Write a clinical CASE STUDY PRESENTATION on ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS).
Edyth T. James Department of Nursing
NURS 489 – Group Project Presentation

Course: ______________________________________________________________

Professor: ____________________________________________________________

Students Names: _________________________________________________________

This is to be a group project which will involve both oral presentation (20 minutes) and a written outline.
Topics:
• Acute respiratory distress syndrome (ARDS)

Expected areas to address in the presentation and written outline are:
* Create a case study with demographics appropriate to the case type
* Pathophysiology
* Assessment of the case study patient
– Include: History
Physical Assessment
Diagnostics (e.g. Lab. tests, X-rays, Nuclear Medicine
studies, etc., as appropriate)
* Plan of Care
– Include: Nursing interventions
Expected medical interventions (e.g. meds, treatments, critical care monitoring equipment, etc.)
Collaborative interventions (e.g. Respiratory Care, Dietitian,
Social Work, etc.)
Family/ S.O. needs and involvement
Family/ S.O. appropriate education
* Patient Response
– Include your expected outcomes on a daily basis in Critical Care and on
discharge from Critical Care.

* Continuum of Care:
– Focus on Critical Care Phase, but mention outcomes that should be
achieved at a lower level of care
– Discharge Plan from the hospital: describe the appropriate level of care
(e.g. Home Health, Skilled Nursing, Sub-acute, etc.), and state expected outcomes
*Consumer Resources
-Length of Stay and charge issues: State the expected LOS and address costs/ cost containment: issues

• Remember, this is a Critical Care focus and your work should emphasize this level of care.
• Your presentation MUST show evidence of collaboration.

• Outline/References
• Professional References (need to be current with 3 years)
• Research (at least 2 nursing journal articles)

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Solution

NURS 489 – Group Project Presentation: Acute Respiratory Distress Syndrome (ARDS)

            Acute respiratory distress syndrome (ARDS) is a life-threatening disorder that causes inflammation of the lungs, damaging them severely. This condition is associated with poor oxygenation, acuity of onset, and pulmonary infiltrates. ARDS is attributed to damage of the alveolar and injury in capillary endothelial at the microscopic level (Huang et al., 2018). In most cases, ARDS patients develop hypoxemia and acute dyspnea within some hours or days after an inciting incident, including trauma, drug overdose, sepsis, massive transfusion, aspiration, or acute pancreatitis (Rawal et al., 2018). This paper presents a case study of M.A, a 60 years old male who presented to the emergency department with persistent right-sided chest pain and cough. The paper includes history, physical assessment, diagnostics, and plan of care.

History

M.A is a 60-year-old African-American man accompanied by his wife to the emergency unit. He complains of persistent cough and pain in the right side chest, which is pleuritic. The client was presented with a similar pain in the previous month. The cough was accompanied by yellow sputum with no hemoptysis. His weight had dropped by about 30 pounds in the past 6 months, although he did not intend to lose weight. He also complained of night sweats. Nonetheless, he denied chills, fevers, nausea, vomiting, or myalgias. Additionally, he denied a recent travel history or getting into contact with a sick contact or a recent travel history. However, the client reported being exposed to an individual diagnosed with tuberculosis during his childhood.

During the interview, the patient added that he had been smoking a pack of cigarettes in a single day for the last 45 years but denied using recreational drugs. The client added that he ingests 15 beers daily. The high alcohol consumption rate resulted in a wrist fracture and right-sided rib fractures. He was an employee of the steel mills, but he had stopped working in the company some years previously. His primary duty in the company involved collecting coins and using mercury to clean them.

The presented medical history indicates a high possibility of upper extremities’ chronic “shakes” that had not been treated previously. The client denies any regular medication apart from daily multivitamin tablets.

Physical Assessment

Upon arriving at the critical care unit, M.A appeared dyspneic and cachectic. He could not complete words or sentences. The client’s vitals were collected to aid in the diagnosis and treatment processes. His BP and heart rate were 125/71 mm Hg and 122/min, respectively. His temperature was 100 °F, oxygen saturation was 77%, 92% on room air, and 40% on venti-mask. Additionally, his respiratory rate was 33/min. His oxygen saturation at the time he was presented to the hospital was 92% on room air. Tachycardia but regular rhythm, gallops, a normal S1 and S2 with no murmurs were revealed by heart examination findings. Diminished breath sounds on the right lung were revealed at auscultation. The abdomen was benign. Additionally, normal findings were reported on his extremities with the absence of clubbing upon assessment. The client was only oriented to one person and could not remember immediate incidents or pay attention. All his four extremities were moving slightly. He had a supple neck, and his pupils were brisk in response to light.

Diagnostics

Diagnostics were conducted to rule out the client’s condition. First, laboratory tests, particularly a complete blood count was conducted. According to the lab findings, white blood cell count was 11,000/mm3, neutrophils were 38%, monocytes 18%, lymphocytes 8%, and bands 35%. Additionally, hematocrit 33% and platelet count was about 187,000/mm3. No acid-fast bacilli (AFB) was detected in sputum samples.

Plan of Care

Nursing Intervention

The nursing interventions for this client constituted of medical interventions, including non-pharmacological treatments and critical care monitoring equipment. No pharmacological treatment for Acute Respiratory Distress Syndrome (ARDS). This disorder is mainly treated through supportive care, including sedation, ventilation, and intubation, and appropriate nutrition (Rawal et al., 2018). Thus, the client received supportive care, was closely monitored, and was given a balanced diet with all food components in the recommended proportions. Additionally, the patient was mechanically ventilated, and diuretics were administered to prevent fluid overload. Additionally, a lung-protective ventilator strategy was applied to prevent lung injury.

Collaborative Interventions

Various professionals were involved in the treatment of this patient. First, critical care nurses provided the patient with respiratory care, such as ventilator weaning. According to Cherian et al. (2018), therapies play a significant role in treating ARDS patients. Dietitians ensured that the patient was received an appropriate diet with all food components in their recommended amounts to enhance faster recovery. A social worker was also involved during the care delivery to educate the patient about the dangers of smoking and excessive alcohol consumption. The social worker emphasized the significance of quitting smoking to prevent recurrence of Acute Respiratory Distress Syndrome (ARDS) in the future. Finally, family members were involved during the treatment process to provide the client with the required psychological support.

Patient Response

The client was expected to respond to the treatment intervention. Similarly, improvement was reported daily for the 2 weeks that the client was in the critical care unit. The client was discharged from the critical care unit upon reporting respiratory rate (RR) and SpO2 of 35 bpm and 95%, respectively. At this point, the client could breathe without ventilation; hence he was out of danger (Chen et al., 2018).

Continuum of Care

The client should be closely monitored at the Critical Care Phase until he attains a minimum SpO2 of approximately 95%. The client was admitted to the hospital ward for two weeks after being discharged from the ICU, where he indicated substantial improvement leading to discharge. However, the client was to continue receiving home care to monitor any danger signs and ensure he was receiving a balanced diet. Additionally, he was scheduled for check-ups after every four weeks for further monitoring.

References

Chen WL, Lin WT, Kung SC, Lai CC, & Chao CM. (2018). The Value of Oxygenation Saturation Index in Predicting the Outcomes of Patients with Acute Respiratory Distress Syndrome. J Clin Med; 7(8):1-8

Cherian SV, Kumar A, Akasapu K, Ashton RW, Aparnath M, & Malhotra A. (2018). Salvage therapies for refractory hypoxemia in ARDS. Respir Med; 141:150-158.

Huang D, Ma H, Xiao Z, Blaivas M, Chen Y, Wen J, Guo W, Liang J, Liao X, Wang Z, Li H, Li J, Chao Y, Wang XT, Wu Y, Qin T, Su K, Wang S, & Tan, N. (2018). Diagnostic value of cardiopulmonary ultrasound in elderly patients with acute respiratory distress syndrome. BMC Pulm Med; 18(1):136.

Rawal G, Yadav S, & Kumar R. (2018). Acute Respiratory Distress Syndrome: An Update and Review. J Transl Int Med; 6(2):74-77.