Question

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) The first prority is to check ventilator is there any tubes are disconnected or any malfunction of ventilator setting,sometimes while vigorous movements the patient may pull.theETT or the tubing that may cause for out of the tube. Then check their vital signs, including pulse oximetry and the last arterial blood gas. Auscultate the chest and determine the RTT is in position and there is good bilateral air entry .Assess the patient for comfort, distress, pain, and hemodynamic stability. Ceck the ventilator settings and the parameters. Review the last order on the ventilator settings and see if they are the same ones on the ventilator.

2)Equipment needed for intubarion

• Laryngoscope for the confirm that light source is functional prior to intubation. ...
• Laryngoscope handle, No.
• Endotracheal (ET) tube.
• Stylet.
• Syringe, 10 mL (to inflate ET tube balloon)
• Suction catheter with canister
• Carbon dioxide detector (eg, Easycap)
• Oral and nasal airways.
• If video assisted means glidescope
• Bag and mask.
• Ventilator.with arranged settings
• If.medication means sedation.
• Cardiac monitor
• Crash cart as nearest
• Stethoscope

3)There are different methods for evaluation of tracheal placement of the ETT such as direct visualization of the endotracheal tube passing, auscultation of the lung and epigastrium, chest radiography, qualitative capnography (colorimetric carbon dioxide detector), quantitative capnography

4)There are a number of causes can be the reason for no wave forms in the monitor for o pulmonary artery catheter Tiny air bubbles in the tubing, a clot at the tip of the catheter, tubing that is “too” stiff or kinked and / or a catheter that is positioned against the wall of the blood vessel..make sure that the cathe is free from all .