Case Study ARDS HELP!

oMerMero · Mar 13, 2008

What do you think the answers are? Tell us what you are thinking so far. We will not answer the questions for you.

UM Review RN, ASN, RN · Mar 13, 2008

This is a great case for you to study. Google everything, read up as much as you can. ARDS is a really significant dx and you'll learn a lot with your research that will serve you well when you have patients that develop ARDS.

leslie :-D · Mar 14, 2008

I am having a hard time answering my first practice case study in nursing school in applying nursing skills in clinical situations any response would be greatly appreciated to get me started in thinking like a nurse, here it goes:
Client is 55-year-old male who was admitted 72 hours ago to a general surgical unit after surgery for a bowel obstruction. The surgical procedure involved extensive abdominal surgery to repair a perforated colon, irrigate the abdominal cavity, and provide hemostasis. During surgery his systolic blood pressure dropped to 70 mm Hg. Six units of packed red blood cells and 3 L of normal saline were administered intravenously to restore blood loss and circulating volume. He is receiving 60%) 2 through an aerosol face mask. He is being monitored with a cardiac monitor and pulse oximeter. He has a central intravenous catheter in place and is receiving 0.9% normal saline intravenously at 125 ml per hour. A urinary catheter is in place.
SOB, inability to lie flat, and diffuse abdominal pain. Respiratory rate 28/min; Sp02 88%; fine crackles at lung bases. Blood Pressure 100/60; sinus tachycardia at 120/min; temp 101, sharp pain on palpation over incisional area. urinary catheter draining concentrated urine, less than 30 ml/hour ABG results: pH 7.35, Pa02 59; PaC02 27; HC03 16, 02 sat 89%. Chest x-ray shows new scattered interstitial infiltrates compatible with ARDS pattern as interpreted by the radiologist.
a. How does the pathophysiology of ARDS predispose the development of refractory hypoxemia?
b. What are the possible complications that the client is at risk for developing secondary to ARDS?
c. Based on the assessment data presented, what are appropriate nursing diagnosis.
d. Discuss any collaborative problems that might apply to this patient.

a. once you understand how/where ards affects the lungs, the refractory hypoxemia will fall into place.

b. is the ards localized to the lungs?

c. abc's...always

d. once you understand the etiologies of ards, secondary complications will become evident.

leslie

Daytonite, BSN, RN · Mar 14, 2008

hi, betterworld365, and welcome to allnurses! :welcome:

a case study like this is very similar to doing a care plan. it involves problem solving. as an rn student in rn school one of the objectives of the school is to teach it's students how to problem solve. why? because every day of a working rns life is filled with problems to solve. to do this, rn school teaches us the nursing process. this is something you are going to hear about all through nursing school. the nursing process is the problem solving method we nurses use. we use it for care planning as well as solving case studies like this. it helps us to organize our thoughts and to think critically. it can be applied to just about any situation. in fact, you have already been using it in your daily life, you just didn't call it the nursing process or think of it in the way nursing school has laid it out for you. these are the five steps of the nursing process which you need to burn into your brain:

assessment (collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
planning (write measurable goals/outcomes and nursing interventions)
implementation (initiate the care plan)
evaluation (determine if goals/outcomes have been met)

here is an analogy to a real life situation that might help you better understand how very common this nursing process really is in our daily lives:

you are driving along and suddenly you hear a bang, you start having trouble controlling your car's direction and it's hard to keep your hands on the steering wheel. you pull over to the side of the road. "what's wrong?" you're thinking. you look over the dashboard and none of the warning lights are blinking. you decide to get out of the car and take a look at the outside of the vehicle. you start walking around it. then, you see it. a huge nail is sticking out of one of the rear tires and the tire is noticeably deflated. what you have just done is step #1 of the nursing process--performed an assessment. you determine that you have a flat tire. you have just done step #2 of the nursing process--made a diagnosis. the little squirrel starts running like crazy in the wheel up in your brain. "what do i do?" you are thinking. you could call aaa. no, you can save the money and do it yourself. you can replace the tire by changing out the flat one with the spare in the trunk. good thing you took that class in how to do simple maintenance and repairs on a car! you have just done step #3 of the nursing process--planning (developed a goal and intervention). you get the jack and spare tire out of the trunk, roll up your sleeves and get to work. you have just done step #4 of the nursing process--implementation of the plan. after the new tire is installed you put the flat one in the trunk along with the jack, dust yourself off, take a long drink of that bottle of water you had with you and prepare to drive off. you begin slowly to test the feel as you drive. good. everything seems fine. the spare tire seems to be ok and off you go and on your way. you have just done step #5 of the nursing process--evaluation (determined if your goal was met).

here is a website that has another real life analogy of the nursing process:

http://studentnursesource.com/nursing_process.html

the help you are looking for to answer the questions posed in this case study is for you to start working through the steps of the nursing process. you are being asked four questions. two of them involve information that involves assessment, or information you need to collect during the first step of the nursing process. nursing diagnoses are determined in step #2 of the nursing process and are based upon the information you find during your assessment in step #1. the last question requires that you have an understanding of what a "collaborative problem" is. you might have already had a lecture on this or will find information about this in your nursing textbooks or a care plan book. as best as i can explain it, collaborative problems are patient problems that require the joint efforts of not only nursing, but other healthcare disciplines as well. often, doctors. but, it can also be physical therapists, respiratory therapists, pharmacists, dieticians, etc. there are some things we nurses can do independently for patients that do not require the consent of a physician. however, the treatment of a collaborative problem will require the help of these other disciplines. make no mistake, however, that these "problems" are still determined by applying the nursing process to the situation. as managers of the patient's care we need to know and plan for this care by collaborative providers. so, as best as i can determine from the questions you are being asked, you need to use the nursing process and apply steps #1 and #2 in that order to answer the questions and complete this case study.

step #1 (assessment) - go through the scenario and pick out the assessment information that it has given you. since this is a made up patient you can't do an actual physical exam, so you must rely on what the scenario gives you. the scenario has also provided you with some very valuable medical information that you need to look up:

what is a bowel obstruction?
what happens when the bowel perforates?
what are the possible side effects of blood transfusion?
what are the potential complications of general anesthesia?
what is ards (adult respiratory distress syndrome), it's signs and symptoms (there are 4 stages), pathophysiology, tests done to diagnose it, what lab and x-rays will generally show, what the doctors will normally order to treat this condition, and what are the possible complications? (if you do not have this information in your nursing textbooks you can find much it online at some of the websites listed on this thread: https://allnurses.com/forums/f205/medical-disease-information-treatment-procedures-test-reference-websites-258109.html - medical disease information/treatment/procedures/test reference websites)
what is refractory hypoxemia?

the answers to the above will help you respond to questions a and b. then, you can move on.

step #2 (determination of the patient's problems/nursing diagnoses) - from all that assessment information that the scenario gives you and the signs and symptoms that you add to it about ards and hypoxemia you make a list of the things that are abnormal. symptoms are abnormal. you are after abnormal data here. why? because it is the abnormal data, or symptoms, that form the foundation of diagnoses. a diagnosis, any diagnosis, is the decision, or opinion, of the problem that you believe the patient has after you have made an examination (assessment) of them. doctors do this all the time. now, you are going to learn to do it. we nurses have something called the nanda taxonomy which contains the information about 188 nursing diagnoses to help us. each of the 188 nursing diagnoses has a list of symptoms (nanda calls them defining characteristics). the trick is to figure out which of your patient's symptoms match up with some of the symptoms (defining characteristics) of nursing diagnoses that will apply to their case. to do this, especially when you are new at it, it is helpful to have a care plan book or a nursing diagnosis book to help you out, preferably one that has the nanda taxonomy information in it. nursing diagnoses are different from medical diagnoses, but they are still diagnoses. you just have to get used to using them. and, the problems that you find that the patient has can very well depend on the collaborative orders of a doctor or the help of other healthcare providers which gets to the heart of question d.

for more information on how the nursing process works, see this thread:

https://allnurses.com/forums/f50/help-care-plans-286986.html - assistance - help with care plans (in the general nursing discussion forum)

otherwise, i've given you information that should help get you started on this assignment. good luck.