Question

While the family is visiting, Mr. Oliver begins experiencing sudden respiratory difficulties. The family calls the nurse immediately who notes distended neck veins, cyanosis, and BP 80/48. Mr Oliver states "I am going to pass out!" 2. What should the nurse do first? After a couple days, Mr. Oliver's condition improves and he is scheduled to go home tomorrow. The evening before discharge, he experiences respiratory distress and is diagnosed with ARDS. Mr. Oliver requires several more days of hospitalization with ventilator support. 3. When should Mr. Oliver be weaned off of mechanical ventilation? 4. What Interprofessional collaboration is warranted to assist with weaning from mechanical ventilation? F7 FS F3 8 4 3

Answer 1

2. The patient is suffering from Core pulmonale one of the complications of COPD. An exacerbration of corruption pulmonale msy also lead to acute respiratory failure.Management of corruption pulmonale includes continuous low -flow oxygen. Long term -term oxygen therapy improves survival of hypoxemic patients, especially when used >15hours per day. Vasodilator therapy has not demonstrated sustained benefit and is not recommended on a routine basis. Diuretics are generally used, but serum creatinine and BUN are needed to monitor renal function as diuretics can cause volume depletion. Electrolytes must be monitored to assess for hypokalaemia, which can predispose to dysrhytmias.

2.Patients likely to require prolonged PPV such as patients with COPD who develops respiratory failure will most likely experience a weaning process that consist of peaks and valleys. Weaning can be viewed as the pre weaning phase, the weaning process and the outcome phase. Patients receiving mechanical ventilation for respiratory failure should undergo a formal assessment of weaning potential if the following are satisfied.

• Reversal of the underlying cause of respiratory failure.
• Adequate oxygenation
• Hemodynamic stability, which is the absence of myocardial ischemia and absence of clinically significant hypotension.
• Patient ability to initiate an inspiratory effort.

3.Conceptually, preparation for weaning should begin when PPV is initiated and should involve a team approach which consist of nurse, physician, patient, family, respiratory therapist, dietitian, physical therapist.