NAME: ___________________ DATE: ________________Score:______________
WEEK: 5 Case Scenario (Spring 2021) Respiratory Failure (RF)
Arthur M., a 57-year-old morbidly obese male, has just been transferred to the Surgical Intensive Care Unit (SICU) from the post-op recovery room following bariatric surgery. The recovery room nurse informs you that Mr. M. self-extubated and the decision was made by the physician to allow him to remain extubated. He is awake but very drowsy and is currently receiving oxygen 5 LPM via face mask (FM).
Past Medical History: hypertension, type 2 diabetes, and of sleep apnea with a cpap machine used at home. He quit smoking 2 years ago following a 26 year history of smoking 1 1/2 pack of cigarettes a day.
Current Medications: hydrochlorothiazide, glucovance, and oxygen at night with is cpap machine.
You must cite your sources with exact page numbers.
Vital Signs and ABG upon admission to the SICU:
|SpO2||92% 5/L FM|
|PaO2||94 mm Hg|
|PaCO2||42 mm Hg|
Content: Wagner and Hardin-Pierce (2014): Chapters 7 and 34
- What risk factors does Mr. M have that decreases his oxygen consumption and places him at risk for respiratory failure? Explain the rationale for each risk factor. (1 point)
- In your report from the recovery room nurse, you remember that Mr. M extubated himself too early and he is still drowsy at this time. In your post extubation follow up assessment, what will you pay particular attention to? (.75 point)
Scenario Continued: You have been monitoring Mr. M for 8 hours now and he is starting to show signs of respiratory deterioration including extreme somnolence. You call the physician to report the following vital signs and he orders: ABGs and PFTs: The results are as follows:
|RR||38 shallow and labored|
|PaO2||55 mm Hg|
|PaCO2||55 mm Hg|
|Respiratory rate (f)||38 breaths/min|
|Vital capacity (VC)||12 mL/kg|
|Maximum inspiratory pressure (MIP)||-14 cm H2O|
- Interpret the ABGs. (1.25 point)
- What is acute ventilatory failure (AVF), how is it diagnosed? What are the criteria for ventilatory support and what are Mr. M’s critical values that meet this criteria?(1.5 point)
- The physician tells you that he wants to use an endotracheal tube for intubation. You grab all the supplies, the physician successfully intubates Mr. M., and now you are performing your post intubation assessment. Explain what will be included in this assessment. (1 point)
Mr. M. has been sedated on a propofol drip and the physician has ordered the settings below.
|Tidal Volume||500 mL|
|Fio2||0.40 or 40%|
|Ventilation Mode: PRVC||Setting Only|
|Respiratory Rate||12 Breaths/min|
- M. is at high risk for ventilator-associated pneumonia (VAP). Explain, in detail, what this is and how it happens. (1 point)
- What interventions will you perform to prevent common complications of mechanical ventilation? (1.5 point)
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