Page 716 - Clinical Application of Mechanical Ventilation

682 Chapter 19

Key Medications

1. 2.5 mg albuterol and 0.5 mg atrovent in 3.0 mL of 0.9% NaCl QID and prn
for wheezing

2. Lasix 20 mg po BID
3. Prednisone po tapering dose
4. Cardizem po

Home Care Plan

The plan was devised by the physician and respiratory therapist. The patient was
informed of the home care plan, as follows:
1. Maintain SpO of 90% to 96%.
2
2. Maintain tidal volume of 650 mL to 900 mL while on NPPV.
3. Use backup frequency of 6/min to ensure adequate ventilation if patient were
to become apneic.

4. Closely monitor patient for signs of CHF, hypercapnia, exacerbation of
asthma/COPD, and pulmonary infection.

5. Notify physician of complications secondary to withdrawal or tapering of
medications; specifically Prednisone and Lasix.

6. Increase exercise level as tolerated.
7. Improve diet and continue to lose weight. (F.W.’s height and weight: 5 ft 2 in
and 235 lb)
8. Educate patient on disease and promote a healthier lifestyle (F.W. had already
quit smoking 10 years ago).
9. Observe patient’s attitude and family support and report to physician.

Patient Monitoring

F.W. required close monitoring for the first month. The same respiratory therapist
visited her twice a week for the first 4 weeks and then once a week for the next
4 weeks. Routine monthly visits started in the third month.

NOTE: Nursing services were present in the home once a day for 2 weeks, and communi-
cation was established between the nurse (from a home care agency) and the respiratory
therapist (from a DME company). During each visit, patient assessment was done and
respiratory equipment was checked and serviced by the therapist.

Parameters monitored were as follows:
1. Tidal volume delivered via NPPV

2. Vital signs (BP, HR, f, SpO , weight, and breath sounds)
2

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