Mr. C., age 68 years with a history of chronic obstructive pulmonary disease (COPD), entered the emergency department 2

[answerhappygod]

Mr. C., age 68 years with a history of chronic obstructive
pulmonary disease (COPD), entered the emergency department 2 days
ago, febrile with a productive cough of large amounts of purulent
sputum and in acute respiratory failure. He was diagnosed with
community-acquired pneumonia and treated with antibiotics,
hydration, aggressive pulmonary hygiene, and supplemental oxygen
therapy. Although his oxygenation improved, he continued to be
diaphoretic, using accessory muscles of respiration and
complaining, “I am exhausted” and “I can’t get enough air.”
Arterial blood gas revealed pH 7.31; partial pressure of carbon
dioxide (PaCO2) 59 mm Hg; partial pressure of arterial oxygen
(PaO2) 59 mm Hg; arterial oxygen saturation (SaO2) 88%; and
bicarbonate (HCO3–)29 mEq/L. The decision was made to intubate and
place him on mechanical ventilation with the following settings:
assist control (AC) mode; tidal volume (VT) 625 mL; respiratory
rate (RR) 16 breaths per minute; fraction of inspired oxygen (FiO2)
0.70; and 5 cm H2O of positive end-expiratory pressure (PEEP). He
was transferred to the critical care unit.
How can we confirm that Mr. C had respiratory failure? What type
of respiratory failure Mr. C had?
Analyze the ABGs of Mr. C? Complete analysis?
Why do you think Mr. C was put on Invasive Mechanical
Ventilation?
Discuss the Mode of ventilator and settings? Are they all
suitable at this stage?
Two days later, his presentation at 0500 hours is as
follows:
Ventilator settings: mode AC, VT 625 mL; RR 12 breaths per
minute; FiO2 0.35; PEEP 5 cm H2O
Total RR 16 breaths per minute, peak inspiratory pressure (PIP);
22 mm Hg
Moderate amounts sputum, rhonchi that is clear with coughing,
chest x-ray image showing clearing pneumonia
Temperature 37.2° C oral; heart rate 86 beats per minute; blood
pressure 132/84 mm Hg
No vasopressor or inotropic agents, urinary output is good, NPO
since admission
Alert and oriented to person, place, and situation;
hypervigilant and restless; has not slept well since
admission
Could we start thinking to wean Mr. C from the ventilator? If
yes, what are the bases of your answer?
What is the next mode in case you want to start weaning Mr. C?
Why?
Explain the complete process of weaning in case everything going
well with Mr. C; from the mode of AC until removing all types of
Oxygen?
The following day, he passes the prewean screening and is again
placed on pressure support (PS) 5 above 5 cm H2O PEEP. Assessment
findings 30 minutes into the weaning trial are as
follows:
Heart rate: 84 beats per minute
Blood pressure: 120/76 mm Hg
RR: 18 breaths per minute, unlabored
SpO2: 96%
Mr. C. is calm, cooperative, and oriented; therefore the weaning
trial is continued for 90 minutes. Arterial blood gas results were
pH 7.34; PaCO2, 48 mm Hg; PaO2, 74 mm Hg; HCO3–, 24 mEq/L; and
SaO2, 95%. The decision was made to extubate, and the patient was
discharged from the critical care unit the following day.
What were the results of Mr. C.’s last arterial blood gas
analysis? What factors contributed to these results?
Why is pressure support the mode used for the weaning trial?
Describe new trend used in weaning from mechanical ventilation
(read from recent literature)? Need Reference
Why we prefer that Mr. C O2 Saturation to stay between 88% and
93% and PaPO2 between 60 and 80 mmhg?
Write two main nursing diagnosis for Mr. C and 5 collaborative
interventions for each diagnosis?