Page 718 - Clinical Application of Mechanical Ventilation

684 Chapter 19

reach 1,600 mL on her incentive spirometer TID. Her weight was down to 208 lb
and she was ambulating more every week. No pedal edema noted.
Vital signs were BP 128/68 mm Hg, f 18/min, HR 70/min, SpO 97% on
2
1 L/min and 93% resting on room air. Ambulating SpO was 88% on room air
2
after walking just 25 ft, indicating that she continued to desaturate upon mild
exertion.
Auscultation revealed bilateral expiratory wheezes. Small amounts of brownish
sputum were noted. Bedside spirometry showed: PEFR 88 L/min, VC 1.69 L,
FEV 0.709 L.
1
F.W. continued to improve and remained positive about improving the quality
of her life.
Week 4. One month out of the hospital, F.W. remained stable. At this time she was
able to go grocery shopping and have her hair done. She used her portable M-6 cyl-
inders with a conserving device while she was out. According to both the patient and
her spouse, her sleep had increased to 8 to 10 hours per night and she no longer took
naps during the day. A decision was made to decrease her nocturnal ventilator pres-
sures to 8/5 cm H O due to the increasing expired volumes (1,100 mL). On bilevel
2
PAP of 8/5 cm H O, F.W. was more comfortable and had volumes of 650 to 850 mL.
2
NOTE: Tidal volumes were obtained with the patient in supine position and were monitored
for 20 min. This allowed the patient to relax in order to obtain more accurate readings.

Vitals and physical signs: BP 100/50 mm Hg, f 20/min, HR 78/min, weight 211 lb,
SpO 94% on 1 L/min. No pedal edema was noted. After ambulating 60 steps: HR 100,
2
f28, SpO 86%. SpO recovering within 3 min upon administration of 1 L/min O .
2
2
2
Complications

F.W. remained stable with no significant complications other than sinusitis for
6 months. During a routine visit almost 7 months after discharge, the therapist
notified the physician with this assessment:

Vitals: BP 165/85 mm Hg, f 22/min, HR 80/min, weight 224 lb., SpO 91% on
2
1 L/min, 1 to 21 pedal edema.
Auscultation: inspiratory and expiratory wheezes bilaterally (audible); diminished
in bases bilaterally.
Tidal volume on bilevel PAP of 8/5 cm H O 5 500 to 600 mL.
2
Patient’s husband reported that she was not sleeping well at night and her legs
were “jittering” during the night. He also stated that F.W. was falling asleep during
her meals and she frequently complained of headaches.
The respiratory therapist increased the nocturnal ventilator pressures to 10/5 cm
H O (expired volume of 800 to 1000 mL) and notified the physician promptly. An ap-
2
pointment was made to see the physician on the following day. As a result of the office
visit, the Lasix dosage was increased. She no longer experienced the signs and symp-
toms that were present prior to the visit, thus avoiding a possible hospital admission.

Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.