[Answered]: A 65-year old Ahmad, who recently had an episode of…

A 65-year old Ahmad, who recently had an episode of choking was presented to the Emergency Department this morning with worsening shortness of breath, fever, productive cough with green sputum and a new onset of altered mental status. Ahmad is well-known to have hypertension for 11 years, and he was diagnosed with heart failure 4 years ago. The primary assessment of Ahmad revealed the following vital signs: SpO2 65% on room air, BP 160/95 mmHg, Pulse 115 beats/min, RR 27 breaths/min, and Temperature 39.2 deg C. His respirations were labored with the accessory abdominal muscle use. His wife stated that Ahmad has been weak for the last few days, getting mixed up and saying inappropriate things. She also noted that her husband has not been taking enough fluids. Ahmad was commenced on CPAP of 5 cm H2O, but his respiratory conditions didn’t improve, and his oxygen desaturation got worse. Ahmad’s CXR showed worsening perihilar airspace opacity, atelectasis, and pulmonary edema. An ABG and venous blood samples were taken (the results are shown in the table below). Ahmad was diagnosed with Acute Respiratory Distress Syndrome (ARDS), whereby he was immediately transferred to the ICU for intubation and mechanical ventilation. Laboratory Results Diagnostic Test Results CBC & Chemistry Patient Value Normal Values WBC 15,000 4,000-10,000 /μL ABG & CXR: pH 7.28 PaO2 40 mm Hg PaCo2 55 mm Hg HCO3 22 mEq/L Hb 14.3 13-16.8 mg/dl Sodium 142 136-146 mmol/L CXR: perihilar airspace opacity, atelectasis and pulmonary edema and cardiomegaly Potassium 5.6 3.5-5.3 mmol/L Chloride 106 98-108 mmol/L BUN 36 7-22 mg/dl Creatinine 2.2 0.7-1.5 mg/dl Blood culture and sensitivity: Streptococcus Pneumoniae Calcium 9 8.9-10.3 mg/dl Phosphorus 10.5 2.6-6.4 mg/dl Alkaline Phosphatase 100 30-110 IU/L Instructions: Read the case study carefully and answer each question accordingly. 1. Ahmad was diagnosed with ARDS. However, his assessment findings indicate many other medical diagnoses. Identify two main medical diagnoses for Ahmad including your assessment evidence of your suggestions. (CLO1) (2 x 2 = 4 marks) 2. Based on the pathophysiological aspects of ARDS and in reference to the assessment findings, justify the presence of severe hypoxemia and atelectasis. (CLO2) (2 X 2= 4 marks) 3. In light of Ahmad’s current condition and medical history: (CLO 3) (4 Marks) A. Explain why patients with ARDS can develop alveolar dead space. (CLO 3) (2 marks) B. Explain how Ahmad’s health condition could deteriorate in light of his history of heart failure. (CLO 3) (2 marks) 4. ARDS is a critical life-threatening health condition and must be treated immediately. (CLO 4) (4 marks) A. What is your interpretation of ABG’s findings? (CLO 4) (1 mark) B. Identify the main medical goal of Ahmad’s medical treatment and list one medical intervention in order to achieve this goal. (CLO 4) (1 mark) C. Select two main pharmacological treatments for Ahmad and explain the rationale for using each of these medications. (CLO 4) (2 marks) 5. You are the nurse looking after Ahmad. Write four immediate nursing interventions. (4 marks) (CLO5)