Worksheet 5 Ards

Vision: A PREMIER UNIVERSITY delivering
“Excellent nursing education that

world-class education that promotes
sustainable development amidst climate
change.
Benguet State University provides graduates with self-
direction, competence and
Mission: To provide quality education to

COLLEGE OF NURSING compassion.”
enhance food security, sustainable La Trinidad, Benguet “The College of Nursing is committed
communities, industry innovation, climate www.bsu.edu.ph/ 422- 2127 to provide a strong academic and
resilience, gender equality, institutional professional foundation for the
development and partnerships. practice of nursing.”
NCM 112
Care of clients with problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory
and immunologic response, Cellular Aberrations, Acute and Chronic.
NAME: [ ] SCORE:________
SECTION: [ ] DATE: _________
Case scenario
The patient is a 21-year-old college student who went swimming in his apartment complex swimming pool after
drinking 10 cans of beer. He hit his head on the side of the pool and was under water for about 2 minutes before
his friends pulled him out.
During CPR, he vomited a large amount of gastric fluids before the emergency squad came to the scene.
In the emergency department, he is unconscious and breathing on his own. Oral, nasal, and tracheal suctioning has
produced stomach contents and fluid that smells strongly of chlorine.
On auscultation, wheezes and mild crackles are present.

The chest x-ray is normal, and these are the ABG values:
pH = 7.28
PaO2 = 88 mm Hg
PaCO2 = 58 mm Hg.
PART 1: CRITICAL THINKING ASSESSMENT
1. What factors could contribute to an acute lung injury in this patient?
2. Is this patient at risk for TRALI? Why or why not?
3. What is your interpretation of the ABG results?
4. Why does the current chest x-ray show no abnormalities?

change.

5. Should this patient be intubated and mechanically ventilated at this time? Why or why not?
6. What are your care priorities for this patient at this time?
PART 2: PATIENT-CENTERED COLLABORATIVE CARE

ASSESSMENT AND NURSING DIAGNOSIS
1. What are the clinical manifestations of patient with ARDS? Enumerate at least 7 physical assessment
finds.
2. Enumerate at least 3 nursing diagnosis of patient with ARDS:

a. 2 actual nursing diagnosis
i. ___________________________________________
ii. ___________________________________________
b. 1 potential nursing diagnosis

change.

i. ___________________________________________
3. What are the common drugs used in patient with ARDS?
4. What is the usual diet?
MEDICAL AND NURSING INTERVENTIONS

The patient with ARDS often needs intubation and conventional mechanical ventilation with positive end-
expiratory pressure (PEEP) or continuous positive airway pressure (CPAP). This intervention will improve
oxygenation and ventilation in patients with moderate to severe ARDS.
PART 3: MECHANICAL VENTILATION

1. Which assessment finding in a client with an endotracheal tube most strongly indicates to the nurse that the
tube remains correctly in the trachea and is not in the esophagus?
A. Stomach contents cannot be aspirated.
B. Oxygen saturation is greater than 50%.
C. End-tidal carbon dioxide level is 38 mm Hg.
D. No air is heard in the stomach when auscultated with a stethoscope.
2. What is the purpose of mechanical ventilator during an acute lung injury?

change.

3. Positioning is important in promoting gas exchange in patient receiving mechanical ventilation after an acute
lung injury. What is the best position for patient in mechanical ventilation?
5. What are your independent nursing interventions when caring for a patient receiving mechanical
ventilation? List at least 5 independent nursing interventions with rationale.
a. _________________________________________________________________________
b. _________________________________________________________________________
c. _________________________________________________________________________
d. _________________________________________________________________________
e. _________________________________________________________________________
PART 4: MODES OF VENTILATION
INSTRUCTION: Define the following terms and explain in 3 sentences using your own words
MODE DEFINITION
Assist-control
Synchronized intermittent mandatory

ventilation (SIMV)
Bi-level Positive airway pressure

(BiPAP)
change.

DEFINITION OF TERMS
INSTRUCTION: Define the following
VENTILATOR CONTROLS AND

SETTINGS
1. Tidal Volume (VT)
2. Rate or breaths/minute
3. Fraction of Inspired Oxygen

(FiO2)
4. Peak airway (inspiratory)

pressure (PIP)
5. Continuous positive airway

pressure (CPAP)
6. Positive end-expiratory
pressure (PEEP)
7. Flow rate
change.

PART 5: COMPLICATIONS OF MECHANICAL VENTILATION

The following items are complications of mechanical ventilation. Explain the following items briefly using 3-4 sentences
only.
1. Cardiac problems
✔ What is the cause of hypotension if the patient is hooked to mechanical ventilator?
✔ What is the reason why patients develop fluid retention during mechanical ventilation?
2. Lung problems
✔ What is the cause of barotrauma during mechanical ventilation?
✔ Why do patients hooked to ventilators develop pneumonia?
3. Gastrointestinal problems
✔ Explain why patients develop stress ulcer or gastric ulcer when they receive mechanical ventilation.
4. Ventilator dependence
✔ Why do patients develop ventilator dependence?

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Vision: A PREMIER UNIVERSITY delivering

“Excellent nursing education that

Mission: To provide quality education to

On auscultation, wheezes and mild crackles are present.

PART 1: CRITICAL THINKING ASSESSMENT

1. What factors could contribute to an acute lung injury in this patient?

2. Is this patient at risk for TRALI? Why or why not?

3. What is your interpretation of the ABG results?

4. Why does the current chest x-ray show no abnormalities?

Mission: To provide quality education to

PART 2: PATIENT-CENTERED COLLABORATIVE CARE

2. Enumerate at least 3 nursing diagnosis of patient with ARDS:

b. 1 potential nursing diagnosis

Mission: To provide quality education to

3. What are the common drugs used in patient with ARDS?

4. What is the usual diet?

MEDICAL AND NURSING INTERVENTIONS

PART 3: MECHANICAL VENTILATION

2. What is the purpose of mechanical ventilator during an acute lung injury?

Mission: To provide quality education to

Synchronized intermittent mandatory

Bi-level Positive airway pressure

Mission: To provide quality education to

VENTILATOR CONTROLS AND

3. Fraction of Inspired Oxygen

4. Peak airway (inspiratory)

5. Continuous positive airway

Mission: To provide quality education to

PART 5: COMPLICATIONS OF MECHANICAL VENTILATION

✔ Why do patients hooked to ventilators develop pneumonia?

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