NR 341 CASE STUDY Ventilatory Assistance & Acute Respiratory Failure 1.

NR 341 CASE STUDY Ventilatory Assistance & Acute Respiratory Failure 1. CASE STUDY: Ventilatory Assistance & Acute Respiratory Failure 1 Mr. R is a 66-year-old man who has smoked 1.5 packs of cigarettes a day for 40 years. He is admitted with an acute exacerbation of COPD. His baseline ABGs drawn in the ER showed: pH, 7.36; PaCO2, 55mmHg; PaO2, 69mmHg; Bicarbonate, 30 mEq/L; SaO2, 92% on 4Lvia NC. In the critical care unit, Mr. R has course crackles in his left lower lung base and a mild expiratory wheeze bilaterally. His cough is productive of thick yellow sputum. His skin turgor is poor; he is febrile, tachycardic, and tachypneic requiring 6L via NC to keep Sats 88%. 1. What is your interpretation of Mr. R’s baseline ABGs from the ER? Did his symptoms improve on admission to CCU? What may have caused his exacerbation? What assessment findings lead you to this conclusion? What ventilatory assistance may improve his symptoms? How? Mr. R has hypoxia because of high PaCO2 indicated by 55mmHg, and low PaO2 indicated by 69mmHg. The patient condition is not improving on admission to CCU because Mr. R is clearly showing a sign of respiratory distress. The exacerbation may be caused by foreign objects, fluid in the lungs and bacterial accumulation. The assessment findings are course crackles in his left lower lung base, a mild expiratory wheeze bilaterally. The noninvasive positive-pressure ventilation, sometimes shortened to NPPV may improve his symptoms, by pushes air into his lungs through a mask that covers the nose and the mouth. This treatment generally is recommended when you're having a very hard time breathing because of COPD. 2. Per physician order, Mr. R is placed on NPPV via face mask with PEEP of 15 and FiO2 50% with sats 92%. The doctor also orders blood and sputum cultures and antibiotics IV to be initiated ASAP. What technique is maintained during blood cultures? During sputum cultures? When should nurse administer antibiotics? What organisms are commonly seen in respiratory infections? During blood culture, standard precaution technique need to be maintain, and for the sputum culture, which is important to prevent transmission of diseases that can be acquired by contact with blood, body fluids, non-intact skin. Antibiotic can be given after obtaining the necessary cultures. The organism seen are Haemophilus influenzae, streptococcus pneumoniae 3. One hour post-NPPV ABGs results showed: pH 7.3, PaCO2 67, PaO2 45, HCO3 26, SaO2 85% on PEEP of 20 and FiO2 60% NPPV. What is your interpretation of his current ABG results? What ventilatory assistance does Mr. R require? What lab findings indicate this? What airway is optimal for him and why? PH is acidosis, paco2 is above 60, pao2 is below 60, SaO2 is at 85%, which is leading to respiratory acidosis. Due to the ABGs result, the patient will need to be mechanical intubated. Nasopharyngeal airway is optimal for him because he is conscious.