Page 56 - Critical Care Nursing Demystified

Chapter 2 CARE OF THE PATIENT WITH CRITICAL RESPIRATORY NEEDS 41

1. Move marker to bottom of peak flow scale.
2. Have the patient take the deepest possible breath.
3. Have patient blow it out as hard and as fast as he or she can into the meter.

4. Repeat the process two more times.
5. Then take the highest of the three numbers to get the patient’s peak flow
result.

APPLYING IT—A PATIENT WITH ASTHMA
A A PPL Y
A e
A 35-y
A 35-year-old male patient is admitted to the ECU with a diagnosis of acute
respiratory failure due to asthma. He is allergic to pollen and pet dander.
respira
He has taken his fast-acting bronchodilator at home four times without
He has
any change in his condition. Since he has lost his job he acknowledges that
he has stopped taking his anti-inflammatory medication. He is tachypneic,
hypertensive, states he has “chest tightness,” and is struggling to breathe.
He brings in his records from several months ago that document his
peak expiratory flow rate (PEFR). He believes his normal value is around
600 mL. You perform a PEFR and find the values to be 250, 200, and 150. Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
What do these PEFR values indicate? What would you anticipate as orders
for this patient?
✔ A
ANSWER
The PEFR is the highest of the three numbers that are recorded. In this case
T
the PEFR is 250, which is less than 50% of this patient’s past-recorded value of
600 mL. Anticipate the following orders: Nebulizers using a bronchodilator
like epinephrine would be used first to increase the diameter of the bronchial
tubes and ensure that following medications will get to the alveolar levels.
Benadryl and IV corticosteroids, depending upon the severity of the attack,
may also be added. Intubation with an endotracheal tube may be needed if
his attack and symptoms do not improve with treatment.

Oxygen Delivery Systems

3 Oxygen delivery systems are titrated according to the SaO , the ABGs, and
2
patient response. From the simple to the most complex, oxygen delivery sys-
tems consist of the following (see Table 2–5):