Page 717 - Clinical Application of Mechanical Ventilation

Case Studies 683

3. Bedside spirometry (PEFR, FVC, FEV ) on initial visit, then every 6 months
1
and prn
4. Pedal edema (present or not)
5. Exercise tolerance—using vital signs and subjective response as indicators

6. Saturation on room air—at rest and with exertion (walking with distance
recorded)

7. Saturation on oxygen—at rest and with exertion (walking with distance re-
corded)

8. Sputum production—amount, color, and consistency
9. Subjective response from patient and family members
10. Patient compliance

NOTE: In order to have a successful outcome with home care, solid family support and
proper emotional well-being of the patient are crucial. Motivation and a positive attitude
on the part of the patient are essential in order to achieve a positive outcome. Any signs of
patient noncompliance, lack of family support, depression, lack of necessary resources, or
other emotional problems should be promptly reported to the physician so that these issues
may be addressed. If a home care nurse is also seeing the patient, then all information
should be shared so that the patient may receive the best quality care.

Patient Weekly Progress

Week 1. F.W. stayed in bed most of the time and got up only to go to the bathroom.
Nocturnal bilevel ventilation was used at 10/5 cm H O with 1 L/min titrated through
2
the nasal mask. Other parameters on the ventilator were: backup frequency 6/min, and
expired tidal volume between 535 and 700 mL. Nebulizer treatments were done QID
and incentive spirometry was done TID. Patient was able to achieve 800 to 1,000 mL
on the incentive spirometry. Patient appeared to be compliant with her medications.
Her weight was 235 lb with no signs of pedal edema. Vital signs were BP 150/84 mm
Hg, f 24/min, HR 82/min, resting SpO 91% on 1 L/min and 88% on room air.
2
Patient had a positive attitude and excellent family support. She was excited
about getting better and used the nocturnal ventilator 6 to 8 hours every night. She
claimed that she was still very tired and sore from her hospital stay.

Week 2. F.W. had improved a great deal. She was walking to the kitchen and watch-
ing television in the living room. She remained on 10/5 cm H O of bilevel PAP
2
with 1 L/min O at night and 1 L/min per nasal cannula continuously during the
2
day. Vital signs were: BP 130/68 mm Hg, f 16/min, HR 84/min, SpO 94% on
2
1 L/min resting and 89% to 90% on room air. Her weight was 218 lb. No pedal
edema noted.
F.W. was in good spirits and compliant with regime.

Week 3. The expired tidal volume was 800 to 1,000 mL on 10/5 cm H O of bilevel
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PAP. This indicated an improvement of pulmonary mechanics. She also was able to

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