GROUP B

ROMERO D.
ROMERO P.
RUFINO L.
SADDI E.
SANCHEZ D.
SANTOS A.
 CASE SCENARIO
P.R., a 61-year-old woman who has no history of respiratory disease, is being
admitted to your unit with a diagnosis of pneumonia and acute respiratory
failure. She was endotracheally intubated orally in the emergency room and
placed on mechanical ventilation. Her vital signs are 112/68, 134, 101° F (38.3°
C) with an SaO2 of 53%. Her ventilator settings are synchronized intermittent
mandatory ventilation of 12 breaths/min (BPM), tidal volume (VT) 700 mL, FiO2
50%, positive end-expiratory pressure (PEEP) 5 cm H2O.
1. Describe the pathophysiology of acute
respiratory failure (ARF). Brief only.
ARF can result from primary pulmonary pathologies or can be
initiated by extra-pulmonary pathology. Causes are often
multifactorial. Respiratory failure happens when the capillaries, or
tiny blood vessels, surrounding your air sacs can’t properly
exchange carbon dioxide for oxygen.The loss of the ability to
ventilate adequately or to provide sufficient oxygen to the blood and
systemic organs. The pulmonary system is no longer able to meet
the metabolic demands of the body with respect to oxygenation of
the blood and/or CO2 elimination.
2. What assessment findings would you expect P.R.
to exhibit?
1. Assessment findings P.R. would exhibit are rapidly progressive dyspnea,
tachycardia and hypoxemia.
The arterial blood gas (ABG) results drawn in the
emergency room before intubation are sent to you.
Interpret P.R.'s ABG results.
- Uncompensated respiratory acidosis with life- threatening low oxygen
levels which can lead to severe hypoxemia.
List 4 interventions that would be implemented for
P.R. and the rationale for each.
 Administer oxygen
Rationale: Because the patient have a decreased oxygen saturation
 Administer antipyretics
Rationale: To reduce the patient’s fever
 Suction using an endotracheal tube
Rationale: To make a clear airway for mechanical ventilation.
 Mechanical Ventilation or non-invasive positive-pressure ventilation
Rationale: Used for assisted breathing
5. After the insertion of the endotracheal tube (ETT),
how is correct placement verified?

 Esophageal Detector Device

 Chest X-Ray
6. Describe each of P.R.'s ventilator settings and the
rationale for the selection of each.
1. The SIMV of 12 bpm is a regular adult breathing pattern, therefore it's
programmed to generate a fixed tidal pattern to allow for spontaneous
breathing.
2. Tidal Volume of 700 ml is above normal which means that the patient is
supplied with extra volume to cope up with normal breathing.
3. Fio2 is usually maintained below 0.5 to avoid oxygen toxicity but in some
cases where saturation is very low 100 % oxygen can be used.
4. PEEP 5 cm of water is normal and is used to prevent a decrease in
functional residual capacity in patient with normal lungs.
7. Evaluate each of the following statements about caring for P.R. or a similar patient receiving mechanical ventilation
with an ETT. Enter “T” for true or “F” for false. Discuss why the false statements are incorrect.

1. __T___1. Administer mandatory muscle-paralyzing agents to keep the patient from “fighting the
vent.”
2. __T___2. Check ventilator settings at the beginning of each shift and then hourly.
3. __T__3. When suctioning the ETT, each pass should not exceed 15 seconds.
4. __ F ___4. Assign an experienced NAP to take vital signs every 2 to 4 hours.
5. __T___5. Perform a respiratory assessment once per shift.
6. __ F ___6. Empty excess water collects in the ventilation tubing back into the humidifier.
7. __T___7. Keep a resuscitation bag at the bedside.
8. _ T____8. Monitor the cuff pressure of the ETT every 8 hours.
9. __ F ___9. Keep ventilator alarms silenced when in the room to maintain a quiet environment.
10. __ F ___10. Change the ventilator tubing every 12 hours.
 You hear the high pressure alarm sounding on the
mechanical ventilator and see that P.R.'s Sao2 is
80%. What are the potential causes of this problem?
• Firstly, the pulse oximeter probe might be loose or put incorrectly, so
that should be readjusted and examined first in low O2 level reading.
9. Discuss five indicators that would help you assess
fluid status.
The five measures that helps us to assess the
fluid status of the patient are first we need to know
the elasticity of the monitor vs, skin turgor, hourly
monitoring of urine output, pitting edema and the
patient jugular venous distention.
 10. What are your nutritional goals for P.R.?

Since the patient is on ventilator. The goal for P.R. is to provide

adequate calories to support metabolic demands, to preserve lean body
mass and prevent muscle wasting. Rest should also be utilized to
conserve calories, as the diet objective is a high protein, high calorie
diet.
 11. Describe interventions that you could use to
assist in meeting P.R.'s nutrition goals.
-Provide adequate nutrition by a tube feeding by the third day of mechanical
ventilations
-Obtain a nutritional consult as needed
-Weigh the client daily
- Monitor I&O
- -If P.R cannot tolerate enteral feeding, comsider total parenteral nutrition
(TPN
- ) -Assess bowel function every 2-4 hours
 12. The goal related to P.R.'s mouth care is to
preserve the oral mucosa and dentition. Identify
three strategies for providing oral hygiene with an
ETT in place.
In ETT in place patients, first remove any dentures. • Use artificial saliva
(normal pH for mouth tid and prn to decrease the risk for an oral infection • Use
suction to remove any chlorhexidine from mouth but do not rinse. It gives
antibacterial activity against gram positive organisms.
 13. What is the rationale for not taking an oral
temperature near an ETT?

We are not taking an oral temperature near an ETT because

patient is inability to form a tight seal around the
thermometer by mouth due to ETT and the patient can be
sedated too. By that it provides inaccurate measurement that
does not reflect body temperature.
 14. You assess P.R.'s skin every 4 hours. Identify
three treatment goals in relation to skin and
positioning.
• Position the patient every 2 hours. To prevent skin breakdown in bedridden
patient and allows good circulation.
• Make sure the skin is clean and dry. Clean the skin with a mild soap and
warm water and rinse thoroughly. Gently pat dry.
• Overlays on mattress. To improve circulation and help prevent pressure
ulcers (bed sores).
 15. What four strategies will facilitate the expected
outcome of maintaining skin integrity?
The four strategies which helps in good skin integrity are change patient’s
position and provide back care every 2 hours of shift. Instruct a well-balanced
protein-rich food and maintain the patient's fluid status.
16. That afternoon, a powerful storm causes a power
failure. What do you do?

The RN must be aware of the structure and operation of backup electrical power
sources.Portable oxygen cylinder and resuscitation equipments and emergency
drugs must be kept ready for emergency
 
THANK YOU!