Question

P.R., a 61-year-old woman who has no history of respiratory disease, is being admitted to your unit with a diagnosis of pneumonia and acute respiratory failure. ABGs in ER before intubation: pH 7.28 PaCO2 62mm Hg HCO3 26 mmol/L PaO2 48mm Hg SaO2 53% She was intubated in the emergency room and placed on mechanical ventilation. Her vital signs are 112/68, 134, 101° F (38.3° C) with an SaO2 of 53%. Her ventilator settings are synchronized intermittent mandatory ventilation of 12 breaths/min (BPM), tidal volume (VT) 700 mL, FiO2 0.50, positive end-expiratory pressure (PEEP) 5 cm H2O.. 1. Describe the pathophysiology of acute respiratory failure (ARF). 2. What assessment findings would you expect P.R. to exhibit? 3. Interpret P.R.'s ABG results that were drawn in the ER before intubation. 4. List three priority nursing interventions that would be implemented for P.R. and the rationale for each. 5. You hear the high pressure alarm sounding on the mechanical ventilator. What are the potential causes of this problem?

Answer 1

1.Pathophysiology

The causative factor here is pneumonia, wgichbhas led to accumulation of fluid in the alveolar sac.This has lead to impaired gas exchange resulting in decreased oxygen level making the patient gasp for oxygenated air ,this simultaneously leads to accumulation of carbon dioxide in the lungs increasing its levels.This leads to acid base imbalance decreasing the pH level causing respiratory acidosis with increase in carbon dioxide and bicarbonate levels.This affects the ventilator capacity of the lungs making the patient to show up with symptoms.

2.The assessment findings which can be expected are

Physical examination

• Breathing difficulties, decreased breath sounds ,tachypnea
• Confusion
• Cyanosis
• Restless
• Perspiration
• Arrhythmia  

Laboratory:

• Changes in ABG value
• Increased WBC due to infection from pneumonia

Diagnostic procedures

• Chest X ray showing collection of fluid

3.ABG

pH:decreased> acidosis

PaCo2 :increased> respiratory issue

HCO3:26 normal

The patient is in Respiratory Acidosis

4.Nursing intervention with rationale

• Maintain oxygen saturation with ventilation as the patient is having decreased oxygen and increased carbon dioxide
• Administer antipyretics as per order to reduce fe er
• Administer antibiotics as per order to treat infection or pneumonia
• Monitor the patient for complications

5.Some of the reason for high pressure alarm sounding are

• In case of the tubing in the ventilator has any blocks because of mucus or any kinks
• Presence of water or chest secretion can cause high alarm
• If the pressure is increased
• In case if the patient foes into hypoxia