Case Study: Care of the Patient on a Ventilator Mr. Thomas came to the emergency room with respiratory distress. He has a history of emphysema and stroke. Due to his poor blood gases and deteriorating condition, a decision was made to electively intubate and put him on a ventilator. Prior to intubation his ABGs were: pH 7.32, PaCO2 64% ; HCO3 22 PaO2 60% and Sat was 75% on 2 liters. A chest x-ray reveals pneumonia. He is sent to ICU.
Initial setting for the ventilator were SIMV with TV of 600 ml, rate of 12, PEEP of 10, FIO2 of 40%. Which of the following statements is true about the settings? A. Mr. Thomas can still breath at his own rate and volume. B. Mr. Thomas can breath at his own rate but volume is controlled. C. Mr. Thomas will receive a paralytic so he can rest. D. Mr. Thomas can not breath spontaneously while intubated.
How would you interpret the initial blood gases? A. Respiratory alkalosis B. Respiratory acidosis C. Metabolic alkalosis D. Metabolic acidosis
What type of breath sounds would you expect to hear on Mr. Thomas? A. Rales B. Rhonchi C. Dimished D. Any or all of the above
During your assessment you find he has scattered coarse rhonchi and is dimished over the left posterior lobe. His color is pale and he has a poor cough effort. What is an appropriate nursing intervention? A. Push fluids B. Call the physician C. Suction as ordered D. Give ordered pain medication
What is the purpose of PEEP? A. Helps keep the alveoli expanded at the end of inspiration. B. Help keep the alveoli expanded at the end of expiratory. C. Assists the patient to take a deep breath. D. Aids with both inspiratory and expiratory effort.
The high alarm on the ventilator keeps alarming. Which of the following is a probable cause? A. Tubing is disconnected. B. Oxygen is disconnected. C. Suctioning is needed. D. All the above
Mr. Thomas improves and an order to wean is written. What is the purpose of weaning? A. To decrease the dependence on the ventilator until it can be removed. B. To drop the amount of oxygen and tidal volume needed. C. To change from an ET tube to a trach tube. D. To help the person speak around the tube and take fluids.
During the weaning process, Mr. Thomas becomes very anxious, his respiratory rate increases and his oxygen saturation decreases. The ventilator starts to alarm but you do not know why. What is the best action? A. Call a code B. Call the physician C. Manually ventilate patient and call for help D. Take vital signs and reassure patient
Due to you expert care, Mr. Thomas improves and is extubated and sent home. He thanks you for being so caring and being able to communicate so well.
