Advanced Ventilation
38576
Prompt
Case Study: Adult Respiratory Distress Syndrome History:
Ms. Y is a 23 year-old woman who was feeling fine until the morning of admission when she began having severe chills, vomiting, diarrhea, headache, and fever of 40*C. The symptoms persisted throughout the day and caused her to seek medical attention at the local ED. Ms. Y had an intrauterine device (IUD) inserted at a local family planning clinic 3 days before admission. At the time of admission, she denied shortness of breath, wheezing, sputum production, cough hemoptysis, orthopnea, chest pain, illicit drug use, or exposure to TB.
Physical Exam:
-General
Patient is well nourished, alert & oriented; she appears anxious but there is no evidence of respiratory distress
-Vital Sign:
Temp 40*C; RR 24 bpm; HR 104/min; BP 126/75
-Chest:
Normal configuration & expansion while breathing; normal resonance to percussion bilaterally
-Lungs:
Clear to auscultation bilaterally
-Abdomen:
Lower abdominal tenderness to palpation
-Extremities:
No cyanosis, edema, or clubbing
Lab Data:
-CBC
WBC 15,500 (high)
Question #1
Does the patient appear to have a pulmonary problem at this time? Why or why not?
Question #2
Does the patient’s medical problem predispose her to the development of ARDS?
Ms. Y has been started on IV antibiotic therapy. Results of a uterine swab show gram-negative diplococci, and a preliminary blood culture also shows gram-negative cocci.
Twelve hours later, she begins complaining of increased shortness of breath.
Assessment:
RR 34 bpm; HR 120/min
She is using accessory muscles to breathe and chest auscultation now reveals fine, inspiratory crackles bilaterally.
ABG: on RA
-pH: 7.25
-PaCO2: 21 mmHg
-HCO3: 16 mEq/liter
-BE: -17
-PaO2: 62 mmHg
-SaO2: 88%
Question #1
What is the pt’s acid-base & oxygenation status? Interpret the blood gas and explain your answer.
Question #2
What pathophysiology accounts for the adventitious lungs sounds (fine, inspiratory crackles)?
The patient continues to experience severe respiratory distress and is placed on an air entrainment mask with a FiO2 of 60%.
ABG on 60% FiO2:
-pH: 7.26
-PaCO2: 35 mmHg
-HCO3: 16 mEq/liter
-PaO2: 49 mmHg Assessment:
-RR 38 bpm
-HR 134/min
The chest film demonstrates an onset of diffuse bilateral infiltrates in the lower lobes; greater on the patient’s right side.
Question #1
Interpret the ABG.
Question #2
What initial settings would you place the patient on? Include mode of ventilation and indicate Why?
Submit your answers in at least 500 words on a Word document. You must cite at least three references to defend and support your position.
Collepals.com Plagiarism Free Papers
Are you looking for custom essay writing service or even dissertation writing services? Just request for our write my paper service, and we'll match you with the best essay writer in your subject! With an exceptional team of professional academic experts in a wide range of subjects, we can guarantee you an unrivaled quality of custom-written papers.
Get ZERO PLAGIARISM, HUMAN WRITTEN ESSAYS
Why Hire Collepals.com writers to do your paper?
Quality- We are experienced and have access to ample research materials.
We write plagiarism Free Content
Confidential- We never share or sell your personal information to third parties.
Support-Chat with us today! We are always waiting to answer all your questions.
