Question

R.B. a 55-year-old woman who presented to the emergency department (ED) via ambulance for acute shortness of breath. Her daughter called an ambulance after finding her mother with an increased respiratory rate and shortness of breath. Upon arrival to the ED, R.B.s respirations were 40 and shallow with wheezing in the lower lobes and rhonchi in the upper lobes bilaterally . She had positive jugular vein distention and a heart rate of 128. After treatment with albuterol nebulizer via mask , her vital signs were temperature 96.8 °Fpulse 98respirations 28, blood pressure 148/84, and O 2 saturation 94% with 15 LPM via mask . Arterial blood gasses showed her pH 7.19, pCO 2 90,PO 2 92\% , HCO ,38. R.B.was intubated for hypercapnia After an echocardiogram showed an ejection fraction less than 50 %, she had an emergency left heart catheterization done with two stent placements into the left anterior descending artery A pulmonary artery catheter was placed , and the initial hemodynamic readings show elevated left ventricular preload . R.B. is now being transferred to the intensive care unit (ICU ).

On arrival to the ICU, R.B. begins to thrash, kick her legs, and wave her arms. The portable transport ventilator alarms are ringing. What is the priority nursing assessment?

Question 2

During the assessment, it was noted that R.B. partially extubated herself and now must be reintubated. What equipment is needed?

Question 3

After reinserting R.B.’s endotracheal tube, how is placement verified?

Question 4

After R.B. is reintubated and sedated, you notice there is no waveform on the monitor for the pulmonary artery catheter. List the initial nursing trouble shooting interventions.

Question 5

You obtain a set of hemodynamic monitoring values. Interpret these results.

Heart rate

110

Blood pressure

142/58

Cardiac output (CO)

4.06 L/min

Pulmonary artery

52/32 mm Hg

Central venous pressure (CVP)

10 mm Hg

Systemic vascular resistance (SVR)

1499 dynes/sec/cm-5

Pulmonary artery wedge pressure (PAWP)

16 mm Hg

Pulmonary vascular resistance (SVR)

549 dynes/sec/cm-5

Cardiac index (CI)

2.25 L/min/m2

Mixed venous oxygen saturation

SvO2 62%

Question 6

Describe each of R.B.’s ventilator settings and the rationale for the selection of each.

Question 7

How does PEEP lower CO?

Question 8

R.B. is started on intravenous dobutamine and sodium nitroprusside. How will these medications affect her hemodynamic status?

Answer 1

1) priority nursing assessment is to check the airway, if it is open or not. Due to airway constrictions, anaphylaxis or extubation the patient is unable to perfuse and thus show symptoms of kicking and thrashing. This can then cause seizures and hypoxia.

2) suction, syringe and laryngoscope with style is needed immediately.

3) Normal chest movement, increase in heart rate and laryngoscopy confirms intubation.

4) Trouble shooting for absent wave forms -

• Disconnect of monitoring system
• Incorrect scale in use
• Loose or cracked transducer dome
• or air in dome
• Defective transducer
• Inadequate pressure in pressure bag
• Check for kinks in the system
• Catheter tip or lumen totally occluded

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answered by: anonymous