Acute Respiratory Distress SyndromePatient ProfileZ.Q., 74-year-old Hispanic male, came to the emergency department (ED) 7 days ago with complaints of 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 revealed dense consolidation of the left lower lobe. An arterial blood gas (ABG) at that time showed: pH 7.60, PaCO232Subjective DataZ.Q. and wife have been married 45 years and live with a daughter and 2 grandchildren Z.Q. and his wife speak both English and Spanish Objective DataPhysical ExaminationBlood pressure 167/98, pulse 112, temperature 102.0° F, respirations 14, oxygen saturation 72% Height 5 feet 6 inches, weight 75 kg Patient localizes to endotracheal tube (ETT) and is intermittently aroused, making several attempts to pull ETTOrally intubated #7.5 ETT, taped at 27 cm to lipVolume cycled ventilator at FIO2 – 60%, in assist control mode of 14 breath per minute, tidal volume 450, positive end-expiratory pressure PEEP 5 cm H2OBreath sounds decreased in bases with bilateral crackles that do not clear after suctioningBrown/yellow secretions returned with suctioningPeripheral pulses weak at 1/4 with capillary refill greater than 4 seconds2+ pitting edema in the bilateral lower extremitiesNewly Obtained Diagnostic Study ResultsArterial blood gas (ABG) pH 7.31, PaCO2 58 mm/Hg, HC03 28 mmol/L, PaO2 54 mm/Hg, EtCO2 38 mm/HgChest x-ray reveals diffuse white out in middle and lower lobes; endotracheal tube present with tip well above the carina; left subclavian central venous catheter is located in the superior vena cavaCT scan reveals alveolar opacities with increasing effusions in the gravity-dependent areas of the lungsDiscussion QuestionsInterpret Z.Q.’s latest set of ABGs.Describe each of Z.Q.’s ventilator settings.After reviewing Z.Q’s ABG results, the physician increases the PEEP from 5 cm H2O to 8 cm H2O. Why would this be necessary and what is the expected outcome associated with this action?Based on the assessment data, what are the nursing priorities for Z.Q.?What measures should be part of Z.Q.’s care to promote respiratory function?List three potential adverse complications with mechanical ventilation.
