Case Study: Acute Respiratory Distress Syndrome

Mr. Nguyen is a 58-year-old patient that had septic shock and developed Acute Respiratory Distress Syndrome. He is orally intubated and on a mechanical ventilator. He is paralyzed and sedated.

What manifestations might you observe for a patient with ARDS?

The clinical manifestations for ARDS include; difficulties in breathing, breathlessness, and acute hypoxemia when the patient is administered with 100% oxygen. Dyspnea, general body weakness, confusion, and pulmonary edema for patients without cardiovascular illnesses and poor circulation of blood. Besides a pulmonary disease, ARDS also results from a severe lung injury caused by sepsis, burns, transfusions, or pancreatitis. Additionally, a lung injury caused by the release of hydrochloric acid into the lungs, bacterial infection, or inhalation of poisonous gases may result in ARDS (Silvestri & Silvestri, 2019).

What complications can Mr. Nguyen develop from being mechanically ventilated?

Mechanical ventilation is used when a patient suffers from hypoxemia, and the efficiency of gaseous exchange in the alveoli is limited by alkalosis—hypoxemia results from the inadequate oxygen supply. Mechanical ventilation serves as temporary support after surgery when the patient requires high oxygen levels than they can acquire through inspiration or those that become unconscious after the administration of sedatives (Thompson, Chambers,  & Liu, 2017).

Mechanical ventilation may result in; the collapsing of the lungs as a result of an increase in pleural pressure, a lung injury due to high pressure applied during inhalation and exhalation, reduced cardiac output due to air trapping, hemodynamic instability as a result of high-pressure ventilation, accumulation of high oxygen levels and respiratory acidosis(Silvestri & Silvestri, 2019)

List priority nursing interventions to prevent complications associated with ventilatory support

Examine the respiratory functioning and check if the patient is conscious, remove the ET tube when necessary and within the shortest time possible, adhere to the aseptic technique and prevention bundles against infections, provide psychological support to the patient to reduce anxiety, administer sedatives as per the prescriptions, administer bronchodilators to the patient, collaborate with the pulmonary physicians in managing the changes in breathing patterns, use Intravenous catheters   to administer fluids and nutrients to the patient(Silvestri & Silvestri, 2019

What interventions can be implemented specifically to prevent the development of Ventilator Acquired Pneumonia (VAP)?

Elevate the head side of the bed to 30-45 degrees, provide regular oral hygiene to the patient using chlorhexidine, provide pulmonary health to the patient and integrate chest physiotherapy and movement aide, prophylaxis to prevent ulcer infections and protection for deep vein thrombosis (Micik et al. 2013)

You are orienting in the ICU; the nurse you are working with is not implementing the VAP interventions. What would you do?

Nurses in the intensive Care Unit play a critical role in creating the VAP measures. Effective nursing interventions require collaboration among physicians. Therefore, in this case, I will examine if the nurse has appropriate knowledge regarding VAP use. I will inform him/her about the importance of using VAP. I will provide education regarding effective prevention measures and the complications prevented through the VAP interventions Subeen, 2012).

Acute Respiratory Distress Syndrome

References

Micik, S., Besic, N., Johnson, N., Han, M., Hamlyn, S., & Ball, H. (2013). Reducing the risk of ventilator-associated pneumonia through nursing-sensitive interventions. Intensive and Critical Care Nursing, 29(5), 261-265.

Silvestri, L. A., & Silvestri, A. E. (2019). Saunders Comprehensive Review for the Nclex-Rn (r) Examination-E-Book. Saunders.

Subeen, P. D. (2012). Effectiveness of communication board on level of satisfaction in meeting patients’ basic needs on a ventilator admitted in ICU at selected hospitals, Salem (Doctoral dissertation, Sri Gokulam College of Nursing, Salem).

Thompson, B. T., Chambers, R. C., & Liu, K. D. (2017). Acute respiratory distress syndrome. New England Journal of Medicine, 377(6), 562-572.