Care of severe ARDS and H1N1 Positive

Sivagami.C

Assistant Nursing Superintendent, Department of Nursing, Kauvery Hospital, Salem

Case Presentation

A 65/F admitted in our hospital on 28.11.2024 at 2pm with history of breathing difficulty and fever, cough for past 7 days.

Patient Progress

On 11.12.2024, She had respiratory distress & dyspnea around 6pm on 11.12.2024, SPO₂was 65% in HFNC O₂ 10 liter.
On 12.12.2024, Patient was started on NIV at 10.30am on 12.12.2024. FiO₂ was 100% and she was slightly irritable & tachypenic. PR: 38/min, SpO₂: 85-90%
Persistent respiratory distress – intubation done and changed to prone position
ET culture shows Klebsiella growth, Antibiotics started on 18.12.2024 at 10 am
Extubation done and NIV started FiO2 – 40%
Cardiology opinion was obtained and the Echo showed Normal LV function.
Dermatologist opinion was obtained for blisters over both breast region, abdomen & right thigh and chin. Orders were carried out as advised.
On 19^th She was on HFNC support – FiO₂ 30%
On 22th she was on Venturi mask support with 35% FiO₂ & SpO₂ – 97%
On 23^rd O₂ 6 litres were administered and the SpO₂ was 98%
On 24^th she was administered O₂ through Nasal Prongs with SpO₂ 99%
On 25^th She was removed from the O2 support as she maintained on room air with SPO2 98% that day evening patient was discharged

Nursing Management

1) Respiratory support

2) Oxygenation goals

3) Prone position

To improve oxygenation by allowing for better lung expansion and ventilation compared to line on the back
Monitor pressure injury and secure lines

4) Antiviral therapy and H1N1 (Eg) Oseltamivir or Zanamivir

5) Hemodynamic Support

6) Prevention of Infection

Isolation precaution Followed (air borne precaution)
The patient was in a negative pressure room
Hand hygiene
Staff protection – Monitor health care workers for signs with infection & ensure compliance with personal protection equipment
Psychological support
Collaborate with HIC, respiratory therapists. Nutritionists rehabilitation.