Question

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, 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).

Case Study Progress

G.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: “She 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° F (37.4° C); bilateral radial pulses 3+. 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.”

  

3. What additional information do you need from the ICU nurse?

 

 

Case Study Progress

You 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%.

 

4. What is the significance of the fine and coarse crackles?

 

 

The nurse from the previous shift charted the following statement: “Fine and coarse crackles that clear with vigorous coughing.”

 

5. Based on your knowledge of pathophysiology, determine the accuracy of this statement.

 

6. It 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?