ARDS Case Study B
Due: March 3 (Rotation 2)
Answer the following discussion questions in your own words, direct quotation from a resource is not acceptable.
Criteria for grading will consider the accuracy of the answer and the rationale, as well as how complete you explore each item. Each item is worth 6 points except for #1 which is 4 points.
Case
Ms. Carson, a 30-year-old 59 KG (130 lb.) black female had a perforated appendix two days ago. She had an open appendectomy and was placed on antibiotics to prevent peritonitis. She had an uneventful postoperative course the first two postoperative days. She was monitored closely for infection, wound drainage and pain management.. At 10 PM on the third postoperative day she began to complain of not feeling “right”. Her urinary output was 100cc over the past 8 hours. She appeared pale confused and short of breath. Blood gases and vital signs were as follows.
BP70/40
HR120/min.
Respirations 32/min
Temperature101.8 F
pH7.48
PaCO232 mm Hg
Pa0265
HCO322
Her shortness of breath worsened (she began gasping of air).
Ms. Carson is intubated she transferred to the ICU with a possible diagnosis of adult respiratory distress syndrome (ARDS)
1. Analyze Ms. Carson’s vital signs. (4 points)
2. Analyze Ms. Carson’s blood gases. Give rationale for your analysis.
3. Discuss the pathophysiology of ARDS related to: SIRS, pulmonary capillary permeability, surfactant, and hyline membrane formation.
4. What is/are possible precipitating event/s leading to Ms. Carson’s ARDS?
5. What radiological changes are seen with ARDS?
On arrival in to ICU, mechanical ventilation in the synchronized intermittent mandatory ventilation (SIMV) mode was begun.
Fio280%
SIMV rate 6
Tidal volume250 ml
6. Explain the SIMV ventilator mode. What is the advantage of this mode?
7. Explain each of the ventilator settings
8. Is the tidal volume reasonable for Ms. Carson? Give your rationale.
Ms. Carson was given a 500-ml bolus of normal saline. He also receives dopamine drip
3-5 ug/kg/min and was given Vancomycin 1 gram intravenously very 12 hours for prophylaxis against staphylococcal infection. A pulmonary artery catheter (Swan-Ganz) was inserted.
9. Why was the pulmonary artery catheter inserted? What information does it give the health care team?
10. What is the action of dopamine? Why was he given dopamine?
Her blood gases are now the following
pH- 7.28
PaO2- 60
PaCO2- 48
HCO- 26
11. Analyze her blood gases. Give rationale for your interpretation.
Her FiO2 was increased from 80% to 90%, and positive end-expiratory pressure (PEEP) of 5 cm H2O was added. The tidal volume was increased to 350 and SMIV rate was increased to She continues to receive dopamine infusion and several boluses of normal saline.
12. What positive end-expiratory pressure? Why was it added?
The following arterial blood gas values were obtained 15 minutes after the ventilator settings were changed.
pH7.3
PaO270 mm Hg
PaCOs46 mm Hg
HCO3 28.9
13. Analyze these blood gases and give your rationale for your interpretation.
14. Tissue hypoxia is a major finding in ARDS. Describe signs and symptoms found on assessment that would be seen with ARDS in the following system:
Central Nervous System
Pulmonary
Cardiovascular
Renal
Gastrointestinal
15. Identify ten appropriate nursing diagnoses seen with ARDS and give your rationale for choosing each diagnosis.
On the 5th postoperative the PEEP was increased to 10cm H2O and the tidal volume (Vt) was increased to 800ml.
pH 7.35 BP130/60
PaCO2 46.2 mm Hg HR100/min
PaO2 86.8 mm HgRespirations 14/min
HCO3 30.5 Temperature101 F
16. Analyze these values and give rationale. Do these values show improvement in his condition? Give rationale.
17. The nurse must continually monitor Ms Carson for medical complications seen with ARDS. Identify several potential complications?
After these changes, Ms. Carson’s oxygen levels gradually stabilized and he was weaned from ventilatory support. His urinary output also increased significantly after administration of the fluid boluses. Ten days after intubation Mr. Farwell was extubated and received oxygen by nasal cannula.
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