The patient is currently here for a CPAP titration study following a home cardiorespiratory monitoring test that revealed symptoms consistent with OSA. CPAP titration protocol was explained upon arrival. The patient expressed prior to hookup that he was unsure if he would be able to tolerate CPAP therapy due to nasal congestion that also affects his ability to initiate/ maintain sleep.
Lights off at 2218, supine quiet 96%. Beginning CPAP 5 CMH2O, mask is a Quattro (medium) full face mask. The patient started the study with a full face due to nasal congestion that would affect therapy.
2232 CPAP to 8 CMH2O for patient comfort. He stated he wasn't getting enough air at the lower pressures
2239 CPAP to 9 CMH2O for patient comfort he was still
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 ... ...
Fluid volume overload within the intervascular space can cause shortness of breath, fluid within the lungs, engorged neck veins, increased blood pressure and heart rate with a bounding pulse. As blood volume increases so will blood pressure and heart rate. Impaired gas exchange related to pulmonary congestion causes crackles within the lung fields. If oxygen saturation is low the nurse should supply supplemental oxygen. The nurse would raise head of the bed at least thirty degrees or higher to promote breathing and reduce cardiac pressure. Having the patient cough and breath deep can pop open alveoli to clear lung passages. Once the patient is comfortable and in safe position the nurse can call the doctor. The nurse should anticipate another dose of diuretics, such as furosemide. This treatment will decrease respiratory rate and blood pressure by reducing the amount of sodium and fluid within the body. Breath sounds will improve as crackles decrease. Maintaining appropriate fluid volume stabilizes blood pressure, cellular metabolism and proper nutrition gained or wastes lost. Supplemental oxygen if oxygen saturation is low and the nurse has already supplied the patient with oxygen. (Ignatavicius & Workman,
John B. Pollard, Ann L. Zboray, Richard I Mazze. The International Anesthesia Research Society. (1996).
As CO Casteel performed CPR on MOODY, CO Dodson arrived back in the cell with a pulse oximetry meter and placed it on MOODY’S right index finger. According to CO Casteel, the pulse oximetry meter reading indicated MOODY’S peripheral oxygen saturation was at 72 percent. After noting MOODY’S peripheral oxygen saturation, CO Casteel resumed CPR on MOODY as Regional Paramedical Service (RPS) personnel entered the cell and joined his efforts to revive
American Association of Nurse Anesthetists. Professional Aspects of Nurse Anesthesia Practice. Philadelphia: F. A. Davis Company, 1994. Print.
The ability to carry out and document a full respiratory and cardiovascular assessment is an essential skill. The severity of illness can be initially evaluated by inspection, palpation, percussion, and auscultation. During analysis, specific locations of symptoms can be identified using landmarks such as the midaxiallary, midclavicular, and, the midsternal line. Indicate anterior or posterior thorax, and use the midaxillary line location when applicable (Bickley & Szilagyi, 2013).
An electrocardiogram (ECG) is one of the primary assessments concluded on patients who are believed to be suffering from cardiac complications. It involves a series of leads attached to the patient which measure the electrical activity of the heart and can be used to detect abnormalities in the heart function. The ECG is virtually always permanently abnormal after an acute myocardial infarction (Julian, Cowan & Mclenachan, 2005). Julies ECG showed an ST segment elevation which is the earliest indication that a myocardial infarction had in fact taken place. The Resuscitation Council (2006) recommends that clinical staff use a systematic approach when assessing and treating an acutely ill patient. Therefore the ABCDE framework would be used to assess Julie. This stands for airways, breathing, circulation, disability and elimination. On admission to A&E staff introduced themselves to Julie and asked her a series of questions about what had happened to which she responded. As she was able to communicate effectively this indicates that her airways are patent. Julie looked extremely pale and short of breath and frequently complained about a feeling of heaviness which radiated from her chest to her left arm. The nurses sat Julie in an upright in order to assess her breathing. The rate of respiration will vary with age and gender. For a healthy adult, respiratory rate of 12-18 breaths per minute is considered to be normal (Blows, 2001). High rates, and especially increasing rates, are markers of illness and a warning that the patient may suddenly deteriorate. Julie’s respiratory rates were recorded to be 21 breaths per minute and regular which can be described as tachypnoea. Julies chest wall appeared to expand equally and symmetrical on each side with each breath taken. Julies SP02 levels which are an estimation of oxygen
Munoz, supra at 123. In this case, Dr. Vega did not follow proper protocol. Consequently, the risk or benefit of intubation was never discussed with the patient. Catherine was administered two blood oxygen test. After the second blood gas test, results became available showing Catherine’s condition had improved. Dr. Vega testified that the results, even if he had read them(he had not) would not have changed his decision to intubate Catherine.
The patient is a 55-year-old man admitted to the hospital for dehydration secondary to vomiting. The physical examination of the patient revealed dry mucous membranes and vital signs as follows: Pulse 110, blood pressure 100/60, and respirations of 20.
Medical technology today has achieved remarkable feats in prolonging the lives of human beings. Respirators can support a patient's failin...
Hess Dean R., M. N. (2012). Respiratory Care: Principles and Practice 12th Edition. Sudbury, MA: Jones and Bartlett Learning.
I was talking care of an 80 years’ elderly lady, who had sudden onset of fever and wheeze. Nursing notes from night before stated that patient has small choking episode at meal time. Upon assessment, patient had temp of 39.2, resp 32, SPO2 @ 82%, BP 170/110, pulse 110. Due to cognitive impairment, patient was unable to report any pain or discomfort but she was frowning, resisted getting changed or dressed. I requested
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
Therefore, I allowed my patient express herself with minimal interruptions. I asked for the character of the chest discomfort to note the likely cause but the shortness of breath was not thoroughly cross-examined by me. Although I asked for ankle swelling, fatigue and dizziness, I however did not ask for orthopnoea and paroxysmal nocturnal dyspnoea which the patient might have had. I also did not ask for the duration of each symptom episode which may have helped to assess the severity and prognosis of my patient. The review of systems revealed dry cough, ankle swelling, fatigue, exercise intolerance, dizziness, syncope, weight gain, cold intolerance, poor sight and limitation of movement but there were no history of weakness in her face or limbs, fever, wheezing,