Mr. P., age 65 years, was transferred to the critical care u
Mr. P., age 65 years, was transferred to the critical care unit… Mr. P., age 65 years, was transferred to the critical care unit from the emergency department after successful resuscitation from a cardiac arrest sustained out of the hospital. Initial diagnosis based on laboratory results and electrocardiography is acute anterior myocardial infarction. It is suspected that Mr. P. aspirated gastric contents during the cardiac arrest. He opens his eyes to painful stimuli. He is orally intubated with a size 7.5 mm endotracheal tube located at the 25-cm marking at the teeth. Placement was confirmed by auscultation, end-tidal carbon dioxide, and chest radiograph. He is receiving mechanical ventilation with volume assist-control ventilation, respiratory rate set at 12 breaths per minute, fraction of inspired oxygen (FiO2) of 0.40, positive end-expiratory pressure (PEEP) of 5 cm H2O, and tidal volume of 700 mL. An arterial blood gas drawn on arrival to the critical care unit shows the following values: pH, 7.33; partial pressure of carbon dioxide (PaCO2), 40 mm Hg; bicarbonate (HCO3-), 20 mEq/L; partial pressure of arterial oxygen (PaO2), 88 mm Hg; and arterial oxygen saturation (SaO2), 99%. A decision is made to maintain the current ventilator settings. The following day, Mr. P.’s chest radiograph shows progressive infiltrates. His oxygen saturation is dropping below 90%, and he is demonstrating signs of hypoxemia: increased heart rate and premature ventricular contractions. Arterial blood gas analysis at this time shows pH, 7.35; PaCO2, 43 mm Hg; HCO3-, 26 mEq/L; PaO2, 58 mm Hg; and SaO2, 88%. The physician orders the FiO2 increased to 0.50 and PEEP increased to 10 cm H2O. s1. What were the results of Mr. P.’s first arterial blood gas analysis? What factors are contributing to these results? 2. What factor is contributing to Mr. P.’s worsening condition the day after hospital admission? 3. Interpret the arterial blood gases done the day after the cardiac arrest. 4. Why did the physician change the ventilator settings after the second set of arterial blood gases? 5. What must the nurse assess after the addition of the PEEP? Why is this especially important for Mr. P.? Moseley, Mary Lou Sole & Deborah Goldenberg Klein & Marthe J. Introduction to Critical Care Nursing, 7th Edition. Elsevier (HS-US), 102016. VitalBook file.Health Science Science Nursing NR 341
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