PICOT Question Does the provision of education to nurses on

Acute Respiratory Distress Syndrome Case Study G.S., a 56-year-old secretary, was involved in a motor vehicle accident; a car drifted left of the centerline and struck G.S. head-on, pinning her behind the steering wheel. She was intubated immediately after extrication and flown to your trauma center. Her injuries were found to be extensive: bilateral flail chest, right hemothorax and pneumothorax, fractured spleen, multiple small liver lacerations, open fractures of both legs, and probable cardiac contusion. She was taken to the operating room (OR) for repair of her injuries. In the OR, she received 36 units of packed red blood cells (RBCs), 20 units of platelets, 12 units of fresh frozen plasma, and 18L of lactated Ringer’s solution. G.S. was admitted to the intensive care unit (ICU) postoperatively, where she developed acute respiratory distress syndrome (ARDS). 1. What is ARDS? 2. What are the risk factors for developing ARDS? Which does G.S. have? Case Study Progress G.S. was in the ICU for 4 weeks, and her ARDS is almost resolved. She is being transferred to your unit. The ICU nurse gives you the following report: “She is awake, alert, and oriented to person and place. Both legs remain casted from hip to toe. She can wiggle her toes on both feet. Heart tones are clear, last vital signs were 138/90, 88, 26, 99.3° F (37.4° C); bilateral radial pulses 3+. All of her surgical incisions are healed. She has bilateral chest tubes to water suction with closed drainage, both dressings are dry and intact. She has a duodenal feeding tube, a Foley catheter to down drain, and a left double-lumen peripherally inserted central catheter (PICC) line. Her morning labs are still pending.” 3. What additional information do you need from the ICU nurse? Case Study Progress Complete the assessment of G.S. she is dyspneic and has fine crackles throughout all lung fields posteriorly and in both lower lobes anteriorly, and coarse crackles over the large airways. She has oxygen on at 2L per nasal cannula and her Spo2 is 94%. 4. What is the significance of the fine and coarse crackles? 5. The nurse from the previous shift charted the following statement: “Fine and coarse crackles that clear with vigorous coughing.” Based on your knowledge of pathophysiology, determine the accuracy of this statement. 6. It is time to administer the scheduled furosemide (Lasix) 60mg intravenous push (IVP). What effect, if any, should furosemide have on G.S.’s breath sounds? 7. What action do you need to take before giving the furosemide? Chart View: Laboratory Results Sodium 129 mmol/L Potassium 3 mmol/L Chloride 92 mmol/L HC0₃ 26 mmol/L Bun 37 mg/dL Creatinine 2 mg/dL Glucose 128 mg/dL Calcium 7.1 mg/dL 8. Which laboratory values concern you, and why? 9. Given G.S.’s laboratory values, what action do you need to take and why? Case Study Progress The physician wants you to administer the furosemide and prescribes the following. Physician’s Order STAT magnesium (Mg) level Potassium chloride (KCl) 40mEq IVPB Calcium gluconate 2g in 100mL NS IVPB over 3hr 10. Why did the physician order a magnesium level? 11. What interventions do you need to perform to safely administer intravenous (IV) potassium chloride? Select all that apply. a. Place G.S. on continuous electrocardiogram (ECG) monitoring. b. Administer the infusion using an intravenous pump. c. Assess the patency of the PICC line before initiating the infusion. d. Administer the potassium infusion over a time period of at least 2 hours. e. Invert the potassium-containing IV bag several times before and during the infusion 12. While you are administering the furosemide, G.S. says, “This is so weird. A couple of times this morning, I felt like my heart flipped upside down in my chest, but now I feel like there’s a bird flopping around in there.” What are the first two actions you should take next? Case Study Progress Chart View: Laboratory Results Arterial Blood Gases (ABGs) on 6L O2 by Nasal Cannula (NC) pH = 7.30 PaCOâ‚‚ = 59 mm Hg PaOâ‚‚ = 82 mm Hg HCO₃ = 36 mmol/L SpOâ‚‚ = 91% 13. You increase her oxygen to 6L, and the physician orders a stat set of ABGs. How would you interpret G.S.’s ABGs? 14. What are your nursing priorities at this time? 15. Describe four interventions you will perform over the next few hours based on this priority.

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