Case Scenario: Respiratory Failure (RF)

Case Scenario: Respiratory Failure (RF)

Order Description

This is a case scenario that required the use of the text book attached only. Please USE THE TEMPLATE OF THE SCENARIO to answer the questions.All answers should be taken from Chapter 6 and chapter 33 of the attached text book. All citations must be in APA FORMAT. Please see attached instructions about APA instructors guideline.

APA Formatting for Case Scenarios (NURS 424)
Case scenarios:
• Use your Wagner text ONLY. The case studies are created so that you dive into the material that is assigned for the week. All answers can be found in the textbook.
•Pay attention to the point value of the question. If it is worth one point or more, I expect a substantial answer.
•When taking material from your text, you must cite your resource.
APA: (2014 edition)
? The first time you cite Wagner it must be as follows:
o (Wagner & Hardin-Pierce, 2014)
? Additional citations should also be:
o (Wagner & Hardin-Pierce, 2014)
? If you copy something word-for-word (direct quote) then you should have this enclosed in quotation marks. This should be followed with the citation that includes a page number (see example)
o (Wagner & Hardin-Pierce, 2014, p.237)
o “Heart rate is the first determinant of cardiac output and is an easily measured parameter” (Wagner & Hardin-Pierce, 2014, p. 151). OR
o According to Wagner and Hardin-Pierce (2014), “heart rate is the first determinant of cardiac output and is an easily measured parameter” (p. 151).
• Failure to properly cite directly quoted material is plagiarism and is an academic integrity violation. This will be enforced.
? If it is not a direct quote, do not place a page number
? If you write the citation in the sentence it should appear as follows:
o According to Wagner and Hardin-Pierce (2014)
? You must provide the reference to your text
o This must be done correctly!!!
? The word reference should be capitalized, centered, and boldface
? You must submit all case scenarios as a word document.
? Points will be deducted for incorrect APA. The objective is for you to perfect this prior to submitting your high-acuity paper due later in the semester.
NAME:       DATE: ________________Score:______________
WEEK: 6 Case Scenario (SPRING 2015) 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.
Vital Signs and ABG upon admission to the SICU:
RR    10 breaths/min
BP    150/90
HR    86 bpm
SpO2    92%  5/L FM
Temp    96.2 oral
PaO2    94 mm Hg
SaO2    96%
pH    7.40
PaCO2    42 mm Hg
HCO3    26 mEp/L

Content: Wagner and Hardin-Pierce (2014): Chapters 6 and 33
1.    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)

2.    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 points)

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
BP    160/94
HR    112
SpO2    82%
Temp    97 oral
PaO2    55 mm Hg
SaO2    90%
pH    7.29
PaCO2    55 mm Hg
HCO3    26 mEq/L

Respiratory rate (f)    38 breaths/min
Vital capacity (VC)    12 mL/kg
Maximum inspiratory pressure (MIP)    -14 cm H2O

3.    Interpret the ABGs.  (1 point)

4.    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?(1.25 points)

5.    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.
Ventilator Settings
Tidal Volume    500 mL
Fio2    0.40 or 40%
PEEP    5 cm
Ventilation Mode: PRVC    Setting Only
Respiratory Rate    12 Breaths/min
6.    Please explain (thoroughly) Tidal Volume, Fio2, and PEEP. (1 point)



7.    Mr. M. is at high risk for ventilator-associated pneumonia (VAP).  Explain, in detail, what this is, how it happens, and what measures can be taken to prevent VAP? (.75 points)

8.    What interventions will you perform to prevent common complications of mechanical ventilation?  (1.25 point)



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