Pоstоperаtive Dаy 2• There is аn advance directive in the patient’s recоrd 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?
Pоstоperаtive Dаy 2• There is аn advance directive in the patient’s recоrd 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?
Pоstоperаtive Dаy 2• There is аn advance directive in the patient’s recоrd 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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