Reference no: EM133295730
Mark Donnelly is a 54-year-old patient admitted 2 days ago in severe DTs. Immediately prior to his admission, he vomited, had a seizure, and probably aspirated. His previous medical history includes hypertension, COPD, and an MI treated with angioplasty and a stent. According to his wife, he was taking Toprol and Lipitor regularly prior to admission and has smoked a pack a day for the past 30 years. He had been drinking a fifth of vodka daily until 3 days prior to admission when he stopped completely. He is 5'11" and weighs approximately 180 pounds. On arrival in the ED, his blood pressure was 193/124 with a heart rate of 150. He was tremulous, nauseated, and agitated. Lorazepam was started according to CIWA protocol, but he began to vomit and had several seizures. He was sedated with propofol and Zemuron, emergently intubated, ventilated, and transferred to the ICU. On arrival in the ICU, his blood pressure was 80/52.
1. What probably caused his blood pressure to drop?
2. What strategies should the nurse institute immediately to prevent VAP?
3. Will his current BP affect the implementation of any of the strategies?
4. Would his DTs and mental status affect the implementation of any of these strategies?
During the initial assessment on his second day of hospitalization, his ET tube was noted to be 24 cm at the lips. His nurse heard crackles and rhonchi in the bases, especially on the right. His chest x-ray showed that his ET tube was approximately 5 cm above the carina. He had infiltrates and a consolidation on the right with an elevated diaphragm. The nurse suctioned him for copious amounts of pale-yellow secretions.
5. What, if any, inferences can the nurse draw from these assessment findings and the results of the chest x-ray?
6. What should the nurse do about these?
7. What factors could predispose Mr. Donnelly to the development of ARDS?
Mr. Donnelly was being mechanically ventilated. On ventilator settings of SIMV rate 14, tidal volume 600, FiO2 50%, PEEP 8, his respiratory rate was 15, he was maintaining an oxygen saturation of 94%, and his peak inspiratory pressures were 22 to 28. His ABGs revealed pH 7.42, PaO2 96, PaCO2 48, and HCO3 29.
8. What information, if any, do his blood gases reveal?
9. If his ventilator is set for 14 breaths per minute with a mode of SIMV, how is he able to breathe at a rate of 15? Why is this useful for a patient?