BetterWorld365

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.