P.R., a 66-year-old woman who has no history of respiratory.
P.R., a 66-year-old woman who has no history of respiratory… P.R., a 66-year-old woman who has no history of respiratory disease, is being admitted to your intensive care unit (ICU) from the emergency department (ED) with a diagnosis of pneumonia and acute respiratory failure (ARF). The ED nurse tells you that P.R. was stuporous and cyanotic on her arrival to the ED. Her initial vital signs (VS) were 90/68, 134, 38, 101° F (38.3° C) an Spo2 of 53%. She was endotracheally intubated orally, was placed on mechanical ventilation, and has equal breath sounds. Her ventilator settings are synchronized intermittent mandatory ventilation of 12/min, tidal volume (VT) 700 mL, Fio2 0.50, and positive end-expiratory pressure (PEEP) 5cm H2O. The nurse tells you P.R. had a chest x-ray (CXR) examination that confirmed the diagnosis of pneumonia before being intubated, but she needs an another CXR examination STAT. 1. Describe the pathophysiology of ARF.2. How does the underlying pathophysiology relate to P.R.’s presenting signs and symptoms?3. Describe each of P.R.’s ventilator settings and the rationale for each.4. Why does P.R. need a second CXR examination? Arterial Blood Gases pH 7.28Paco2 62 mm HgHCO3 26 mEq/LPao2 48 mm Hg Spo2 56%5. The ABG results from the sample drawn in the ED before intubation are sent to you. Interpret P.R.’s ABG results. Physician’s OrdersBlood and sputum cultures STAT ABGs via arterial line every 6 hours NGT to intermittent, low suction Insert indwelling urinary catheter Enoxaparin (Lovenox) 40 mg subcutaneous q24hr at 1700 Apply anti-embolism and intermittent pneumatic compression stockings Pantoprazole (Protonix) IV 40 mg daily Lorazepam 1 mg IV every 4 hours Ceftriaxone 1gram IV q8hr D5 1/2 NS at 125 mL/hr 6. What is the rationale for each order? 7. What is your priority nursing goal at this time?8. Describe the interventions you will perform over the next 2 hours based on this priority and the orders you need to implement.9. P.R. is not heavily sedated and seems anxious about all that is going on. Describe how you can help her. Health Science Science Nursing NURS SURGICAL N
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