
G.S. was within the ICu for four weeks, and her ARDS is nearly resolved. She is being transferred to your unit. The ICu nurse provides you the next report: “She is awake, alert, and oriented to individual and place. Each legs stay casted from hip to toe. She will wiggle her toes on each toes. Coronary heart tones are clear, final very important indicators have been 138/90, 88, 26, 99.three° F (37.four° C); bilateral radial pulses three. All of her surgical incisions are healed. She has bilateral chest tubes to water suction with closed drainage, each 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 nonetheless pending.”

three. What extra info do you want from the ICU nurse?

CaSE StuDy ProGrESS
You full your Assessment of G.S. You notice she is dyspneic and has high quality crackles all through all lung fields posteriorly and in each decrease lobes anteriorly, and coarse crackles over the massive airways. She has oxygen on at 2 L per nasal cannula and her Spo2 is 94%. You end your analysis of G.S. You discover that she is in need of breath and that she has high quality crackles in all again lung fields and in each entrance decrease lobes, in addition to coarse crackles over the massive airways. Her Spo2 is 94% and she or he is getting 2 L of oxygen by a nasal cannula.
four. What’s the significance of the high quality and coarse crackles?

5. The nurse from the earlier shift charted the next assertion: “High quality and coarse crackles that clear with vigorous coughing.” Primarily based in your information of pathophysiology, decide the accuracy of this assertion.

6. It’s time to administer scheduled furosemide (Lasix) 60 mg intravenous push (IVP). What impact, if any, ought to furosemide have on G.S.’s breath sounds?

7. What motion do you should take earlier than giving the furosemide?

eight. Which laboratory values concern you, and why?

9. Given G.S.’s laboratory values, what motion do you should take and why?

CaSE StuDy ProGrESS
The doctor desires you to manage the furosemide and prescribes the next.

10. Why did the doctor order a magnesium stage?

11. G.S. has one accessible port to make use of on the PICC line. Define a plan for administering the potassium chloride and the calcium gluconate.

12. What interventions do you should carry out to securely administer intravenous (IV) potassium chloride? Choose all that apply.
a. Place G.S. on steady electrocardiogram (ECG) monitoring.
b. Administer the infusion utilizing an intravenous pump.
c. Assess the patency of the PICC line earlier than initiating the infusion.
d. Administer the potassium infusion over a time interval of a minimum of 2 hours.
e. Invert the potassium-containing IV bag a number of instances earlier than and through the infusion.

13. You go to arrange G.S.’s furosemide dose and discover just one 20-mg vial within the medication- dishing out system. The ground inventory is empty. The pharmacist tells you that it is going to be a minimum of an hour earlier than he can ship the drug to you. What are your choices?

14. While you’re administering the furosemide, G.S. says, “That is so bizarre. A pair instances this morning, I felt like my coronary heart flipped the other way up in my chest, however now I really feel like there’s a chook flopping round in there.” What are the primary two actions you must take subsequent?

15. G.S.’s pulse is 66 beats/min and irregular. Her blood strain is 92/70 and respirations are 26. She admits to being “a little lightheaded” however denies having ache or nausea. Your co-worker connects G.S. to the code cart monitor for a “fast look.” Interpret what you see.

16. Why is G.S. seemingly experiencing a dysrhythmia?

17. What’s going to your subsequent actions be?

18. You improve her oxygen to six L and the doctor orders a stat set of ABGs. How would you interpret G.S.’s ABGs?

19. What are your nursing priorities at the moment?

20. Describe 4 interventions you’ll carry out over the subsequent few hours based mostly on this precedence.

21. You discover that G.S. appears to be like frightened and is mendacity stiff as a board. How would you reply to this case?

CaSE StuDy outCoME
G.S.’s pulmonary standing doesn’t enhance after administration of the furosemide and she or he continues to have frequent ventricular dysrhythmias regardless of the administration of the electrolytes. The doctor transfers G.S. again to the ICu, the place she is discovered to have a pulmonary embolus. sadly, 1 week later she throws one other embolus and all a

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