Another follow up ABG at 0100 shows a small improvement on the Ph to 7.18, the Pco2 became more acidotic moved to 53, the Po2 improved to 77 which shows he is oxygenating better but still hypoxic, his Hco3 acidosis is improving at a change to 19.8, and sating 91% now. The Pt is now breathing at a rate has come down to 10 BPM on his own above and beyond the vent. After consulting with the physician we changed the Vt to 600 and the pressure support to 20 and Cpap to 15. The Pt continued on these settings till 0415. The physician then made the change to Bi-level with the settings of a rate of 14 pressure support of 25, and an H/L pressure of 35/15. The Pt at this time is pulling a Vt of 745 and a spontaneous rate of 17 and still at 100% Fio2 and sating 92%. This is the point when the Pt makes the turn. The Bi-level or APRV was the proper setting for this Pt. He continued to improve over the next several days with his peek pressure climbing to 40. The Pt continues these settings and slowly improves and eventually weaned from the ventilator till the Pt no longer needs support.
Hypertension is exceedingly common in the United States and can lead to heart attack, stroke, kidney disease, and eye disease. Given the importance of this condition, it is critical for patients to recognize its causes, diagnosis, and treatment. By the end of this article, you will know the
The human body is a very complex organism composed of different types of systems and functions. All the functions that each system has, is what makes possible for the body to obtain life. One of the most important systems in one’s body is the circulatory system, where the heart, the lungs, and the blood vessels work together to form the circle part of the circulatory system. The pumping of the heart forces the blood on its journey. The body’s circulatory system really has three parts: pulmonary circulation, coronary circulation, and systemic circulation. Each part must be working independently in order for them to all work together. However, when one of the parts of the circulatory system does not
(Marieb and Hoehn, 2010, p 703) defined Blood Pressure (BP) as ‘the force per unit area exerted on a vessel wall by the contained blood, and is expressed in millimetres of mercury (mm Hg)’. BP is still one of the essential and widely used assessment tools in healthcare settings. Nurses generally record the arterial BP which is the forced exerted blood that flows through the arteries, to establish a baseline and to determine any risk factors. BP
When the organs fail the only option is a transplant. With lungs there is only a 50% rate of a five year survival rate after a lung transplantation involving the end-stage respiratory disease. With such a drastic survival rate a study was completed to determine if patients could have a better outcome. This study was done to help determine effective methods to enhance lung transplants before surgery; the Doctors placed the recipients on bi-level positive airway pressure ventilation (BIPAP.) “BIPAP is a noninvasive mode of ventilation administered through a tight-fitting mask to assist spontaneously breathing patients”
Therefore, the overall prognosis is guarded in view of the underlying pathology, its extent and the post-operative respiratory insufficiency. The life expectancy is difficult to anticipate but the
However, there is a multitude of effective ways to treat the disease that can increase the lifespan of an affected person. Constant vigilance for changes in one’s health is crucial. The main goals of treating the disease are clearing out mucus from the lungs and pancreas to prevent infection and providing necessary nutrition due to metabolic problems. A common treatment is the use of antibiotics, which aid in thinning excess mucus, lowering the risk of infection and increasing metabolism. Devices called nebulizers, which convert liquid medicine into a breathable “mist”, are used to easily move medication into the lungs through inhalation. Another common treatment is anti-inflammatories, which lessen swelling in your airways. To address digestive problems, people may take supplements of pancreatic digestive enzymes to increase the amount of absorbed nutrients within the body. In severe cases, surgical procedures may be applied to control the disease. Procedures include nasal polyp removal, where doctors remove any obstructive buildups in the nose, Endoscopy, where mucus is physically removed through endoscopes. In the most critical or life-threatening cases, a lung transplant may be performed to completely rid the patient of mucus buildup in the thoracic cavity. Unfortunately, due to the way mucus builds up in the lungs, a lung transplant requires both lungs to be
As a respiratory therapist depending on the facility you may be required to insert an arterial catheter and manage its hemodynamic. It is important for the respiratory therapist or any clinician at the bedside to know how manage arterial catheters and be competent with blood pressure monitoring as well as troubleshooting. Arterial cannulating with continuous pressure waveform display remains the primary choice for monitoring blood pressure of hemodynamically unstable patients (Pittman, Ping, & Mark, 1998). If the therapist notice the arterial waveform is dampen first assess the patient than the respiratory therapist should check arterial tubing for possible obstruction due to air bubbles, blood clots, or blood in the system. If the problem
Post-transplant, patients are monitored very closely in the intensive care unit (ICU) and pharmacological and mechanical management is implemented when necessary. Within the first 24-48 hours after surgery, a patient is ventilated and their Po2 and Pco2 levels are scrutinized. Diuretics may be used in order to avoid any complications from fluid buildup or imbalances that may occur and help with pulmonary recovery.2 Other complications that may occur within the first two days of surgery include: technical complications, graft dysfunction, infections, and rejection. Stenosis of one or more of the anastomoses accounts for 15% the technical complications, which may lead to graft dysfunction.4 Other components of graft dysfunction incorporate pathology from
The current treatments available for PAH are prostaglandin (PG), calcium channel blocker (CCB), Endothelin Receptor Antagonist (ERA), and Phosphodiesterase-5-inhibitors (PDE-5-I). The need for new drug therapy is due to the drawbacks of the current treatment as shown in the tables below. (3) This has led to the development of Opsumit (Macitentan), a new drug therapy for PAH.
Usually physicians will prescribe a number of different medications, including calcium channel blockers; which help relax the muscles around blood vessels allowing the pressure to lower. However, treatment can be complex requiring extensive follow up care if surgery is needed. For example, in dealing with pulmonary hypertension one of best surgical options is lung transplant, which 78% of patients survive the first year. This is one of the most popular choices and one of the main problems associated with lung transplant, is infection with the new
Modern medical advancements have significantly decreased the prevalence and severity of infectious disease as well as the treatment of acute, traumatic conditions. Pharmacological research has also gained insight into the management of chronic disease. Still, there is an epidemic of chronic, treatable diseases like stroke, heart disease, and kidney disease. Hypertension proves to be the underlying factor associated with these diseases. Hypertension is often referred to as the silent killer because of its indication in deadly disease, and the importance of monitoring ones blood pressure is vital. Lifestyle, diet, and genetic predisposition are all factors of high blood pressure. Chronic high blood pressure above safe levels, known as hypertension, puts elevated physical stress on the renal and cardiovascular systems. By controlling this factor in patients, healthcare providers can decrease cardiovascular events, improve health outcomes, and decrease overall mortality. Patient education is often overlooked in its role in the control and prevention of high blood pressure. This paper analyzes the causes and physiology behind high blood pressure as they relate to the current nursing interventions. The role of nurses is discussed in relation to patient education regarding high blood pressure, and educational approaches are analyzed.
Galie’s et al. compared the six-minute walk distance (6-MWD) in patients twelve years or older with symptomatic pulmonary arterial hypertension (PAH) who took placebo versus 4 doses of oral tadalafil with or without bosentan. This multi-center, double-blind, placebo-controlled, randomized controlled study lasted 16 weeks. The patients were placed into 5 different groups: tadalafil 2.5mg, 10mg, 20mg, 40mg, or placebo once daily, and stratification was based on walking distance of 325m, type of PAH, and bosentan use. Patients were not qualified to participate in this study if they had a 6-mintue walk distance <150m or > 450m. Safety was determined by the level of adverse events severity. It was shown that all doses, but 2.5mg, improved 6-MWD at week 16, although, the tadalafil 40mg was the only one that was statistically significant (p<0.01). Compared with placebo, tadalafil 40mg had statistical significance of 6-MWD without bosentan therapy at 44m, versus patients with bosentan with a 6-MWD of 23m. The WHO functional class was not statistically significant in comparison with placebo because patients with better WHO functional class showed no difference in comparison to people with worse WHO functional class. After the 341 patients completed the 16 week trial, 334 of them accepted participation in another 16 week trial. Their 6-MWD slightly improved from 37m to 38m after 44 weeks, which was shown to be statistically significant (95% CI, 29 to 47). In addition, WHO functional
Radiographic features with heart failure will demonstrate changes in cardiac output and pulmonary venous pressure, evident in dilated pulmonary vessels, interstitial, pleural and alveolar fluid leakage, and increased systemic venous pressure with chronic disease (Cremers, Bradshaw & Herfkens, 2010). Based on the pathophysiological process present with Mrs. Smith, some of the following features might be noticeable: Redistributed pulmonary blood flow will be appreciated through an increased (normal 1-2 mm) artery-to-bronchus ratio at the hilar level in the upper and middle lobes; since gravity and positioning (supine versus erect and decubitus) will have an impact, comparison with serial or old films if existing will be helpful (Cremers et al.,
1. Which action will the nurse in the hypertension clinic take in order to obtain an accurate