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.