Question

1.How will you feel with a post operative patient who is complaining that he cannot breath.

2.What is the use of adjunct oxygen therapy, different types and rate of flow of one of them.

3. Arterial blood gas (ABG) analysis and result baseline. What can make the result bad?

4. Discuss the use of heparin nomogram (guideline for heparin titration)

8.How will you actually care for the patient in acute respiratory distress

Answer 1

1.How will you feel with a post operative patient who is complaining that he cannot breath ?

As a nurse it is my obligation and responsibilty to make the post surgical and post anaesthetic breathing issues. I can clarify the probable and expected breathing trouble to the patient and supply an incentive spirometer as the doctor's prescription.

2.What is the use of adjunct oxygen therapy, different types and rate of flow of one of them

Adjunct oxygen therapy is mainly indicated for:

• Treatment of hypoxia- by raising the levels of oxygen in lung alveoli as well as blood
• Decreasing work of breathing- helpful in dyspnoea and laboured breathing
• Decreasing myocardial workload  

Different types of adjunct therapies are:

• Orthobaric- oxygen higher that 21% at ambient atmospheric pressure
• Hyperbaric- oxygen higher than 21% at high atmospheric pressure

Rate of flow in orthobaric oxygen therapy is 4-6 L/ min

3. Arterial blood gas (ABG) analysis and result baseline. What can make the result bad?

ABG analysis measures the blood levels of oxygen and carbon dioxide as well as the pH or acid- base equilibrium of the body.

The result baseline of ABG analysis are:

• pH : 7.35 -7.45
• pCO₂ : 35 - 45 mmHg
• pO₂ : 80 - 110 mmHg
• HCO₃- : 21 - 28 mmol/L

An abnormal result can be interpreted as hyper or hypo ventilation and/or corresponding alkalosis or acidosis or eevn bacteremia.

4. Discuss the use of heparin nomogram (guideline for heparin titration)

Heparin nomogram is a standard calculation basis for titrating heparin doses in patients without delay in reaching a reliable activated partial thromboplastin time. This helps in therapeutic drug monitoring of the patients. The calculation is majorly based on the body weight.

8.How will you actually care for the patient in acute respiratory distress

First of all the emergency department should be notified regarding the issue so as to give the emergency respiratory assistance, substitutes and so on. Prior to that the manifestations should be noted and primary assessment should be done and care should be given.

• Heimlich maneuver can be begun when a patient does not make any kind of sound, which can be predictive of choking.

• CPR should be started when the patient neither chokes nor breathes.

• Adrenaline can be given and take to emergency department if there are symptoms of anaphylactic manifestations.

• The patient should be given routine respiratory devices if any, in case of routine usage. E.g.: Inhaler