Question

A 50 year old patient is admitted to the medical-surgical floor from the emergency department with severe abdominal pain thought to be from acute pancreatitis. He case a history of drinking at least a case of beer a day. He also smokes and appears cachectic. His old chart indicates a history of COPD, but he does not take drugs for this. He does have a new productive cough. At chage of shift, the nurse finds the patient dyspneic and slight confused. Lung sounds have wheezes, and he is mildly febrile. Pulse is 120 beats per minute, respirations are 32 breaths per minute, and blood pressure is 118/64. Oximetry shows a SpO2 of 91%. • What risk factors for ARDS does this patient have? • Explain the relationship between the lung sounds and the oximetry reading • What diagnostic testing should you be prepared to obtain? Two hours after applying oxygen at 3 liters/nasal cannula, the patient’s Spo2 is now 89%4. What additional measures do you anticipate for this patient?

Answer 1

• What risk factors for ARDS does this patient have?

Acute pancreatitis is the major risk factor for this patient to get affected with ARDs. Pancreatitis occurs due to heavy drinking which activates of intrapancreatic digestive enzyme. This causes abdominal pain and additionally if the patient vomits, aspiration of acidic content into the lungs results in acinar cell damage and the inflammatory reaction continues leads to cell necrosis and finally pulmonary damage. This increases the risk of ARDs.

• Explain the relationship between lung sounds and oximetry reading.

Lung sounds of wheezing present due to COPD and is not related to ARDs. It denotes the ventilation-perfusion mismatch. Oximetry reading of 91% indicates that the amount of oxygen present in the blood. It predicts the severity of acute pancreatitis and the level of hypoxia.

• What diagnostic testing should you be prepared to obtain?

• Chest X-ray - To rule out lung structure and function.
• ABG Analysis - To rule out alveolar oxygen level and the level of hypoxemia.
• Sputum culture - To determine lung infection.
• Hemodynamic monitoring - To determine the severity of dyspnea.
• CT scan - For the cross-sectional view of lung structure and function.

4. What additional measures do you anticipate for this patient?

Mechanical ventilation has to be initiated to pushes air into the lungs. Positive end-expiratory pressure helps to keep the pressure and oxygen saturation at adequate levels.