II. Objective
A. Physical Assessment Findings
1) Current Oxygen Device- The patient was intubated and was being mechanically ventilated and oxygenated via cuffed Endo-tracheal tube of size 4.0 mm as the patient weighed 10.5 kg (appropriate for the weight), which was secured on the left side at 13.0 cm at the gum (12 cm at the lips) (3 × 4 (ETT size) = 12 cm) with set FiO2 of 40% and PEEP of 5 cmH2O. A self-inflating Ambu bag and a mask were present at the bedside.
2) Ventilator Settings-
a) Mode- VC-SIMV/PS (Volume Control- Synchronized Intermittent Mandatory Ventilation/Pressure Support)
b) Set Parameters- FiO2 40%; Tidal Volume 70 ml; Peak Flow Auto-flow; RR 30/min; PEEP 5 cmH2O; Pressure Support 10 cmH2O; Minute Ventilation 2.1 L/min; Slope
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c) Measured Parameters- PIP 33 cmH2O; RRtotal 30/min; RRspon 0 s; I:E Ratio 1:2; MAP 11 cmH2O; PEEP 5 cmH2O; Tidal Volume Exhaled 61 mL; Spontaneous Tidal Volume 0 mL; Exhaled Minute Ventilation 1.81 L/min; Spontaneous MV 0 L/min; I-time 0.5 sec; E-time 2 sec; Humidifier’s Temperature 37.1°C
d) Alarms- High pressure 45 cmH2O; High MV alarm 5 L/min; Low MV alarm 0.5 L/min; High RR 70 s; Low RR 20 s; Apnea 20 seconds; High tidal volume 120
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8) Sputum:
a) Consistency: Thick
b) Amount: Large
c) Color: Cloudy
9) Previous Lab data
a) CBC
i. White Blood Cells- 11.59 10*3/µL ii. Red Blood Cells- 3.26 10*6/µL iii. Hemoglobin- 11.5 g/dL iv. Hematocrit- 31%
v. Platelets- 323 10*3/µL vi. Electrolytes- Sodium 137 mmol/L, potassium 4.3 mmol/L, chloride 100 mmol/L, BUN 13 mg/dL, creatinine 0.8 mg/dL, calcium 9 mg/dL.
b) ABG-
i. pH- 7.34 ii. PCO2- 56 iii. HCO3- 27 iv. PO2- 81
v. SaO2- 95%
c) Micro-
i. Rhinovirus- Positive
10) Previous Chest X-Ray-
a) The reason for chest X-ray was to evaluate the patient’s respiratory distress.
b) An anterioposterior technique was used for the chest X-ray.
c) Airway, trachea was in the middle, tip of the endotracheal tube ends at 2.2 cm above the carina in between the second and third thoracic vertebrae; Bones, there were no broken bones; Cardiac silhouette, normal; Diaphragm, right hemi-diaphragm was higher than the left with sharp costophrenic angles; Effusion, no pleural effusion or pneumothorax; Fields, subsegmental atelectasis noted in the left upper lobe, right upper lobe and right middle lobe; Endotracheal tube (ETT), and Nasogastric tube (NG) were seen on the
The risk factors that Jessica presented with are a history that is positive for smoking, bronchitis and living in a large urban area with decreased air quality. The symptoms that suggest a pulmonary disorder include a productive cough with discolored sputum, elevated respiratory rate, use of the accessory respiratory muscles during quite breathing, exertional dyspnea, tachycardia and pedal edema. The discolored sputum is indicative of a respiratory infection. The changes in respiratory rate, use of respiratory muscles and exertional dyspnea indicate a pulmonary disorder since there is an increased amount of work required for normal breathing. Tachycardia may arise due to the lack of oxygenated blood available to the tissue stimulating an increase in heart rate. The pedal edema most probably results from decreased systemic blood flow.
Examination revealed an oxygen saturation of 98% and blood pressure of 145/90. Oropharyngeal inspection revealed significant crowding (Mallampati class 3) with macroglossia. Chest auscultation was clear and two heart sounds were audible with nil else.
After the rinses, close the stopcock and fill the buret up to the 0.00mL line with NaOH. Quickly, open the stopcock to fill the tip of the buret and then close the stopcock. Record the initial volume of the NaOH to the nearest 0.01mL.
A total of 22 patients were admitted for the study, with 11 on the BiPAP side and the other half on the BiPAP using the AVAPS. Every patient had to be in a select range of APACHE II score within 4, age within 10, pH within.04, Glasgow Coma Scale within 2, and BMI within 2 points; also referred by a doctor who did not know about the study. Both of the groups received the same parameters for their BiPAP machines, including an IPAP of 12 cmH2O, EPAP as 6 cmH2O, a tidal volume 8-12 ml/kg of ideal body weight, respiratory rate of 15 bpm, rise time 300-400 ms, and finally Helsinki-based inspiration time at a minimum of.6 seconds. Arterial blood gases, maximum tidal volumes and IPAP, EVT, leaks, respiratory and heart rates, and blood pressure were all assessed every 1, 3, 12, and then every 24 hours.... ... middle of paper ... ...
British Thoracic Society, (2008), Guideline for Emergency Oxygen Use in Adult Patients, Thorax: an International Journal of the Respiratory Medicine, 63 (6), DOI: 10.1136/thx.2008.102947
Medical technology today has achieved remarkable feats in prolonging the lives of human beings. Respirators can support a patient's failin...
Parker, Steve. "Chronic Pulmonary Diseases." The Human Body Book. New ed. New York: DK Pub., 2007.
A Peak flow meter is a medical device that measures how well your lungs are able to expel air [2.1]. By blowing rough a mouthpiece a peak expiatory flow (PEF) reading can be found. This reading is measured in litres per minute and can be read directly from the device. When the person’s airways are more closed the lower the rate in which air can be blown out. The peak flow meters are used as a simple and efficient way of monitoring how well your lungs are and see if there functioning properly.
Ascertaining the adequacy of gaseous exchange is the major purpose of the respiratory assessment. The components of respiratory assessment comprises of rate, rhythm, quality of breathing, degree of effort, cough, skin colour, deformities and mental status (Moore, 2007). RR is a primary indicator among other components that assists health professionals to record the baseline findings of current ventilatory functions and to identify physiological respiratory deterioration. For instance, increased RR (tachypnoea) and tidal volume indicate the body’s attempt to correct hypoxaemia and hypercapnia (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). The inclusive use of a respiratory assessment on a patient could lead to numerous potential benefits. Firstly, initial findings of respiratory assessment reveals baseline data of patient’s respiratory functions. Secondly, if the patient is on respiratory medication such as salbutamol and ipratropium bromide, the respiratory assessment enables nurses to measure the effectiveness of medications and patient’s compliance towards those medications (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). Thirdly, it facilitates early identification of respiratory complications and it has the potential to reduce the risk of significant clinical
From looking at the results I can conclude that when the pH was 3 and
Rinse a 25mL buret with three 5mL portions of standard permanganate solution. Fill the buret with the standard permanganate solution and record initial and final readings.
0.1M HCl, 10 mL of 0.1N KMnO4, 0.2 g. KI, 5 mL of alcohol, and 5 mL of
This reflection of vital signs will go into discussion about the strengths and weaknesses of each vital sign and the importance of each of them. Vital signs should be assessed many different times such as on admission to a health care facility, before and after something substantial has happened to the patient such as surgery and so forth (ref inter). I learned to assess blood pressure (BP), pulse (P), temperature (T) and respiration (R) and I will reflect and discuss which aspects were more difficult and ways to improve on them. While pulse, respiration and temperature were fairly easy to become skilled at, it was blood pressure which was a bit more difficult to understand.
Data from this source will be collected through Internet searching and obtained documents in hard copies if they are available. Thus, I will go through those documents to be familiar with all aspects of CFM.
The patient has high temperature-sign of fever, a very fast pulse rate (tachycardia), and chest wheezing when listened to using a stethoscope (Harries, Maher, & Graham, 2004, p.