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Acid-base balance
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Patient number 1 has a normal ABG except for the PaO2, which is 229. The FIO2 is way too high and should be decreased.” Although supplemental oxygen is valuable in many clinical situations, excessive or inappropriate supplemental oxygen can be deleterious”(Sawatzsky, D. 2016). The question is how far should the FIO2 be decreased. I would titrate the FIO2 down by ten every hour, and watch the patients pulse oximetry to ensure the patient does not desaturate. Patient number 2 has had exploratory abdominal surgery. His ABG shows an acute respiratory alkalosis. “ Hyperventilation is typically the underlying cause of respiratory alkalosis. Hyperventilation is also known as over breathing. Someone who is hyperventilating breathes very deeply or
-The patient was having pitting edema and inspiratory rales because the increase of sodium caused an increase of fluid in the vascular system and lungs.
1. Nine year old Jerry stumbled into a drug store, which is usually open late with very few attendants, gasping for breath. Blood was oozing from a small hole in his chest wall. When paramedics arrived, they said that Jerry had suffered a pneumothorax and atelectasis. Just what do both these terms mean and how do you explain his respiratory distress? How will it be treated?
Mrs. Jones, An elderly woman, presented severely short of breath. She required two rest periods in order to ambulate across the room, but refused the use of a wheel chair. She was alert and oriented, but was unable to speak in full sentences. Her skin was pale and dry. Her vital signs were as follows: Temperature 97.3°F, pulse 83, respirations 27, blood pressure 142/86, O2 saturation was 84% on room air. Auscultation of the lungs revealed crackles in the lower lobes and expiratory wheezing. Use of accessory muscles was present. She was put on 2 liters of oxygen via nasal canal. With the oxygen, her O2 saturation increased to 90%. With exertion her O2 saturation dropped to the 80's. Mrs. Jones began coughing and she produced large amounts of milky sputum.
The first test showed a decrease in blood pH and a major increase in the partial pressure of oxygen. The patient was placed on a ventilator during surgery on the date of admission, which could be the reason as to why his partial pressure of oxygen was increased. The patient’s blood pH was low in the first test. While it was barely in the normal range, the patient’s bicarb was close to being low as well. The patient was injured which resulted in fluid shifts that could have affected the amount of bicarbonate in the patient’s blood, resulting in a decrease in the blood’s pH. This means the patient was at risk for metabolic acidosis. The next day the patient’s blood pH had increased to a normal level and the bicarbonate level had also increased. The patent’s partial pressure of oxygen had also decreased, due to a decrease in the fraction of inspired oxygen, possibly from changes to the setting of the
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 ... ...
Darien is a patient who possibly displays comorbidity. His symptoms lead me to believe that he could possibly be diagnosed with obsessive-compulsive disorder and generalized anxiety disorder. Darien’s symptoms that point to OCD are that he has rituals he must complete and if he does not he becomes anxious and is unable to continue with his day. He is however aware that these rituals are not actually helping him but he cannot stop doing them. He also reports feeling anxious most of the day, especially if he cannot perform his rituals, and that he is becoming increasingly more anxious. He is also unable to keep himself from worrying and feeling anxious.
A 61-year-old gentleman was admitted on 25/1/2016 to Letterkenny General Hospital with central chest pain after history of a fall. He also had drastic weight loss and loss of motor and sensory function. He walks with the aid of a walking stick as he has problems walking due to his lower limb weakness. The patient was a heavy smoker of 90 pack years (3 packs/day for 30 years) and stopped nine years ago. He stopped drinking seven years ago. He is married and lives at home with his wife. He works as a plasterer. He has a strong family history of ischaemic heart disease and type 2 diabetes mellitus. Two of his brothers had coronary bypasses and stents. His father died of a myocardial infarction. Two of his brothers are also type 2 diabetics. During
Pritesh has a previous medical history of asthma and has experienced right-sided haemothorax as he got hit by a hockey ball during a competition. Currently, the nurse suspects that Prithesh may be developing tension pneumothorax which is a life-threatening medical emergency (Brown & Edwards, 2012). Tension pneumothorax develops when a hole in the airway structures or the chest wall allows air to enter but not leave the thoracic cavity (Rodgers, 2008). The pressure in the intrathoracic space will continue increase until the lung collapses, place tension on the heart and the opposite lung leading to respiratory and cardiac function impairment, and eventually shock may result (Professional guide to pathophysiology, 2011; Rodgers, 2008). Tension pneumothorax usually results from a penetrating injury to the chest, blunt trauma to the chest, or during use of a mechanical ventilator (Brown & Edwards, 2012; Rodgers, 2008).
Client Profile: Lane Bronson is a 55 year old male with a history of angina, hypertension, Type 2 diabetes, COPD, and sleep apnea. He comes to the physican’s office complaining of worsening shortness of breath. His skin tone is grey, and his angina is worsening. Previously stable, he now does not get relief from rest or nitroglycerin. The physician called 911 and had Mr. Bronson directly admitted to the hospital.
The purpose of this paper is to identify a quality safety issue. I will summarize the impact that this issue has on health care delivery. In addition, I will identify quality improvement strategies. Finally, I will share a plan to effectively implement this quality improvement strategy.
would not deny his prescription; however, I would inform Jack that I am going to refill his Crestor medication for one month only to last until he is seen in the office. I would have Jack schedule an office visit within the month for assessment and lab work before hanging up the phone.
Alveolar hyperventilation causes a decreased partial pressure of arterial carbon dioxide (PaCO2). The decrease in PaCO2 increases the ratio of bicarbonate concentration to PaCO2 which increases the pH level. The decrease in PaCO2 develops when a strong respiratory stimulus causes the respiratory system to remove more carbon dioxide than is produced. Respiratory alkalosis can be acute or chronic. Acute respiratory alkalosis is when the PaCO2 level is below the lower limit of normal and the serum pH is alkalemic. Chronic respiratory alkalosis is when the PaCO2 level is below the lower limit of normal, but the pH level is relatively normal or near normal. Respiratory alkalosis is the most common acid-base abnormality observed in patients who are critically ill. It is associated with numerous illnesses and is a common finding in patients on mechanical ventilation. Many cardiac and pulmonary disorders can occur with respiratory alkalosis. When respiratory alkalosis is present, the cause may be a minor or non–life-threatening disorder. However, more serious disease processes should also be considered in the differential diagnosis (Byrd, 2017). Hyperventilation is most likely the underlying cause of respiratory alkalosis. Hyperventilation is also known as over breathing (O’Connell, 2017).
...o those patients with chest pain, in order to maintain oxygen saturations as close to 100%, unknowingly realizing that the patient is being exposed to significant periods of hyperoxia (Moradkham & Sinoway, 2010 ). It has been suggested that this is due to poor monitoring skills by health professionals. (Moradkham & Sinoway, 2010 ). From reading this essay it is clear that there is a high demand and need of further clinical research into the effectiveness of oxygen in the client with chest pain. More research also has to be conducted in order for the health professionals to fully understand what oxygen does to the body. Through completing and implementing more updated and reviewed evidence and research on the effect of oxygen on the client with chest pain, a better practice can be put in place to ensure the patient is receiving the best care to save their life.
(Royal United Hospital Bath Trust, 2007) Hence I chose breathing and maintain safe environment as in this stage they are the most important and also because ‘surgery causes physiological stress’ in the body. (Torrance and Serginson 2000 as cited in Huges, 2004) Immediate post-operatively, it carries the risks of shock and haemorrhage and my primary goal is to ensure that John’s recovery is as well as possible. (Newton, 1991 and Huges, 2004 and Nursing Times, 2013) And also his surgery was under general anaesthesia hence it is important to observe for any signs of changes in respiration that could indicate respiratory depression/failure. In order to maintain safe environment for John, his breathing would also come under same topic as if his breathing is impeded then his safety is not
My first patient that I started as student nurse on one of the long Rehab Center was a seventy two year old man who had Clostridium difficile (C.diff), Dementia, Hip replacement, and Obesity. Due to the above sickness he had many complications. I can still remember his face suffering from pain. Because of his lack of ambulation and incontinence, he had developed a very serious pressure ulcer under his sacral area. I went through to the room with my instructor and the instructor introduces me for the patient as his student nurse from Towson University and will taking care of him. However the patient was not happy and he becomes a challenging patient in my first experience day. But I may learned more from that challenging patient for my future experience.