UNFOLDING CASE STUDY: OXYGENATION
The nurse cares for a 78-year-old female admitted to the medical intensive care unit in respiratory
distress.
Nurses’ Notes
0900. Client was admitted to the ICU in respiratory distress after minimal response to high flow oxygen for a pulse
oximeter reading of 83% in room air. Crackles heard bilaterally in lower lobes with diminished breath sounds in right
middle lobe; S1S2 auscultated; bowel sounds positive in all 4 quadrants; skin warm dry and intact. VS T 99.8F(37.7C); HR
110; RR 34; B/P 148/90; pulse oximeter is 87% on 100% non-rebreather; pain-0/10.
Laboratory Report
Lab Results Reference range
ABG pH 7.2 7.35-7.45
ABG P02 75 mm Hg 75-100 mm Hg
ABG PC02 51 mm Hg 35-45 mmHg
ABG HC03 28 mEq/L 22-26 mEq/L
WBC 35,000 cells/mm3 4.5 – 10.5 x 103 cells/mm3
Platelets 250,000/ mm3 140,000 to 450,000/ mm3
Potassium(serum) 4.0 mEq/L 3.5 to 5 mEq/L
Sodium (serum) 140 mEq/L 135 to 145 mEq/L
Magnesium 1.5 mEq/L 1.5 to 2.1 mEq/L
Blood culture Gram negative cocci negative
Urine culture pending negative
Sputum culture pending negative
➢ Which 4 findings are most urgent?
□ B/P 148/90
□ WBC 35,000 cells/mm3
□ Ph 7.2- ACIDIC
□ PCO2 50 mm Hg- ACIDIC
□ PO2 75 mm Hg
□ Respiratory rate 34
□ Gram negative cocci
□ Pulse oximeter 87%
, The nurse cares for a 78-year-old female admitted to the medical intensive care unit in
respiratory
distress.
Nurses’ Notes
0900. Client was admitted to the ICU in respiratory distress after minimal response to high flow oxygen for a pulse
oximeter reading of 83% in room air. Crackles heard bilaterally in lower lobes with diminished breath sounds in right
middle lobe; S1S2 auscultated; bowel sounds positive in all 4 quadrants; skin warm dry and intact. VS T 99.8F(37.7C); HR
110; RR 34; B/P 148/90; pulse oximeter is 87% on 100% non-rebreather; pain-0/10.
Laboratory Report
Lab Results Reference range
ABG pH 7.2 7.35-7.45
ABG P02 75 mm Hg 75-100 mm Hg
ABG PC02 51 mm Hg 35-45 mmHg
ABG HC03 28 mEq/L 22-26 mEq/L
WBC 35,000 cells/mm3 4.5 – 10.5 x 103 cells/mm3
Platelets 250,000/ mm3 140,000 to 450,000/ mm3
Potassium(serum) 4.0 mEq/L 3.5 to 5 mEq/L
Sodium (serum) 140 mEq/L 135 to 145 mEq/L
Magnesium 1.5 mEq/L 1.5 to 2.1 mEq/L
Blood culture Gram negative cocci Negative
Urine culture pending Negative
Sputum culture pending Negative
➢ For each finding click to indicate if the finding is consistent with Acute
Respiratory Failure or Pneumonia. Each finding may support more than
one condition.
Findings Acute Respiratory Failure Pneumonia
Crackles bilateral lower lobes □X □X
Pulse oximeter 87% on 100% □X □X
PCo2 51 mmHg □X □
pH 7.2 □X □
Note: Each column must have at least 1 response option selected.
The nurse cares for a 78-year-old female admitted to the medical intensive care unit in respiratory
distress.
Nurses’ Notes
0900. Client was admitted to the ICU in respiratory distress after minimal response to high flow oxygen for a pulse
oximeter reading of 83% in room air. Crackles heard bilaterally in lower lobes with diminished breath sounds in right
middle lobe; S1S2 auscultated; bowel sounds positive in all 4 quadrants; skin warm dry and intact. VS T 99.8F(37.7C); HR
110; RR 34; B/P 148/90; pulse oximeter is 87% on 100% non-rebreather; pain-0/10.
Laboratory Report
Lab Results Reference range
ABG pH 7.2 7.35-7.45
ABG P02 75 mm Hg 75-100 mm Hg
ABG PC02 51 mm Hg 35-45 mmHg
ABG HC03 28 mEq/L 22-26 mEq/L
WBC 35,000 cells/mm3 4.5 – 10.5 x 103 cells/mm3
Platelets 250,000/ mm3 140,000 to 450,000/ mm3
Potassium(serum) 4.0 mEq/L 3.5 to 5 mEq/L
Sodium (serum) 140 mEq/L 135 to 145 mEq/L
Magnesium 1.5 mEq/L 1.5 to 2.1 mEq/L
Blood culture Gram negative cocci negative
Urine culture pending negative
Sputum culture pending negative
➢ Which 4 findings are most urgent?
□ B/P 148/90
□ WBC 35,000 cells/mm3
□ Ph 7.2- ACIDIC
□ PCO2 50 mm Hg- ACIDIC
□ PO2 75 mm Hg
□ Respiratory rate 34
□ Gram negative cocci
□ Pulse oximeter 87%
, The nurse cares for a 78-year-old female admitted to the medical intensive care unit in
respiratory
distress.
Nurses’ Notes
0900. Client was admitted to the ICU in respiratory distress after minimal response to high flow oxygen for a pulse
oximeter reading of 83% in room air. Crackles heard bilaterally in lower lobes with diminished breath sounds in right
middle lobe; S1S2 auscultated; bowel sounds positive in all 4 quadrants; skin warm dry and intact. VS T 99.8F(37.7C); HR
110; RR 34; B/P 148/90; pulse oximeter is 87% on 100% non-rebreather; pain-0/10.
Laboratory Report
Lab Results Reference range
ABG pH 7.2 7.35-7.45
ABG P02 75 mm Hg 75-100 mm Hg
ABG PC02 51 mm Hg 35-45 mmHg
ABG HC03 28 mEq/L 22-26 mEq/L
WBC 35,000 cells/mm3 4.5 – 10.5 x 103 cells/mm3
Platelets 250,000/ mm3 140,000 to 450,000/ mm3
Potassium(serum) 4.0 mEq/L 3.5 to 5 mEq/L
Sodium (serum) 140 mEq/L 135 to 145 mEq/L
Magnesium 1.5 mEq/L 1.5 to 2.1 mEq/L
Blood culture Gram negative cocci Negative
Urine culture pending Negative
Sputum culture pending Negative
➢ For each finding click to indicate if the finding is consistent with Acute
Respiratory Failure or Pneumonia. Each finding may support more than
one condition.
Findings Acute Respiratory Failure Pneumonia
Crackles bilateral lower lobes □X □X
Pulse oximeter 87% on 100% □X □X
PCo2 51 mmHg □X □
pH 7.2 □X □
Note: Each column must have at least 1 response option selected.
