In: Nursing
Mr. C., age 68 with a history of COPD, presented in the emergency department 2 days ago febrile with a productive cough of large amounts of purulent sputum and in acute respiratory failure. He was diagnosed with community-acquired pneumonia and treated with antibiotics, hydration, aggressive pulmonary hygiene, and supplemental oxygen therapy. Although his oxygenation improved, he continued to be diaphoretic, using accessory muscles of respiration and complaining, "I am exhausted" and "I can't get enough air." Arterial blood gas revealed: pH 7.31, PaCO2 59 mm Hg, PaO2 89 mm Hg, SaO2 91%, HCO3 29 mEq/L. The decision was made to intubate and place him on mechanical ventilation with the following settings: assist control (AC) mode, tidal volume (VT) 625 mL, respiratory rate 16 breaths/min, FiO2 0.70, and 5 cm H2O of positive end-expiratory pressure (PEEP). He was transferred to the critical care unit.
Two days later, his presentation at 0500 is as follows:
The team decides to perform a ventilator weaning trial. At 0620
Mr. C. is placed on 10 cm H2O of pressure support with
an FiO2 0.40.
Assessment at 0720 is as follows:
He is diaphoretic and alternates between picking at his gown and
falling asleep and needing to be aroused to stimulate breathing. He
is placed back on the ventilator at the previous settings.
Late that morning, during rounds, Mr. C. is started on nutritional
support via tube feeding and given trazodone at night for sleep. He
is allowed a morning nap and has physical therapy that
afternoon.
The following day he passes the pre-wean screening and is again placed on PS 5 above 5 cm H2O PEEP. Assessment findings 30 minutes into the weaning trial are as follows:
Mr. C. is calm, cooperative, and oriented, so the weaning trial is continued for 90 minutes. Arterial blood gas results were pH 7.34, PaCO2 48 mm Hg, PaO2 74 mm Hg, HCO3 24 mEq/L, and SaO2 95%. The decision was made to extubate, and the patient was discharged from the critical care unit the following day.
Please answer the following questions concerning Mr. C,
Ans of Part 1: All these parameters of Mr C suggests that he is suffering from the diseases such as Community Acquired Pneumonia ~
A) He was having a fast heart rate.
B) His blood pressure was normal most often.
C) Respiratory rate was a little bit disturbed with regards of Mr C.
D) Tidal volume shows the breathing capacity of Mr C, which seems abnormal sometimes.
Answer of Part 2:
Various other parameters could also be assessed :
A) Respiratory rate less than 25 breathes/minute.
B) Tidal volume greater than 5ml/kg.
C) Vital capacity greater than 5ml/kg.
D) Minute Ventilation less than 10 L/min.
E) PaO2/FIO2 greater than 200.
Answer of Part 3 :
A) Pressure support lowers the work of breathing for Patients. Weaning is performed by gradually decreasing the amount of pressure support and by transporting an increased proportion of the work to the patient.
B) When the patient can tolerate this level of ventilatory support, extubation is usually successful.