Problem
Scenario:
The nurse is working in the emergency department when the paramedics call in and report that they are in route with Mr. T, who was involved in a motor vehicle accident. He is presently unconscious and receiving supplemental oxygen. Vital signs are BP, 110/68; HR, 100; RR, 10; and shallow, T. 98°F.
Mr. T was the driver, and he was wearing a seatbelt. His compact car collided head-on with a full-size pickup truck. There was no evidence of alcohol or drug involvement, and the only history that can be obtained is that he has a pre-existing chronic lung problem.
A chest tube was inserted, and Mr. T was placed on a ventilator. He also sustained a significant head injury that has left him unconscious and in need of ventilator support. Several days later, he starts to regain consciousness and becomes extremely restless. When the nurse suctions his artificial airway, the nurse observes blood-tinged sputum. Mr. T has a low-grade fever and is tachycardic.
The next day, the nurse notices that Mr. T has marked hypoxemia, which is not responding to increased levels of oxygen. A chest x-ray is obtained, which reveals diffuse bilateral infiltrates. He is diagnosed with ALI/ARDS.
Make sure you answer each of these questions:
A. What additional information will be helpful for the ER nurse and Provider at the scene and when the patient arrives?
B. What potential chronic lung problems could affect the treatment he is receiving after the accident? How would the treatment need to be altered?
C. Assessment reveals absent breath sounds on the right side with minimal chest movement. What does the nurse suspect and why? Related to the Pneumothorax
D. The patient is on bed rest, what could the patient develop, name a few?
E. How would a pulmonary embolus be diagnosed? List at least three methods.
F. What are the nurse's concerns related to a DVT and the patient's other injuries from the accident, such as the head injury? What is the pathophysiology associated with ALI/ARDS? Describe this process in detail, starting with pulmonary injury and ending with impaired gas exchange.