Question

Case Study Week 5 – Acute Respiratory Distress Syndrome (60 Min)

Student Name: ________________________                     Date: ________________

Your Week 5 Case Study and questions are below. The questions must be completed in Week 5 during your clinical timeframe. You are to do your own work in answering the questions, this is not a shared group project. There are consequences (see syllabus) in conducting group work without direction from faculty. Submit to clinical instructor.

Patient Profile

Z.Q., 74-year-old Hispanic man, came to the emergency department (ED) 7 days ago with shortness of breath. His wife stated that he had a history of hypertension, depression, and chronic obstructive pulmonary disease (COPD). The admission chest x-ray examination revealed dense consolidation of the left lower lobe. An arterial blood gas (ABG) at that time showed: pH 7.60, PaCO₂ 29mm/Hg, HC0₃ 32mmol/L, and PaO₂ 75mm/Hg. Z.Q. quickly deteriorated and subsequently was intubated. He has been in the intensive care unit for 3 days.

Subjective Data

• Z.Q. and wife have been married 45 years and live with a daughter and two grandchildren.
• They speak both English and Spanish.

Objective Data

Physical Examination

• Blood pressure 167/98, pulse 112, temperature 102.0°F, respirations 14, oxygen saturation 72%
• Height 5'6", weight 75 kg
• Patient localizes to endotracheal (ET) tube and is intermittently aroused, making several attempts to pull ET tube
• Orally intubated #7.5 ET tube, taped at 27 cm to lip
• Volume cycled ventilator at FIO₂ - 60%, in assist control mode of 14 breaths per minute, tidal volume 450, positive end-expiratory pressure PEEP 5 cm H₂O
• Breath sounds decreased in bases with bilateral crackles that do not clear after suctioning
• Brown-yellow secretions returned with suctioning
• Peripheral pulses weak at 1/4 with capillary refill greater than 4 seconds
• 2+ pitting edema in the bilateral lower extremities

Newly Obtained Diagnostic Study Results

• Arterial blood gas (ABG) pH 7.31, PaCO₂ 58mm/Hg, HCO₃ 28mmol/L, PaO₂ 54mm/Hg, EtCO₂ 38 mm/Hg
• Chest x-ray examination reveals diffuse white out in middle and lower lobes; endotracheal tube present with tip well above the carina; left subclavian central venous catheter is in the superior vena cava
• Computed tomography scan reveals alveolar opacities with increasing effusions in the gravity-dependent areas of the lungs

Case Study Questions:

1. You have read the patient’s profile and physical assessment data. What clinical data from this information is relevant and must be recognized as significant to you as the nurse? Student Must List at Least 7 answers

2. Blood pressure 167/98, pulse 112, temperature 102.0°F, respirations 14, oxygen saturation 72%

What are your nursing interpretations of the client’s presenting vital signs? What would be your initial assumption from your already learned knowledge – Student’s are to apply their own assumption/thinking, faculty want you to think on your own; see what you come up with. Student Must Address All Vital Signs:

• Temp =
• BP =
• Pulse á =
• RR =
• O2 Sat â =

3. What would be your initial nursing priority that will guide the plan of care for Z.Q.?

4. What would be two prioritized nursing diagnoses for Z.Q. prior to providing client care? Include all 3 parts of nursing diagnosis. Student Must List at Least 2

5. Although Z.Q. speaks both Spanish and English, what would be two cultural aspects to consider in caring for the client? Student Must List at Least 2

6. What 5 prioritized nursing interventions will be initiated by you as the nurse based on your listed initial nursing priority in question 3? Student Must List at Least 5

7. Once treatment has been initiated, what relevant clinical assessment data would you need to closely monitor in detecting a possible change in status or complications? Student Must List at Least 4

8. How would you as the nurse, evaluate the effectiveness of your nursing interventions for Z.Q.? Student Must List at Least 4

Reference(s)

Answer 1

1. the initial nursing priority that will guide for the nursing care plan are first priority should be focus on any airway problem then next to the problem related to breathing followed by any cardiovascular problem to the patient.

Another techniques to prioritize nursing care is by using Maslow hierarchy of needs. By using the priority needs base on the Maslow, the nursing care also can be prioritized.

2.

The two nursing diagnosis for this patient are

- Ineffective airway clearance related to endotracheal intubation as evidence by excessive secretion

- ineffective breathing pattern related to respiratory distress as evidenced by decrease respiratory rate to 14 breath per minute.

- hyperthermia related to infection as evidence by increase temperature to 102°F.

3.

The cultural aspects that need to considered while taking care of the patient includes

- Respect the patient's culture and believe.

- Care should be given base the culture and believe of the patient

- avoid discrimination against cultural differences.

- allow to conduct or performed ritual prayer by the patient and its family members.

4.

The 5 priority nursing interventions are

- administer oxygen as per needed by patient

- suction should be done 2 hours to prevent blocking of airway by the excessive secretion

- provide little upright position to the patient

- administered antipyretic after consult to the doctor

- maintain proper hygiene before touching and after touching the patient to prevent from cross infection.

5.

The clinical assessment that need to monitor after the treatment has been started includes

- monitor the oxygen saturation level continuously

- monitor the vital signs frequently

- performed ABG analysis everyday

- chest x ray should be check to see for any recovery or develop complication.

6.

The evaluation of the nursing intervention can be done by comparing that the plan goal for the particular nursing interventions are meet or not. Identify the client's behavioural response and subside of the symptoms of the disease to the nursing interventions.