Respiratory Case study Mr. Smith, a 77-year-old man who was admitted to the intensive care
unit (ICU) post-surgery for peritonitis following a perforated colon. Due to your superior
intellect nursing skills over the course of a few days, he is stabilized and recovering from sepsis.
You are now attempting to wean him off of the ventilator.
Questions
1. Describe briefly what you know about the pathophysiology of ARDS and risk factors.
ARDS is a syndrome of acute respiratory failure that presents with progressive arterial hypoxemia,
dyspnea, and a marked increase in the work of breathing. Most patients require endotracheal
intubation and positive pressure ventilation. Occurs when fluid builds up in the tiny, elastic air sacs
(alveoli) in your lungs. The fluid keeps your lungs from filling with enough air, which means less
oxygen reaches your bloodstream. This deprives your organs of the oxygen they need to
function. Most people who develop ARDS are already hospitalized for another condition, and
many are critically ill. Patients are especially at risk if you have a widespread infection in your
bloodstream (sepsis). People who have a history of chronic alcoholism are at higher risk of
developing ARDS.
2. Describe what you know about the goals of ventilator support; what is PEEP and how do you
know he is ready to be weaned from the ventilator?
the primary goals of mechanical ventilation should be to, cause no additional injury, avoiding
ventilator-induced lung injury by minimizing lung stress and strain. Maintaining gas exchange
and acid-base balance at a level appropriate for the specific patient, accepting hypercapnia and
hypoxemia where indicated. And also ensure patient-ventilator synchrony, selecting the mode
and ventilator settings that best match the patient's respiratory drive while ensuring lung
protection.
PEEP: Positive end expiratory pressure.
The use of PEEP mainly has been reserved to recruit or stabilize lung units and improve
oxygenation in patients who have hypoxemic respiratory failure. It has been shown that this
helps the respiratory muscles to decrease the work of breathing and the amount of infiltrated-
atelectatic tissues. He is ready to be weaned off the ventlator when his lungs are stable and
resolving. Low FiO2 (< 0.5) and PEEP (< 5-8cmH2O) requirement, hemodynamic stability and
able to initiate spontaneous breaths (good neuromuscular function).
Unfortunately, on his way home from the hospital he hits a tree and sustains blunt chest trauma.
A chest tube was inserted in the ER to treat a pneumothorax and hemothorax. Although he is in a
lot of pain, he is ecstatic to have you as his nurse again. You note that the drainage system has
unit (ICU) post-surgery for peritonitis following a perforated colon. Due to your superior
intellect nursing skills over the course of a few days, he is stabilized and recovering from sepsis.
You are now attempting to wean him off of the ventilator.
Questions
1. Describe briefly what you know about the pathophysiology of ARDS and risk factors.
ARDS is a syndrome of acute respiratory failure that presents with progressive arterial hypoxemia,
dyspnea, and a marked increase in the work of breathing. Most patients require endotracheal
intubation and positive pressure ventilation. Occurs when fluid builds up in the tiny, elastic air sacs
(alveoli) in your lungs. The fluid keeps your lungs from filling with enough air, which means less
oxygen reaches your bloodstream. This deprives your organs of the oxygen they need to
function. Most people who develop ARDS are already hospitalized for another condition, and
many are critically ill. Patients are especially at risk if you have a widespread infection in your
bloodstream (sepsis). People who have a history of chronic alcoholism are at higher risk of
developing ARDS.
2. Describe what you know about the goals of ventilator support; what is PEEP and how do you
know he is ready to be weaned from the ventilator?
the primary goals of mechanical ventilation should be to, cause no additional injury, avoiding
ventilator-induced lung injury by minimizing lung stress and strain. Maintaining gas exchange
and acid-base balance at a level appropriate for the specific patient, accepting hypercapnia and
hypoxemia where indicated. And also ensure patient-ventilator synchrony, selecting the mode
and ventilator settings that best match the patient's respiratory drive while ensuring lung
protection.
PEEP: Positive end expiratory pressure.
The use of PEEP mainly has been reserved to recruit or stabilize lung units and improve
oxygenation in patients who have hypoxemic respiratory failure. It has been shown that this
helps the respiratory muscles to decrease the work of breathing and the amount of infiltrated-
atelectatic tissues. He is ready to be weaned off the ventlator when his lungs are stable and
resolving. Low FiO2 (< 0.5) and PEEP (< 5-8cmH2O) requirement, hemodynamic stability and
able to initiate spontaneous breaths (good neuromuscular function).
Unfortunately, on his way home from the hospital he hits a tree and sustains blunt chest trauma.
A chest tube was inserted in the ER to treat a pneumothorax and hemothorax. Although he is in a
lot of pain, he is ecstatic to have you as his nurse again. You note that the drainage system has
