Page 98 - Critical Care Nursing Demystified

Chapter 2 CARE OF THE PATIENT WITH CRITICAL RESPIRATORY NEEDS 83

CASE STUDY 3

With the removal of an entire lung (pneumonectomy), there is a chance that the remaining
lung can not handle the work of breathing. Because all vital signs are elevated, it can not
be shock, as shock will trend the BP downward. This might be early respiratory failure. Do
a thorough lung assessment moving through all phases: inspection, palpation, percussion,
and auscultation. If protocol allows, get an ABG and a chest x-ray. Also look at the surgical
site: Is there bleeding, crepitus, and are the sutures intact? Call the surgeon to let him or
her know your fi ndings.

CORRECT ANSWERS AND RATIONALES

1. D. Lung compliance is the ease of distention of the lungs during inspiration. If the
patient uses more effort or work of breathing, then compliance of lung tissues have
decreased.
2. C. The patient who has aspirated gastric contents might go into shock from aspirating
acidic contents. There is no relationship of ARDS to chest tubes, open-heart surgery, or
MVAs unless the patient’s situation is complicated by shock.
3. A. Tachypnea, tachycardia, and hypertension can all be signs a patient is going into
ARDS. But the cardinal sign is a decreasing pO when the FiO is increasing. Hypoventi-
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lation and coma are very late signs, and peak airway pressure will increase. 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.
4. C. PEEP expands the alveolar surface area, therefore increasing pO and decreasing
2
pCO . PEEP increases the FRC and can only be used after the patient is intubated.
2
5. A. Although B to D are important in the care of the patient on MV, only A is included in
the IHCI ventilator care bundle.
6. D. A rebreather has a reservoir with flaps on the side of the mask that do not open and
close with breathing. It delivers less concentration than a nonrebreather, which has
flaps on the mask that close during inhalation and open at exhalation. This allows the
patient to breathe almost 100% FiO as he or she exhales most of the carbon dioxide
2
and inhales mostly oxygen. A Venturi’s mask gives precise concentrations of oxygen.
Humidity is given with masks and the highest FiO without MV is delivered by a non-
2
rebreather.
7. C. Louder breath sounds over the right chest wall indicate that the endotracheal tube
may be misplaced in the right mainstem bronchus and only one lung is being me-
chanically ventilated.
8. B. The other signs and symptoms are late. The nurse must catch that agitation and
confusion occur first!
9. D. Wheezes are musical sounds produced when the muscles between the upper air-
way structures constrict. Gurgles are mucus in the upper airways and usually clear with
coughing. B and C are unrelated.
10. C. The classic sign of ARDS is a dropping pO and rising pCO in spite of increasing
2 2
the oxygenation level. A metabolic acidosis might occur but it is not related to the
respiratory issues the patient has. Headache and substernal chest pain are not related
to ARDS.