Question

What are 8 key items you will monitor for Mr. Hayato for while he is on a ventilator and in your care? Explain the rationale behind each one.   

Pt:  Kyle Hayato

DOB: 10/23/60

Age: 60

Sex: M

Education BA degree

Occupation: marketing analyst

Living situation: wife, no children

Ethnic Background: Asian American

Dx:  Exacerbated COPD, peripheral vascular disease

CC:                  “ …I’ve had emphysema for 11 years. After trimming the hedges today, I had trouble catching my breath”

Mr. Hayato has smoked 2 PPD for 27 years. His exercise potential is poor today due to dyspnea on exertion.  Swelling in the lower extremities is visible. Chest x-ray reveals a pneumothroax forming in his right lung. Cyanosis.

Hx:  Dx with emphysema 11 yrs ago. MI in 2008.  Knee surgery in 91’

Meds:  Inhaler delivered albuterol

Family Hx:  CA: father with colon CA;   uncle with lung CA                                

Diet Hx:          Pt feels full after eating only a few bites and has difficulty preparing meals.  “ I am too tired to eat after I prepare my dinner.  When I am coughing a lot it makes it hard to eat too.  I don’t know how much weight I have lost, but I have had to buy smaller clothes. I wear dentures, but they fit kind of loosely.  I normally weigh about 170#.”  NKA.  No supplements.  Our niece prepares a lot of our meals, or else my wife does now.

Height:  5’8”

Weight: 149# (actual)

Hospital Events:

            Chest tube inserted in right thorax to drain fluid using suction.   Client was ventilated with oxygen and intubated using a laryngoscope and placed on a ventilator. Enteral feedings were initiated on day 2 following admittance. ProcAlamine was administered as peripheral parenteral nutrition due to high gastric residuals and enteral feeding was stopped and not resumed for 4 more days.  By day 5, respiratory status had worsened (same time ProcalAmine was discontinued).  The patient was fed enterally until day 8 when he was weaned from the ventilator and discharged from the hospital on day 12.

Typical Food Intake:  

                        Morning:  hot cereal, egg, toast, hot tea (with milk and lemon)

                        Lunch:  sandwich, soup, hot tea (with milk and lemon)

                        Dinner:  Meat, rice, lots of vegetables, water

Labs:                                       Normal                                    on day of admit

            WBC                                       4.3—10 x10³/mm³                  5.6 x10³/mm³

            RBC                                        4.3-5.9 x 10⁶/mm³                       4.7 x 10⁶/mm³

            Hgb                                         14-18 g/dL                              13.2 g/dL

            Hct                                          37-47%                                   39%

            pH                                           7.35-7.45                                 7.22

            pCO2                                      35-45 mmHg                           50 mmHg

            pO2                                         > 80 mmHg                             72 mmHg

            HCO3-                                    24-28 mEq/L                           21 mEq/L            

            alb                                           3.5-5.0 g/dL                            3.9 g/dL

            sodium                                    135-155 mEq/L                       137 mEq/L   

            potassium                                3.5-5.5 mEq/L                        3.5  mEq/L

            osmolality                               275-295 mmol/L                     285 mmol/L

            chloride                                   98-108 mEq/L                         104 mEq/L

Answer 1

8 KEY ITEMS TO MONITOR WHEN HE IS ON VENTILATOR-

1) Blood pressure- it is an important vital sign . As the patient have peripheral vascular diease , emphysema, attack of myocardial infarction , a change in blood pressure can be seen . Most probably the patient can present with hypertensive features.

2) Temperature- it is needed if there is increased temperature or not. Incresed temperature says that the patient has fever.

3)Sp02( oxygenation saturation)-- it is describes the peripheral oxygenation saturation which is attached with hemoglobin . Here in this case, partial pressure of oxygenation is given but it is different from oxygenation saturation level. The oxygen saturation level is normal when it is more than 90%. As the patient has emphysema, the oxygen saturation level will be lower than 90%.

4) Respiratory rate-- it justify how hard body is trying to continue the respiration. As the patient have emphysema , the respiratory rate will be more ( normal is 12-18 / minute) and the respiration will the shallow not deep. In emphysema there is presence of airway obstruction so the respiration rate also be high and shallow.

5) Pulse and ECG wave monitoring-- when the patient is in ventilation it is mandatory . Also the patient has a history of myocardial infarction for this reason There can be alteration in ECG wave and also problems in pulse. Both might be irregular .

6) Pain rating-- is there is any pain present during ventilation. If present then that should be rated in between o to 10. If the patient feels extreme pain , Intravenous painkillers can be given.

7) Consciousness level-- Is the patient can cooperate with nurse , health personnel or not. Level of consciousness detects the cerebral perfusion limit means how much amount of blood is going to the brain. As there is Myocardial infarction history , peripheral vascular disease so problem can be seen.

8) Urine output-- As the patient is in ventilation the patient may be immobile so , catheter can be attached . Urine output is also an important parameter as it describes the excretory , urinary system function properly or not.