ARDS Case Study B

Due: March 3 (Rotation 2)

Answer the following discussion questions in your own words, direct quotation from a
resource is not acceptable.
Criteria for grading will consider the accuracy of the answer and the rationale, as well as how
complete you explore each item. Each item is worth 6 points except for #1 which is 4 points.

Case

Ms. Carson, a 30-year-old 59 KG (130 lb.) black female had a perforated appendix two days
ago. She had an open appendectomy and was placed on antibiotics to prevent peritonitis.
She had an uneventful postoperative course the first two postoperative days. She was
monitored closely for infection, wound drainage and pain management.. At 10 PM on the
third postoperative day she began to complain of not feeling “right”. Her urinary output was
100cc over the past 8 hours. She appeared pale confused and short of breath. Blood gases and
vital signs were as follows.

BP 70/40
HR 120/min.
Respirations 32/min
Temperature 101.8 F
pH 7.48
PaCO2 32 mm Hg
Pa02 65
HCO3 22

Her shortness of breath worsened (she began gasping of air).

Ms. Carson is intubated she transferred to the ICU with a possible diagnosis of adult
respiratory distress syndrome (ARDS)

1. Analyze Ms. Carson’s vital signs. (4 points)

2. Analyze Ms. Carson’s blood gases. Give rationale for your analysis.

3. Discuss the pathophysiology of ARDS related to: SIRS, pulmonary capillary permeability,
surfactant, and hyline membrane formation.

4. What is/are possible precipitating event/s leading to Ms. Carson’s ARDS?

5. What radiological changes are seen with ARDS?

 On arrival in to ICU, mechanical ventilation in the synchronized intermittent mandatory
ventilation (SIMV) mode was begun.
Fio2 80%
SIMV rate 6
Tidal volume 250 ml

6. Explain the SIMV ventilator mode. What is the advantage of this mode?

7. Explain each of the ventilator settings

8. Is the tidal volume reasonable for Ms. Carson? Give your rationale.

Ms. Carson was given a 500-ml bolus of normal saline. He also receives dopamine drip
3-5 ug/kg/min and was given Vancomycin 1 gram intravenously very 12 hours for
prophylaxis against staphylococcal infection. A pulmonary artery catheter (Swan-Ganz) was
inserted.

9. Why was the pulmonary artery catheter inserted? What information does it give the health
care team?
10. What is the action of dopamine? Why was he given dopamine?

Her blood gases are now the following

pH- 7.28
PaO2- 60
PaCO2- 48
HCO- 26

11. Analyze her blood gases. Give rationale for your interpretation.

Her FiO2 was increased from 80% to 90%, and positive end-expiratory pressure (PEEP) of 5
cm H2O was added. The tidal volume was increased to 350 and SMIV rate was increased to
She continues to receive dopamine infusion and several boluses of normal saline.

12. What positive end-expiratory pressure? Why was it added?

The following arterial blood gas values were obtained 15 minutes after the ventilator settings
were changed.
pH 7.3
PaO2 70 mm Hg
PaCOs 46 mm Hg
HCO3 28.9

13. Analyze these blood gases and give your rationale for your interpretation.
14. Tissue hypoxia is a major finding in ARDS. Describe signs and symptoms found on
assessment that would be seen with ARDS in the following system:

Central Nervous System

Pulmonary

Cardiovascular

Renal

Gastrointestinal

15. Identify ten appropriate nursing diagnoses seen with ARDS and give your rationale for
choosing each diagnosis.
On the 5th postoperative the PEEP was increased to 10cm H2O and the tidal volume (Vt) was
increased to 800ml.
pH 7.35 BP 130/60
PaCO2 46.2 mm Hg HR 100/min
PaO2 86.8 mm Hg Respirations 14/min
HCO3 30.5 Temperature 101 F

16. Analyze these values and give rationale. Do these values show improvement in his
condition? Give rationale.

17. The nurse must continually monitor Ms Carson for medical complications seen with
ARDS. Identify several potential complications?

After these changes, Ms. Carson’s oxygen levels gradually stabilized and he was weaned from
ventilatory support. His urinary output also increased significantly after administration of the
fluid boluses. Ten days after intubation Mr. Farwell was extubated and received oxygen by
nasal cannula.