P.R., a 61-year-old woman who has no history of respiratory disease, is being admitted to your unit with adiagnosis of pneumonia and acute respiratory failure. She was endotracheally intubated orally in the emergency room and placed on mechanical ventilation. Her vital signs are 112/68, 134, 101° F (38.3° C) with an Sa O2 of 53%. Her ventilator settings are synchronized intermittent mandatory ventilation of 12 breaths/min (BPM), tidal volume (V T ) 700 mL, Fi O2 0.50, positive end-expiratory pressure (PEEP) 5 cm H 2 O.1. Describe the pathophysiology of acute respiratory failure (ARF).  2. What assessment findings would you expect P.R. to exhibit? CHART REVIEW:  Arterial Blood GasespH       7.28PaCo2    62 mm HgHCO3    26 mmol/LPaO2     48 mm HgSaO2     53% 3. The arterial blood gas (ABG) results drawn in the emergency room before intubation are sent to you. Interpret P.R.’s ABG results.  4. List eight interventions that would be implemented for P.R. and the rationale for each. 5. After the insertion of the endotracheal tube (ETT), how is correct placement verified? 6. Describe each of P.R.’s ventilator settings and the rationale for the selection of each.  CHART REVIEW:Arterial Blood GasespH       7.30PaCo2    52 mm HgHCO3    22 mmol/LPaO2     70 mm HgSaO2     88% 7. ABGs are redrawn after P.R. is on mechanical ventilation for 1 hour. What ventilator changes do you anticipate, based on your interpretation of these values? (Select all that apply, and explain your rationale.) a. Increasing the PEEP to 10 cm b. Increasing the rate on the ventilator to 16 breaths/min c. Increasing the tidal volume to 850 mL d. Changing to continuous mandatory ventilation 8.  Evaluate each of the following statements about caring for P.R. or a similar patient receiving mechanical ventilation with an ETT. Enter “T” for true or “F” for false. Discuss why the false statements are incorrect._____ Administer mandatory muscle-paralyzing agents to keep the patient from “fighting the vent.”_____ Check ventilator settings at the beginning of each shift and then hourly._____ When suctioning the ETT, each pass should not exceed 15 seconds._____ Assign an experienced NAP to take vital signs every 2 to 4 hours._____ Perform a respiratory assessment once per shift._____ Empty excess water as it collects in the ventilation tubing back into the humidifier._____ Keep a resuscitation bag at the bedside._____ Monitor the cuff pressure of the ETT every 8 hours._____ Keep ventilator alarms silenced when in the room to maintain a quiet environment._____ Change the ventilator tubing every 12 hours.  9. You hear the high pressure alarm sounding on the mechanical ventilator and see that P.R.’s SaO2 is 80%. What are the potential causes of this problem?  CASE STUDY PROGRESS As P.R.’s nurse, you are concerned about meeting her needs for fluids, nutrition, oral hygiene, and skin integrity.10. Discuss five indicators that would help you assess fluid status. 11. What are your nutritional goals for P.R.?  12. Describe interventions that you could use to assist in meeting P.R.’s nutrition goals. 13. The goal related to P.R.’s mouth care is to preserve the oral mucosa and dentition. Identify three strategies for providing oral hygiene with an ETT in place. 14. What is the rationale for not taking an oral temperature near an ETT? 15. You assess P.R.’s skin every 4 hours. Identify three treatment goals in relation to skin and positioning.  16. What four strategies will facilitate the expected outcome of maintaining skin integrity? 17. That afternoon, a powerful storm causes a power failure. What do you do?Remember to document your references.  Health ScienceScienceNursing NUR MISC

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