a 36-year-old secretary, was involved in a motor vehicle accident; a car drifted left of the center line struck G.S

a 36-year-old secretary, was involved in a motor vehicle accident; a car drifted left of the
center line struck G.S. head-on, pinning her behind the steering wheel. She was intubated
immediately after e•Üication and flown to your trauma center. Her injuries were found to be
extensive: bilateral flail chest, ern innominate artery, right hemothorax and pneumothorax,
fractured spleen, multiple small liver lacer•ons, compound fractures of both legs, and probable
cardiac contusion. She was taken to the operating for repair of her injuries. In OR, she
received 36 units of packed RBCs, 20 units of platelets, 20 units cryoprecipitate, 12 units fresh
frozen plasma, and 18L of lactated Ringer's solution. G.S. was admitted z: ICU postop, where she
developed adult 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
has been in ICU for 6 weeks, and her ARDS has almost resolved. She is transferred to your
unit. You -eeö.•e the following report: She is awake, alert, and oriented to person and place and
can move both
arms and wiggle her toes on both feet. Heart tones are clear, vital signs are 138/90, 88, 26,
99.3 0 F C); bilateral radial pulse 3+, and foot pulses by Doppler only. All of her incisions and
lacerations healed. She has bilateral chest tubes to water suction with closed drainage, both
dressings are and intact. She has a duodenal feeding tube, a Foley catheter to down drain,
and a double lumen fine.
What additional information will you require during this report?

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PARTI MEDICAL-SURGICAL CASES

CASE STUDY PROGRESS
You complete your assessment of G.S. You note shortness of breath (SOB), fine crackles
throughout all lung fields posteriorly and in both lower lobes anteriorly, and coarse crackles
over the large airways.
4. What is the significance of the fine and coarse crackles in G.S.'s case?

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 furosemide (Lasix) 40 mg IV push (IVP). What effect, if any, will
furosemide have on G.S.'s breath sounds?

7. What action should you take before giving the furosemide (Lasix)?

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8. Keeping in mind that you are about to administer furosemide (Lasix), which laboratory
values concern you, and why?

9. Given the laboratory values listed, what action would you take before administering the
furosemide (Lasix), and why?

CASE STUDY
PROGRESS
The physician prescribes the following:

10. G.S. has one available port to use on the PICC line. Describe your plan for administering the
potassium chloride and the calcium gluconate.

11. You open G.S.'s medication drawer, prepare the furosemide (Lasix) for administration, and
find one 20-mg ampule. The pharmacist tells you that it will be at least an hour before he can
send the drug to you. You realize it is illegal to take medication dispensed by a pharmacist
for one patient and use it for another patient. What should you do?

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PARTI MEDICAL-SURGICAL CASES
12. While you administer the furosemide (Lasix) and hang the IVPB medication, G.S. says,
"This is so weird. A couple times this morning, I felt like my heart flipped upside down
in my chest, but now I feellike there's a bird flopping around in there." What are the
first two actions you should take next? Give your rationale.

13. G.S.'s pulse is 66 beats/min and irregular. Her BP is 92/70 and respirations are 26. She
admits to being "a little lightheaded" but denies having pain or nausea. Your co-worker
connects G.S. to the code cart monitor for a "quick look." This is what you see. What do
you think is happening with G.S.?

14. What will your next actions be?

15. What are the most likely causes of G.S. having abnormal beats?

CHAPTER RESPIRATORY DISORDERS CASE STUDY 31

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16. How would you interpret G.S.'s ABGs?

17. You notice that G.S. looks frightened and is lying stiff as a board. How would you respond to
this situation?