NR293/NR 293 Pharmacology For Nursing Practice Case Study Acute
I I I I I I I I
Respiratory Distress Syndrome
I I I
Difficulty: IAdvanced
Setting: IHospital
I
Index IWords: Iacute Irespiratory Idistress Isyndrome I(ARDS), Imedications, Ipain Imanagement,
Iassessment, Ilaboratory Ivalues, Idysrhythmias, Icrisis Imanagement
Giddens IConcepts: IClinical IJudgment, ICollaboration, IFluid Iand IElectrolyte IBalance, IGas
IExchange, IOxygenation, ISafety
HESI IConcepts: IAssessment, IClinical IDecision IMaking—Clinical IJudgment,
ICollaboration/Managing ICare, IFluid Iand
Electrolyte IBalance, IGas IExchange, IOxygenation, ISafety
Scenario
G.S., Ia I56-year-old Isecretary, Iwas Iinvolved Iin Ia Imotor Ivehicle Iaccident; Ia Icar Idrifted Ileft Iof Ithe
Icenterline Iand Istruck IG.S. Ihead-on, Ipinning Iher Ibehind Ithe Isteering Iwheel. IShe Iwas Iintubated
Iimmediately Iafter Iextrication Iand Iflown Ito Iyour Itrauma Icenter. IHer Iinjuries Iwere Ifound Ito Ibe
Iextensive: Ibilateral Iflail Ichest, Iright Ihemothorax Iand Ipneumothorax, Ifractured Ispleen, Imultiple
Ismall Iliver Ilacerations, Iopen Ifractures Iof Iboth Ilegs, Iand Iprobable Icardiac Icontusion. IShe Iwas
Itaken Ito Ithe Ioperating Iroom I(OR) Ifor Irepair Iof Iher Iinjuries. IIn Ithe IOR Ishe Ireceived I36 Iunits Iof
Ipacked Ired Iblood Icells I(RBCs), I20 Iunits Iof Iplatelets, I12 Iunits Iof Ifresh Ifrozen Iplasma, Iand I18L Iof
Ilactated IRinger's Isolution. IG.S. Iwas Iadmitted Ito Ithe Iintensive Icare Iunit I(ICU) Ipostoperatively,
Iwhere Ishe Ideveloped Iacute Irespiratory Idistress Isyndrome I(ARDS).
1. What Iis IARDS?
2. What Iare Ithe Irisk Ifactors Ifor Ideveloping IARDS? IWhich Idoes IG.S. Ihave?
Case IStudy IProgress
G.S. Iwas Iin Ithe IICU Ifor I4 Iweeks, Iand Iher IARDS Iis Ialmost Iresolved. IShe Iis Ibeing Itransferred Ito
Iyour Iunit. IThe IICU Inurse Igives Iyou Ithe Ifollowing Ireport: I“She Iis Iawake, Ialert, Iand Ioriented Ito
Iperson Iand Iplace. IBoth Ilegs Iremain Icasted Ifrom Ihip Ito Itoe. IShe Ican Iwiggle Iher Itoes Ion Iboth Ifeet.
IHeart Itones Iare Iclear, Ilast Ivital Isigns Iwere I138/90, I88, I26, I99.3° IF I(37.4° IC); Ibilateral Iradial
Ipulses I3+. IAll Iof Iher Isurgical Iincisions Iare Ihealed. IShe Ihas Ibilateral Ichest Itubes Ito Iwater Isuction
Iwith Iclosed Idrainage, Iboth Idressings Iare Idry Iand Iintact. IShe Ihas Ia Iduodenal Ifeeding Itube, Ia IFoley
Icatheter Ito Idown Idrain, Iand Ia Ileft Idouble-lumen Iperipherally Iinserted Icentral Icatheter I(PICC)
Iline. IHer Imorning Ilabs Iare Istill Ipending.”
3. What Iadditional Iinformation Ido Iyou Ineed Ifrom Ithe IICU Inurse?
Case IStudy IProgress
I I I I I I I I
Respiratory Distress Syndrome
I I I
Difficulty: IAdvanced
Setting: IHospital
I
Index IWords: Iacute Irespiratory Idistress Isyndrome I(ARDS), Imedications, Ipain Imanagement,
Iassessment, Ilaboratory Ivalues, Idysrhythmias, Icrisis Imanagement
Giddens IConcepts: IClinical IJudgment, ICollaboration, IFluid Iand IElectrolyte IBalance, IGas
IExchange, IOxygenation, ISafety
HESI IConcepts: IAssessment, IClinical IDecision IMaking—Clinical IJudgment,
ICollaboration/Managing ICare, IFluid Iand
Electrolyte IBalance, IGas IExchange, IOxygenation, ISafety
Scenario
G.S., Ia I56-year-old Isecretary, Iwas Iinvolved Iin Ia Imotor Ivehicle Iaccident; Ia Icar Idrifted Ileft Iof Ithe
Icenterline Iand Istruck IG.S. Ihead-on, Ipinning Iher Ibehind Ithe Isteering Iwheel. IShe Iwas Iintubated
Iimmediately Iafter Iextrication Iand Iflown Ito Iyour Itrauma Icenter. IHer Iinjuries Iwere Ifound Ito Ibe
Iextensive: Ibilateral Iflail Ichest, Iright Ihemothorax Iand Ipneumothorax, Ifractured Ispleen, Imultiple
Ismall Iliver Ilacerations, Iopen Ifractures Iof Iboth Ilegs, Iand Iprobable Icardiac Icontusion. IShe Iwas
Itaken Ito Ithe Ioperating Iroom I(OR) Ifor Irepair Iof Iher Iinjuries. IIn Ithe IOR Ishe Ireceived I36 Iunits Iof
Ipacked Ired Iblood Icells I(RBCs), I20 Iunits Iof Iplatelets, I12 Iunits Iof Ifresh Ifrozen Iplasma, Iand I18L Iof
Ilactated IRinger's Isolution. IG.S. Iwas Iadmitted Ito Ithe Iintensive Icare Iunit I(ICU) Ipostoperatively,
Iwhere Ishe Ideveloped Iacute Irespiratory Idistress Isyndrome I(ARDS).
1. What Iis IARDS?
2. What Iare Ithe Irisk Ifactors Ifor Ideveloping IARDS? IWhich Idoes IG.S. Ihave?
Case IStudy IProgress
G.S. Iwas Iin Ithe IICU Ifor I4 Iweeks, Iand Iher IARDS Iis Ialmost Iresolved. IShe Iis Ibeing Itransferred Ito
Iyour Iunit. IThe IICU Inurse Igives Iyou Ithe Ifollowing Ireport: I“She Iis Iawake, Ialert, Iand Ioriented Ito
Iperson Iand Iplace. IBoth Ilegs Iremain Icasted Ifrom Ihip Ito Itoe. IShe Ican Iwiggle Iher Itoes Ion Iboth Ifeet.
IHeart Itones Iare Iclear, Ilast Ivital Isigns Iwere I138/90, I88, I26, I99.3° IF I(37.4° IC); Ibilateral Iradial
Ipulses I3+. IAll Iof Iher Isurgical Iincisions Iare Ihealed. IShe Ihas Ibilateral Ichest Itubes Ito Iwater Isuction
Iwith Iclosed Idrainage, Iboth Idressings Iare Idry Iand Iintact. IShe Ihas Ia Iduodenal Ifeeding Itube, Ia IFoley
Icatheter Ito Idown Idrain, Iand Ia Ileft Idouble-lumen Iperipherally Iinserted Icentral Icatheter I(PICC)
Iline. IHer Imorning Ilabs Iare Istill Ipending.”
3. What Iadditional Iinformation Ido Iyou Ineed Ifrom Ithe IICU Inurse?
Case IStudy IProgress
