Question

Presentation: Post-op day #3 Mr. Smith, a 68-year-old Caucasian male, weighs 150 lb. He has undergone an anterior colon resection for rectal polyps and had an uneventful postoperative course until the evening of the third postoperative day. He was on a telemetry floor and had no unusual complaints. At 11pm on the third postoperative day, he began to complain of not feeling “right”. Assessment of the patient revealed hypotension and shortness of breath. Within minutes he became confused and agitated. The shortness of breath worsened and he began to gasp for air., experiencing severe hypoxia. He was intubated, placed initially on 100% FiO2 and transferred to the ICU. Initial assessment indicated the following: BP 60/40 mmHg, pH 7.52, HR 160 bpm, pCO2 30 mmHg, Respirations 22-35 breaths per min, pO2 104 mmHg, Temp 38.8 o C, HCO3 24 mmol/L 1. What is the analysis of the ABGs? In the ICU, mechanical ventilation in the Assist Control (A/C) mode was begun: FiO2 90 % AC rate 10 Tidal Volume 600 PEEP 5 cm Mr. Smith was given a 500 mL bolus of normal saline. He received dopamine 3 to 5 mcg/kg/min and was given vancomycin 1 G intravenously every 12 hours for prophylaxis against staphylococcal infection. A pulmonary artery wedge catheter was inserted and the patient’s pulmonary capillary wedge pressure was 8 mm Hg. Sedation was started with Propofol continuous IV drip. The nurse assesses bronchovesicular breath sounds over all lung fields. He continued to have a RR of 28/min. The PEEP was increased to 7cm. The vent settings outlined were continued and ABGs were drawn after two hours on the changed settings. BP 90/50 mmHg pH 7.42 HR 120 bpm pCO2 36 mmHg Respirations 12-35 breaths per min pO2 75.2 mmHg Temp 38.8 o C HCO3 22 mmol/L 2. What is the P/F ratio for the patient at this time? 3. What is ARDS? 4. Discuss the pathophysiological changes associated with ARDS. 5. What are the pathophysiologic phases of ARDS? 6. How is ARDS diagnosed? 7. What are some medical complications seen with ARDS? 8. What laboratory findings are diagnostic with ARDS? 9. What radiologic changes are seen with ARDS? 10. What changes are seen in pulmonary function studies with ARDS? 11. Tissue hypoxia is a major finding in ARDS. Describe signs and symptoms found on assessment that would be seen with ARDS in the following systems: a. Central nervous b. Pulmonary c. Cardiovascular d. Renal e. Gastrointestinal f. Hepatic 12. What is the goal of treatment with ARDS? 13. What are the principal treatments for ARDS? List and describe the types of ventilator support available. 14. Describe non-ventilatory means of pulmonary support. 15. What are some of the pharmacological interventions used in ARDS? 16. What role does hemodynamic monitoring play in the management of ARDS? 17. Describe 5 appropriate nursing diagnoses seen with ARDS 18. Provide the goal for each of the nursing diagnoses.

19. Provide the appropriate nursing interventions for each of the five nursing diagnoses. You may use the table below to fulfill the answers to the last 3 questions. Nursing Diagnosis

Goal

Interventions

Answer 1

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