Peggy Adamson is a 36-year-old single woman admitted to the hospitalfollowing a near drowning in a local lake. On admission to the emergency department, Ms. Adamson is alert and oriented, having been rescued and resuscitated within 2 minutes of the accident. Rescuers report that she seemed to have aspirated “a lot” of water as she was waterskiing when the accident occurred. She is admitted to the intensive care unit for observation. Oxygen is started per nasal cannula at 6 L/min, intravenous fluids are administered to correct electrolyte imbalances, and 40 mg of furosemide (Lasix) is given intravenously for hypervolemia. ASSESSMENT Nadia Mucha cares for Ms. Adamson the evening of the day after her admission. Throughout her stay, Ms. Adamson has remained alert and oriented with stable vital signs. Her respiratory rate has been 20 to 24 per minute, with scattered crackles, oxygen saturations of around 94%, and a PO2 of 75 to 80 mmHg on 6 L/min of oxygen. Her pulse has been 96 to 100 and regular. On her initial assessment, Ms. Mucha notes that Ms. Adamson seems apprehensive and anxious. Although her blood pressure is 116/74, unchanged from previous levels, her heart rate is up to 106 and respiratory rate is 28 per minute. Her lungs have scattered crackles but good breath sounds throughout, unchanged from previous assessments. Ms. Adamson’s oxygen saturation has dropped to 84%, so Ms. Mucha orders ABGs and increases the oxygen to 8 L/min. ABG results show PO2 65 mmHg and respiratory alkalosis pH 7.48, and PCO2 32 mmHg. Ms. Mucha orders a portable chest X-ray and notifies the physician of the arterial blood gas results and the change in Ms. Adamson’s status. The physician orders a nonrebreather mask at 8 L/min and repeat ABGs in 1 hour. The chest X-ray reveals scattered infiltrates and a normal heart size. Ms. Adamson’s oxygen saturation continues to fall, and subsequent blood gases show a PO2 of 55 mmHg. The attending physician diagnoses probable ARDS and orders nasotracheal intubation and mechanical ventilation. Develop a plan of care for Ms. Adamson. Health Science Science NursingShare
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