Biipap Case Study

Mr. GL’s sedation was paused thirty minutes prior to performing assessment. The patient was unresponsive throughout the entirety of the head-to-toe assessment with a GCS of 3. The patient’s pupillary response was sluggish. He was on mechanical ventilation set to assist control with a respiratory rate of 26, FiO2 of 80%, PEEP of 5, and tidal volume of 500. His endotracheal tube remained at 23 inches. His chest rise was equal. Wheezing was heard in all lung fields. Heart sounds were muffled, but S1 and S2 were present. EKG revealed sinus tachycardia with a heart rate of 106. The patient’s abdomen was soft and non-distended with hypoactive bowel sounds in all four quadrants. The patient’s foley catheter was intact and patent with dark yellow, clear urine output. A

4:35 p.m.: B/P 110/62, Oxygen saturation is 92%. Nurse J and the LPN on duty receives the emergency transport patient, and they are also discharging two other patients. ED lobby is congested with new patients.

is Pneumonia. This is based on the patient’s subjective and objective data. The collaborative diagnosis to address this problem is Pneumonia r/t immobilization; r/t pleural effusion, and r/t debilitation (Carpenito, 2013, p. 859-860). The nursing goal for this patient on the day of care is to control and reduce the complication of pneumonia (Carpenito, 2012, p. 860). The nurse will monitor the patient’s respiratory status while assessing for sign and symptoms of infection, and inflammation (Carpenito, 2012, p.

Action: Ambulated her to chair, assisted with bath and oral care, d/c Foley, encourage fluids, educated on fall prevention and incentive spirometry, applied SCDs and gave enoxaparin to prevent DVTs, gave acetaminophen/ hydrocodone (scheduled) as well as HYDROmorphone (for breakthrough) to control her pain. Performed EKG per order because potassium was 5.2… decreased O2 to 1 LPM then d/c.

On arrival to the emergency department the patient was in mild to moderate respiratory distress. Physical Examination: BP 80/51, Pulse 144, Respiration 49, and Height 5’10, Weight 93.44kg (206lb) the emergency room physician ordered the following test:

An unlicensed assistive personnel (UAP) is taking vital signs for a client postoperative right hip replacement surgery. The client suddenly begins experiencing difficulty breathing and complains of chest pain. The nurse is called to the room and notes the client’s respiratory rate of 30 breaths per minute, heart rate of 120 beats per minute, and blood pressure of 90/60 mm/ Hg. Which nursing priority intervention should be implemented first?

What medications did you administer to this patient? Why did you give them? What was the patient’s response to these medications? What should you monitor / nursing responsibilities?

uence, see Figure 2.2 for an example. Coaching the patient in deep breathing or quiet breathing, abdominal versus or chest breathing and using diaphragmatic support to increase

On your physical exam, what is most concerning to you on Sarah’s presentation? My main concern would be that the patient Sarah is so short of breath she cannot finish a sentence. Her oxygen saturation is only 87%, she is tachypneic disoriented and has ashen skin. I would be concerned that she is hypoxic.

The nurses, nursing techs, wound care specialist, pulmonologist, respiratory therapist, attending physicians and the rest of the healthcare team members are involved to take care of the patients. They have their own work according to their specializations, but most often they work as a team to help each other to meet the needs of the patients. The nurses are the main communicators in the unit. In the LTAC unit of WWHH, people with ARF are provided with supplemental O2 therapy. The majority of people with this disease need intubation and mechanical ventilation because they cannot oxygenate and ventilate adequately. At the hospital, ARF patients with chronic obstructive lung disease who retain CO2 are needed to be monitored very closely because of adverse effects (Nursing Central). The underlying cause of the RF needs to be considered before giving treatment. For example, patient with asthma need bronchodilators; patient with pneumonia needs antibiotics, and patient with congestive heart failure need diuretics. ARF patients are positioned properly for comfort and for performing optimal gas exchange to reduce O2 demand. These patients need very close monitoring and assessed frequently for respiratory arrest, arrhythmias, O2 saturation, adverse effects, O2 toxicity, vital signs, fever, serum electrolyte levels, arterial blood gas, and so on. “Various devices are

D: If I want to do differently next time, I would educate the patient and his family to understand and report any acute changes to the nurse immediately. In that way, the patient can be treated timely and reduce the risk of complication. As a nurse, now I understand how important for keeping a close eye on I/O on patients like this one. This ICU observation did help me understand nurses can make a big difference in patient care and that’s all what made me feel special and being

1. After noting a pulse deficit when assessing a 74-year-old patient who has just arrived in the

Her medical care would take preference in the emergency department while she was improving. Interventions would include the medical treatments of oxygen, nebulizer treatments, steroids, antibiotics and pulmonary toilet to rid the lungs of mucus. The outcomes would include not smoking while in the hospital. Education and coaching on smoking cessation would be ongoing while hospitalized. Improvements in oxygen saturations, decrease workload of breathing and decreased need for oxygen would be the anticipated outcomes for day

End of the shift: The patient came back toward the end of my shift. When the patient came back from the OR, he was intubated. The NG tube, the porta catheter for chemo therapy and IV line were still on. He had an arterial line, a colostomy bag, a Foley catheter and sequential compression devices. His vital signs were blood pressure 86/ 70 mmHg, respirations were 20 breaths per minute, heart rate 110 bmp, and temperature 97.8 F. The nurse gave 2 units of

Abby, is 21 years of age and is a female patient who received a permanent atrial-ventricular pacemaker for the diagnosis of sick sinus rhythm, a disorder that leads to periods of tachycardia and periods of extreme bradycardia or sinus arrest. The nurse received the end-of-shift report and arrives at Ms. Abby’s’s room where she assesses the patient’s incision dressing on the upper left chest and it is dry. The patient’s left arm is edematous and ecchymotic and twice the size of the other