OPIANA, CHRISTIAN JOSEPH I.

BSN4 BLOCK 6
N036 NCM 118N
CASE STUDY 3

a.) Your patient with a COPD exacerbation is placed on a spontaneous breathing

trial consisting of CPAP mode. Fifteen minutes after the wean from the ventilator
begins, the high minute ventilation alarm sounds. What assessments will you
make?

Continuous positive airway pressure (CPAP) is the gold standard treatment for
OSA, having been shown to reduce the risk of cardiovascular fatal and non-fatal
events, as well as mortality rates, when compared to untreated OSA. CPAP
therapy has also been shown in adherent patients to improve OSA symptoms
such as excessive daytime sleepiness and decreased quality of life.

When an alarm sounds, quickly assess the patient’s vital signs, including
heart rate,respiratory rate, breath sounds, and peripheral oxygen
saturation (SpO2). Vital signs are an important part of monitoring the
progress of an adult or child patient during hospitalization because they
allow for the early detection of delayed recovery or adverse events.

Examine the circuit for any leaks or disconnections. Tighten or reconnect

the wires.

Look for leaks or deflation in the patient's artificial airway cuff.

Check for leaks or disconnections in the humidifier and tighten or

reconnect the connections.

Check for leaks or disconnections in the inline suction system. Tighten or

reconnect the wires. If the leak persists, replace the inline suction system.

Inline adapters for a metered-dose inhaler (MDI) or a small volume

nebulizer should be checked (SVN). Examine them for leaks or
disconnections, and tighten or reconnect the adapter connections if
necessary.

Examine the chest tube for leaks. If one is discovered, consult the
practitioner for additional interventions.

Ascertain that the proximal pressure line is connected and free of

obstructions.

b.) You get report on Mr. Smith, a 48-year-old intubated patient with
amyotrophic lateral sclerosis (ALS), disease in which muscle atrophy
progressively prevents the patient from being able to move or maintain adequate
ventilation. Mr. Smith can move only his facial muscles and his left thumb. The
nurse giving you report tells you that Mr. Smith has been withdrawn and tearful.
What communication methods might be most appropriate for him?

A communication board is a sheet of symbols, pictures, or photos that a

child will learn to point to in order to communicate with others.

BLINK TO SPEAK is the world's first eye sign language designed for
paralyzed patients who are unable to communicate. Blink to speak is a
collection of 50 commands that anyone can use to speak with their eyes. A
specific message was assigned to basic eye actions with the help of
patients and doctors, covering the most common phrases needed in daily
OPIANA, CHRISTIAN JOSEPH I.
BSN4 BLOCK 6
N036 NCM 118N
life. Patients who are paralyzed and have difficulty speaking can
communicate through their eyes. It benefits patients with ALS / MND
(Amyotrophic Lateral Sclerosis / Motor Neuron Disease), Spinal Cord
Injury (Quadriplegia - paralysis below the neck), Stroke, Cerebellar Ataxia,
Multiple Sclerosis, Cerebral Palsy, Head Injury, Parkinson's Disease,
Muscular Dystrophy, and any other Neuro-degenerative disorder. Patients
on mechanical ventilation who are alert can also use it. Patients in an ICU
(Intensive Care Unit) or those using Bi-pap, C-pap, or a home ventilator
are examples. This language will make it easier for patients to
communicate with caregivers and family members. It can be a permanent
or temporary communication aid.

Select the Appropriate Environment

Speaking can be exhausting for ALS patients who still have the ability to speak. It
can be even more exhausting if they feel the need to speak above background
noise and other people's conversations. Caregivers can assist by turning off the
television, radio, or other sources of noise. Caregivers can also assist the
individual in moving to a quieter room.

Slow Down the Discussion

Because the muscles do not work well when speaking quickly or at a normal
pace, words may be unclear. Caregivers can encourage their loved one to slow
down and speak as clearly as possible. Listeners must be patient and give the
ALS patient as much time as they need to express themselves.

Allow Rest Periods Before Conversation

If someone are aware that someone will be calling or visiting the family member,
encourage them to rest for a short period of time beforehand. Allow them to sit
quietly without speaking so that the muscles used for speaking can rest.

Consult a Doctor About Augmented Speech

Signs and pointing at a letter board are two ways to communicate without
speaking. There are even electronic devices that can track eye movement and
speak for the user, such as the one used by the late scientist Stephen Hawking.
Family caregivers can discuss options with the person's doctor or another
member of the medical team.