Question

Ricky Waltz, a 50-year-old American-Asian patient, is admitted to the medical-surgical floor from the emergency department with severe abdominal pain thought to be from acute pancreatitis. He has a history of drinking at least a case of beer a day. He also smokes and appears cachectic. His old chart indicates a history of COPD, but he does not take drugs for this. He does have a new productive cough. At change of shift, the nurse finds the patient dyspneic and slightly confused. Lung sounds have wheezes, and he is mildly febrile. Pulse is 120 beats/min, respirations are 32 breaths/min, and blood pressure is 118/64 mm Hg (baseline). Oximetry shows an Spo2 of 91%.

Case Scenario Progress

You complete your assessment of R.W. You note shortness of breath (SOB), fine crackles throughout all lung fields posteriorly and in both lower lobes anteriorly, and coarse crackles over the large airways.

Case Scenario Progress

R.W.'s pulse is 66 beats/min and irregular. His BP is 92/70 and respirations are 26. He admits to being “a little lightheaded” but denies having pain or nausea. Your co-worker connects R.W to the code cart monitor for a “quick look.” This is what you see.

Case Scenario Progress

Arterial Blood Gases on 6L O2 by NC

pH 7.30

PaCO2 59 mmHg

PaO2 82 mm Hg

HCO3 36 mmol/L

SaO2 91%

1. How would you interpret R.W.'s ABGs?
2. You notice that R.W. looks frightened and is lying stiff as a board. How would you respond to this situation?
3. Create a schematic diagram of the Pathophysiology of ARDS.

Answer 1

Answer

1. Interpretation of ABG

Here the ABG indicates respiratory acidosis. In which lungs cannot remove enough carbon dioxide produced by the body. This decreases the blood pH. Normal pH range of 7.35 to 7.45. Less than 7.35 indicates acidic pH.

Normal bicarbonate levels are: 23 to 30 mEq/L in adults. Here the bicarbonate level also decreased.

2. Management

• Bronchodilator and corticosteroids to reverse some types of airway obstruction.
• Noninvasive positive-pressure ventilation if needed.
• Administer oxygen if the blood oxygen level is low.
• Advice the patient to stop smoking.

3. Pathophysiology of ARDS

ARDS is caused by protein-rich pulmonary edema that causes severe hypoxemia and impaired carbon dioxide excretion

The clinical disorders associated with the development of ARDS include sepsis, pneumonia, aspiration of gastric contents, and major trauma.The lung injury is caused primarily by neutrophil-dependent and platelet-dependent damage to the endothelial and epithelial barriers of the lung.

Failure of the transfer of oxygen across the alveolus, the transport of tissues and the removal of carbon dioxide from the blood into the alveolus with subsequent exhalation into the environment.

It causes a diffuse inflammatory reaction of the lung to an insult and is characterized by increased pulmonary capillary permeability, lung edema, and atelectasis.