Page 87 - Critical Care Nursing Demystified

72 CRITICAL CARE NURSING DeMYSTIFIED

to blood-tinged sputum from the ETT. You also note that she is in a sinus
tachycardia and has an elevated BP of 150/90. A stat chest x-ray shows she
has cloudy white infiltrates throughout both lung fields. ABGs are pH 7.30,
pCO 50, pO 60, HCO 24. What do you think is happening to Jane?
2 2 3
✔ A
ANSWER
J Jane was in a cardiac arrest for an undetermined period of time, which might
have led to substances being released in her body to allow noncardiogenic
pulmonary edema to occur. This is also based upon her worsening VS status
(tachycardia, hypertension), the decreased lung compliance (signified by the
alarms and hemoptysis), and whiteout appearance of her chest x-ray. Her
ABGs indicate an uncompensated respiratory acidosis with severe hypoxemia.
She has all the classic signs of ARDS.

Pneumothorax

What Went Wrong?
A pneumothorax is a condition where there is partial or total collapse of a lung.
Conditions that cause pneumothorax include chest surgery, a buildup of tumor Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
fluid from cancer, MV, and chest trauma. When a lung partially collapses, alve-
oli in the areas of collapse can not perform oxygenation; therefore, hypoxemia
and hypercarbia result. The higher the percentage of pneumothorax as deter-
mined by chest x-ray, the worsening of the ventilation problems.

Prognosis
The prognosis for recovery from a pneumothorax is excellent, but catching it
in time is key to the outcome. So be keenly cognizant that any patient with a
pulmonary problem or on MV can develop this at any time.

Hallmark Signs and Symptoms
Elevated temperature if from empyema or malignant pleural effusion (lung
fluid)
Fatigue
Cough
Pleuritic chest pain

Decreased or absence of breath sounds in the area of the pneumothorax
Dull or flat sound when percussed
Possible pleural friction rub