Page 97 - Critical Care Nursing Demystified

82 CRITICAL CARE NURSING DeMYSTIFIED

ANSWERS

CASE STUDY 1

Uncompensated respiratory acidosis. The pH is below 7.35 indicting you have an acidosis.
The pCO is elevated indicating the acidosis is caused by the lungs retaining CO . The patient
2 2
has hypoxemia as the pO is below 80 and it is severe. The HCO level is normal indicating no
2 3
compensation is being done by the kidneys. The anion gap is normal (145 + 4) – (110 + 24) = 14.
Prepare to intubate this patient as he has severe acidosis, is severely hypoxic, and is hypercarbic.
A nurse might also prepare BiPAP as an alternative to intubation and steroids to help decrease
infl ammation.

CASE STUDY 2

1. As a critical care nurse, a very comprehensive assessment should be completed with-
out exception and must include the patient’s health history; occupation; comfort level;
physical, emotional, and respiratory status; medication history; vital signs; and diagnos-
tic results.
2. Since the patient has a diagnosis of COPD, acute respiratory distress, and URI (upper
respiratory infection)–flu-like symptoms, the nurse should be very aware of her tachy- 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.
cardia, tachypnea, and rapid shallow breathing. She is febrile. She has moist crackles
throughout both lung fields. She is diaphoretic and has marked circumoral cyanosis.
SaO is below normal levels especially since she is on a nonrebreather mask at 50%.
2
ABG results should be analyzed (see question 3). She has a moist, productive cough
with sputum that is thick and brown. Primary importance is given to maintaining a clear
airway and preventing the further compromise of COPD.
3. No! Since the patient has acute respiratory distress, she requires oxygen assistance to
carry the desired percentage of oxygen via hemoglobin to the tissues. Her current SaO
2
is 88% on 50% nonrebreather. This is not adequate. She is extremely hypoxic because
her oxygen level is below 80%. Her ABGs indicate a combined respiratory and metabolic
acidosis. Her pH is below 7.35 and her pCO is above 45, which indicate a respiratory
2
acidosis. Her HCO is below 22, which shows a metabolic acidosis. Larger drops in her
3
pH will result if she is not intubated immediately.
4. A sputum culture is a microbiologic examination of obtained sputum from the patient
either through suctioning or the patient’s own efforts of producing sputum from a pro-
ductive cough. It is sent to the laboratory for analysis and diagnosis of infection and to
determine if the strain is resistant to certain antibiotics. In this situation, the patient’s
sputum specimen contained numerous gram-positive diplococci, which will require
antibiotic therapy.
5. Chest x-rays are noninvasive studies that are useful to identify blood, air, fluid , infiltrates,
foreign bodies, and abnormal lung shadows. The chest x-ray on Mrs. F. M. shows lung
infiltrates, which frequently occur if fluid is retained from pneumonia. This in conjunction
with her positive sputum culture and her febrile stat could indicate she has pneumonia.