Mr. K is a 70-year-old male who has past medical history significant for rheumatoid arthritis, mild COPD, quit smoking 20 years ago, HTN, and HLD who presented to the hospital with a 3-day history of dyspnea, fever, chills, and productive cough. His son called the ambulance this morning because Mr. K was in significant respiratory distress. His saturations upon arrival were 72%. He was placed on a nonrebreather mask. CXR revealed a right lower lobe infiltrate consistent with pneumonia.
1. Describe the risk factors associated with the development of pneumonia that Mr. K has. Is there any other risk factor you would want to ask about or assess for? Click here to enter text.
2. What is the standard treatment for community-acquired pneumonia? . Mr. K is confused and continues to pull at the NRB mask. He is breathing 32x/minute with oxygen saturations 89%. His ABG is 7.32/50/35/23.
3. Mr. K is in respiratory distress. Discuss the signs and symptoms of respiratory distress the RN would assess for.
4. Interpret the ABG. Please describe both his acid/base balance and his oxygenation status.
The provider and the RN discuss with the family the option of mechanical ventilation and the decision is made to proceed with intubation.
5. The family asks you to explain the breathing machine. Using your own words, describe what the mechanical vent is and how it benefits the patient. Click here to enter text. Initial settings for the patient are AC 16/450/10/100%
6. Describe each of the components for the ventilator settings. Each day the patient is assessed for extubation with a spontaneous awakening trial (SAT) and a spontaneously breathing trial (SBT)
7. What is a SAT and an SBT?
. 8. What criteria should the nurse assess for daily to aid in extubation?
. Mr. K is successfully extubated after 2 days and transferred out of the ICU the following day.
Scenario #2
Mrs. Jones is a 68-year-old female with past medical history significant for HTN, HLD, and systolic heart failure, EF 45%. Her family called EMS after she had increasing shortness of breath over the last two days. Oxygen saturations were 85% when EMS arrived, and she was placed on a non-rebreather. Upon arrival to the ED, lab work and chest x-ray were obtained. Chest x-ray was consistent with pulmonary edema. Her BP initially in the ED was 172/82. She was alert and oriented but unable to speak in full sentences. The provider ordered Lasix IVP and BiPAP therapy for her.
1. The family asks what bipap is. Explain in your own words what bipap is used for.
. 2. Describe a minimum of 3 different contraindications to bipap therapy:
3. Her settings are described as 15/5. Describe what these settings are.
. 4. What are three nursing priorities in caring for someone on bipap therapy?
1. The risk factors associated with the development of pneumonia are :-
- age
- COPD
- immobility
- history of smoking
- cardiovascular disease
2. Standard treatment for community acquired pneumonia include :-
1. Antibiotics. These medicines are used to treat bacterial pneumonia. It may take time to identify the type of bacteria causing your pneumonia and to choose the best antibiotic to treat it. If your symptoms don't improve, your doctor may recommend a different antibiotic.
2. Cough medicine. This medicine may be used to calm your cough so that you can rest. Because coughing helps loosen and move fluid from your lungs, it's a good idea not to eliminate your cough completely. In addition, you should know that very few studies have looked at whether over-the-counter cough medicines lessen coughing caused by pneumonia. If you want to try a cough suppressant, use the lowest dose that helps you rest.
3. Fever reducers/pain relievers. You may take these as needed for fever and discomfort. These include drugs such as aspirin, ibuprofen (Advil, Motrin IB, others) and acetaminophen (Tylenol, others).
3. The RN should assess for the following sign and symptoms :-
- Tachypnea, tachycardia
• Lung examination
- Dullness to percussion
- Diminished breath sounds
- Inspiratory crackles
- Rales, rhonchi
- Tactile fremitus, egophony
- Chest wall retractions
- Use of extra strenuous muscles to breath
4. ABG is 7.32/50/35/23 , which means the patient is in metabolic acidosis and his saturation is 89% . In view of this the physician has decided to intubate the patient .
Mr. K is a 70-year-old male who has past medical history significant for rheumatoid arthritis, mild...
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Wallace Peterson is a 69-year-old male with a 6-year history of chronic obstructive pulmonary disease who presented to the emergency department at 0100 on Tuesday morning with moderate respiratory distress, a productive cough, and a fever. He was admitted to the inpatient medical-surgical unit for treatment of pneumonia. Questions 1: What are the early signs and symptoms of inadequate oxygenation? 2: Is maintaining oxygen saturation greater than 88% adequate for this patient? 3: What type of pneumonia does this patient...
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