Morbidly obese male<\/p>\n
WEEK: 6 Case Scenario (SPRING 2015) Respiratory Failure (RF)
\nArthur M., a 57-year-old morbidly obese male, has just been transferred to the Surgical Intensive Care Unit (SICU) from the post-op recovery room following bariatric surgery. The recovery room nurse informs you that Mr. M. self-extubated and the decision was made by the physician to allow him to remain extubated. He is awake but very drowsy and is currently receiving oxygen 5 LPM via face mask (FM).
\nPast Medical History: hypertension, type 2 diabetes, and of sleep apnea with a cpap machine used at home. He quit smoking 2 years ago following a 26 year history of smoking 1 1\/2 pack of cigarettes a day.
\nCurrent Medications: hydrochlorothiazide, glucovance, and oxygen at night with is cpap machine.
\nVital Signs and ABG upon admission to the SICU:
\nRR 10 breaths\/min
\nBP 150\/90
\nHR 86 bpm
\nSpO2 92% 5\/L FM
\nTemp 96.2 oral
\nPaO2 94 mm Hg
\nSaO2 96%
\npH 7.40
\nPaCO2 42 mm Hg
\nHCO3 26 mEp\/L<\/p>\n
Content: Wagner and Hardin-Pierce (2014): Chapters 6 and 33<\/p>\n
1. What risk factors does Mr. M have that decreases his oxygen consumption and places him at risk for respiratory failure Explain the rationale for each risk factor. (1. point)<\/p>\n
2. In your report from the recovery room nurse, you remember that Mr. M extubated himself too early and he is still drowsy at this time. In your post extubation follow up assessment, what will you pay particular attention to (.75 points)<\/p>\n
Scenario Continued: You have been monitoring Mr. M for 8 hours now and he is starting to show signs of respiratory deterioration including extreme somnolence. You call the physician to report the following vital signs and he orders: ABGs and PFTs: The results are as follows:<\/p>\n
RR 38 shallow and labored
\nBP 160\/94
\nHR 112
\nSpO2 82%
\nTemp 97 oral
\nPaO2 55 mm Hg
\nSaO2 90%
\npH 7.29
\nPaCO2 55 mm Hg
\nHCO3 26 mEq\/L<\/p>\n
Respiratory rate (f) 38 breaths\/min
\nVital capacity (VC) 12 mL\/kg
\nMaximum inspiratory pressure (MIP) -14 cm H2O<\/p>\n
3. Interpret the ABGs. (1 point)<\/p>\n
4. What is acute ventilatory failure (AVF), how is it diagnosed What are the criteria for ventilatory support and what are Mr. M\u2019s critical values that meet this criteria(1.25 points)<\/p>\n
5. The physician tells you that he wants to use an endotracheal tube for intubation. You grab all the supplies, the physician successfully intubates Mr. M., and now you are performing your post intubation assessment. Explain what will be included in this assessment. (1 point)<\/p>\n
Mr. M. has been sedated on a propofol drip and the physician has ordered the settings below.
\nVentilator Settings
\nTidal Volume 500 mL
\nFio2 0.40 or 40%
\nPEEP 5 cm
\nVentilation Mode: PRVC Setting Only
\nRespiratory Rate 12 Breaths\/min
\n6. Please explain (thoroughly) Tidal Volume, Fio2, and PEEP. (1 point)
\nTIDAL VOLUME:<\/p>\n
Fio2:<\/p>\n
PEEP<\/p>\n
7. Mr. M. is at high risk for ventilator-associated pneumonia (VAP). Explain, in detail, what this is, how it happens, and what measures can be taken to prevent VAP (.75 points)<\/p>\n
8. What interventions will you perform to prevent common complications of mechanical ventilation (1.25 point)<\/p>\n
-Custom essays that are affordable for everyone \u261d! Order your heathcare essays today. Enjoy high-quality academic writing services<\/p>\n","protected":false},"excerpt":{"rendered":"
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