0800: A 58-year-old male was admitted 24 hours ago with community-acquired pneumonia. The client is receiving oxygen at 6 L/min via nasal cannula. This morning, the nurse notes that the client is increasingly restless and complaining of shortness of breath. The client is sitting upright in bed, visibly anxious, and using accessory muscles to breathe. Lung auscultation reveals bilateral crackles in the lower lobes. The client’s oxygen saturation has decreased from 93% to 86% on current oxygen settings, and respiratory rate is 32 breaths/min. The skin is cool and slightly diaphoretic. Temperature is 101.4°F (38.6°C), BP 132/78 mmHg, HR 90 bpm.

0800

• Chest x-ray STAT

0830

Chest X-Ray Report

Indication: Acute onset hypoxemia, worsening dyspnea.

Findings:

There is diffuse bilateral pulmonary opacification with prominence in the lower lung fields. No evidence of pleural effusion or pneumothorax. Cardiac silhouette is normal in size. The pulmonary vasculature is within normal limits.

1005: Client presents with acute onset of hypoxemia, tachypnea, and bilateral infiltrates on imaging unresponsive to oxygen therapy. Based on clinical presentation and diagnostic findings, acute respiratory distress syndrome (ARDS) is confirmed.

1000

• CPAP 50% FiO2, pressure 5 cmH2O
• Notify provider for any signs of respiratory decline
• Obtain arterial blood gas (ABG)
• Continuous pulse oximetry
• Draw CBC, BMP, and lactate
• Insert peripheral vascular access device
• NPO status until further evaluation
• Acetaminophen 650 mg PO PRN for temperature ≥ 100.4°F
• Albuterol 2.5 mg via nebulizer every 4 hours PRN for wheezing or shortness of breath