Postoperative Day 1• The patient’s lung function continues t…
Postoperative Day 1• The patient’s lung function continues to worsen ventilator settings include 100% FIO2 and high levels of PEEP.• The patient has developed acute renal failure• There is an advance directive in the patient’s record indicating that this patient does not want to be kept alive by artificial means.Subjective Data• Patient is unable to communicate.• Family is at the bedside and voicing concerns and questions regarding the patient’s progress.Objective DataPhysical Examination• General: Head of bed elevated 45 degrees; skin cool with moderate diaphoresis• Respiratory: Endotracheal tube in place with mechanical ventilation. No accessory muscle use, retractions, or paradoxic breathing; respiratory rate 28 breaths/min; SpO2 92%, bilateral crackles at lung bases. Ventilator settings: A/C – Tidal Volume 450/mL, FIO2 100%, Respiratory Rate 10/minute, PEEP 10/cm H2O, pressure limit 35cm H2O.• Cardiovascular: Apical-radial pulse equal, BP 100/60mmHg• Weak peripheral pulses; temperature 101° F (38.3° C) rectally• Gastrointestinal: Surgical dressing dry and intact; colostomy draining serosanguineous drainage• Urologic: Indwelling bladder catheter draining concentrated urine less than 30mL/hrDiagnostic Findings• ABGs obtained 4 hours following intubation: pH 7.15, PaO2 59mmHg, PaCO2 57mmHg, HCO3 16mEq/L, O2 saturation 86%.• Chest x-ray: new bilateral, scattered interstitial infiltrates compatible with an ARDS pattern as interpreted by the radiologistWhich assessment finding obtained by the nurse indicates the need for suctioning?
Read DetailsPostoperative Day 2• There is an advance directive in the pa…
Postoperative Day 2• There is an advance directive in the patient’s record indicating that this patient does not want to be kept alive by artificial means.The patient remains in acute renal failure.Subjective Data• Patient is unable to communicate.Objective DataPatient was medicated with a 10mg bolus of morphine due to restlessness.Physical Examination• General: Sedated, head of bed elevated 45 degrees; skin cool with moderate diaphoresis• Respiratory: Endotracheal tube in place with mechanical ventilation. No accessory muscle use, retractions, or paradoxic breathing; respiratory rate in phase with ventilator, bilateral crackles at lung bases. Ventilator settings: A/C – Tidal Volume 450/mL, FIO2 100%, Respiratory Rate 10/minute, PEEP 10/cm H2O, pressure limit 35cm H2O.• Cardiovascular: Apical-radial pulse equal, BP 100/60mmHg• Weak peripheral pulses; temperature 101° F (38.3° C) rectally• Gastrointestinal: Surgical dressing dry and intact; colostomy draining serosanguineous drainage• Urologic: Indwelling bladder catheter draining concentrated urine less than 30mL/hrDiagnostic Findings• Arterial blood gas results include a pH of 7.20, PaO2 of 88 mm Hg, PaCO2 of 60 mm Hg, and HCO3– of 18 mEq/L. What changes to the ventilator settings will the nurse anticipate?
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Which nursing interventions should be included for the patient who has full thickness and deep partial thickness burns to 50% of their body who is receiving hydrotherapy for debridment and open method of wound care? (Select all that apply)
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