Question

G.S., a 36-year-old secretary, was involved in a motor vehicle accident where a car drifted left of the center line and struck her head-on, pinning her behind the steering wheel. She was intubated and injuries were extensive: bilateral flail chest, torn innominate artery, right hemothorax and pneumothorax, fractured spleen, multiple small liver lacerations, compound fractures of both legs, and probable cardiac contusion. She was taken to the operating room for repair of her injuries. G.S. was admitted to the ICU postop, where she developed adult respiratory distress syndrome (ARDS). 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 double lumen PICC line.

1. Explain ARDS and the risk factors this patient has for developing ARDS.

2. What is the significance of the flail chest?

3. Explain hemothorax and pneumothorax, how are they different?

4. What are the priority nursing interventions for a patient with ARDS? Include rationale

5. What are the priority nursing assessments/interventions for a patient with a chest tube? Include rationale

Answer 1

1.ARDS refers to Acute Respiratory Distress Syndrome where the air sacs of the respiratory system is fluid filled leading to difficulty in breathing.This is a severe condition which requires immediate care otherwise will be life threatening. The risk factors for this patient is any infection in the blood post operatively,motor vehicle accident, heamothorax and pneumothorax.

2.The flail chest can occur when there is breakage of the rib bone in the rib cage,usually a segment of the ribs misaligned from its position.

3.

Hemothorax	Pneumothorax
Collection of blood in the lungs breath sounds are absent Dullness can be noted on percussion at the anterior and at left side. Opacity can be noted in chest X ray No lung marking is seen in the images	Collection of air in the lungs It is also called as collapsed lung Breath sounds are absent Hyperresonnace can be noted Pleurql lining can be seen in chest X ray Lung sliding is absent in ultrasound

4.The priority nursing intervention for the patient is

• To administer oxygen as the patient will have difficulty in breathing and there will be definitive need of ventilator as patient cannot breath on self
• ABG has to be checked for abnormalities in the acid base balance as this is an expected one for alteration
• To position the patient to drain the fluid or remove the air appropriately
• Chest tube care has to be done.