Reference no: EM133922493

Case Study

The nurse is working in the emergency department when the paramedics call in and report that they are in route with Mr. Toll, who was involved in a motor vehicle accident. He is presently unconscious and receiving supplemental oxygen. Vital signs are BP, 110/68; HR, 100; RR, 10; and shallow, T. 98°F.

What additional information will be helpful?

Mr. Toll was the driver, and he was wearing a seatbelt. His compact car collided head-on with a full-size pickup truck. There was no evidence of alcohol or drug involvement, and the only history that can be obtained is that he has a chronic lung problem.

Why would the nurse need to obtain more information about his lung problem?

Assessment reveals absent breath sounds on the right side with minimal chest What does the nurse suspect and why?

A chest tube was inserted, and Mr. Toll was placed on a ventilator. He also sustained a significant head injury that has left him unconscious and in need of ventilator support. Several days later, he starts to regain consciousness and becomes extremely restless. When the nurse suctions his artificial airway, the nurse observes blood-tinged sputum. Mr. Tol has a low-grade fever and is tachycardia.

What does the nurse suspect and why?

How would a pulmonary embolus be diagnosed?

A diagnosis of pulmonary embolus was confirmed, and Mr. Toll was given streptokinase and started on heparin.

What are the nurse's concerns related to this therapy?

The next day, the nurse notices that Mr. Toll has marked hypoxemia, which is not responding to increased levels of oxygen. A chest x-ray is obtained, which reveals diffuse bilateral infiltrates. He is diagnosed with ALI/ARDS.

What is the pathophysiology associated with ALI/ARDS?