Assignment
Case Study: Acute Respiratory Distress Syndrome
Patient Profile
Z.Q., 84-year-old Hispanic male, came to the emergency department (ED) 7 days ago with complaints of shortness of breath. His wife stated that he had a history of hypertension, depression, and chronic obstructive pulmonary disease (COPD). The admission chest x-ray revealed dense consolidation of the left lower lobe. An arterial blood gas (ABG) at that time showed: pH 7.60, PaCO2 29mm/Hg, HC03 32mmol/L, and PaO2 75mm/Hg. Z.Q. quickly deteriorated and subsequently was intubated. He has been in the intensive care unit for 5 days.
• Subjective Data
o Z.Q. and wife have been married 45 years and live with a daughter and 2 grandchildren
o Z.Q. and his wife speak both English and Spanish
• Objective Data
• Physical Examination
o Blood pressure 167/98, pulse 112, temperature102.0° F, respirations 14, oxygen saturation 72% on 6L via venture mask.
o Height 5 feet 6 inches, weight 75 kg
o Patient localizes to endotracheal tube (ETT) and is intermittently aroused, making several attempts to pull ETT
o Orally intubated #7.5 ETT, taped at 27 cm to lip
o Volume cycled ventilator at FIO2 - 60%, in assist control mode of 14 breaths per minute, tidal volume 450, positive end-expiratory pressure PEEP5 cm H2O
o Breath sounds decreased in bases with bilateral crackles that do not clear after suctioning
o Brown/yellow secretions returned with suctioning
o Peripheral pulses weak at 1/4 with capillary refill greater than 4 seconds
o 2+ pitting edema in the bilateral lower extremities
• Newly Obtained Diagnostic Study Results
o Arterial blood gas (ABG) pH 7.31, PaCO2 58mm/Hg, HCO3 28mmol/L, PaO2 54mm/Hg, EtCO2 38 mm/Hg
o Chest x-ray reveals diffuse white out in middle and lower lobes; endotracheal tube present with tip well above the carina; left subclavian central venous catheter is located in the superior vena cava
o CT scan reveals alveolar opacities with increasing effusions in the gravity-dependent areas of the lungs
Complete the following Case study questions. Answers must be thorough and cited appropriately in APA format
Interpret Z.Q.'s latest set of ABGs.
o Describe each of Z.Q.'s ventilator settings and the rationale for the selection of each.
o After reviewing Z.Q's ABG results, the provider increases the PEEP from 5 cm H2O to 8cm H2O. Why would this be necessary and what is the expected outcome associated with this action?
o The provider decides to begin Z.Q. on IV dobutamine and milrinone. What is the rationale for using each of these medications?
o Based on the assessment data, what are the nursing priorities for Z.Q.?
o List three potential adverse complications with mechanical ventilation.
o You are concerned about Z.Q.'s nutritional status and approach the provider for a dietary consult, thinking that Z.Q. is a candidate for enteral feedings with Pulmocare. What is your reason for making this recommendation?
Format your assignment according to the following formatting requirements:
o The answer should be typed, using Times New Roman font (size 12), double spaced, with one-inch margins on all sides.
o The response also includes a cover page containing the title of the assignment, the student's name, the course title, and the date. The cover page is not included in the required page length.
o Also include a reference page. The Citations and references must follow APA format. The reference page is not included in the required page length.