ARF Case Study Linda Winn, RN, MSN Ed. Acute Respiratory Failure: Case Study

You are receiving a patient from ICU Report is called to you: – DS is 56 y.o. male – PMH: chronic bronchitis – Saw MD with c/o increasing exertional dyspnea – mass found --- adneocarcenoma – 3 days post-op: RML and RLL lobectomy ARF: Case Study

Report Continues Current VS – 120/70, 110, 30, IV D5 ½ NS at 50/hr, Right FA Chest tube (right chest) – Small amt serosanguineous drainage – Site D&I O2 at 5L N/C Refuses pain meds All pulses + Heart tones clear

What additional information would you ask the nurse to provide at this time?

Case Study Progresses DS is transported via W/C past nurses’ station to a room at far end of the hall. Upon entering his room you find him sitting on edge of bed with his left leg in bed and right foot on the floor. You introduce yourself to him. You note he keeps rubbing his left hand over the right side of his chest.

What issues or problems can you already identify? List 4 things you would do for DS right now.

Case Study Progresses DS states, “I have a nephew who rolled his Jeep and busted himself up real bad. He got hooked on those drugs. I don’t want any part of them.” How would you respond? Why is DS experiencing difficulty using his right arm? Is this expected after the type of surgery he had?

Case Study Progresses You administer Morphine 8mg IV. 15 minutes later you notice his call light is on. When you enter his room, DS says, “I think I’m going to throw up.” What 3 things would you do?

Case Study Progresses After controlling DS’s pain and nausea, you assess his chest tube insertion site. – Slightly inflammed – Incisional area is white and moist – Scant brown drainage What action will you take now?

Case Study Progresses The following day during report, the nurse tells you DS has been paranoid and demanding, but is fine. Upon entering his room he states, “I just can’t [breath] seem to [breath] get enough [breath] air.”

Identify 6 possible problems that DS could be having that would account for his behavior. What actions should you take first?

Assessment Findings RR 46 Auscultation – Slight air movement over upper airways – Absent breath sounds below 3 rd ICS Sitting on side of bed, leaning over bedside table Intercostal retractions with inspiration Diaphoretic

What would you do first?

Case Study Progresses DS is transferred to ICU after successful resuscitation

From: Winningham and Preusser, (2009), Critical Thinking Cases in Nursing, 4 th Ed., Mosby, Inc., St. Louis.