Patient Barry King is a 27-year-old, asthma patient with COVID-19, who now needs Mechanical ventilation due to respiratory failure related to complications from COVID. He currently weighs 75kg. His current vitals are as follows: RR-24, Breath sounds- coarse crackles in both lungs. His temperature is 102.3, BP- 152/100, HR- 115 bpm, FiO2 on 50% high flow oxygen and ABG results are:pH- 7.29, PACO2-58, PAO2-49, HCO3- 23. The MD wants you to suggest ventilator orders for RT to carry out. Please write reasonable orders and defend your order (include Vt, RR, Mode, PEEP, FiO2 and other procedures or orders that would help).
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- For each of the following Patient Profiles, determine the most appropriate triage category (red, yellow, green, or black), and why. patient profiles: 1. soaked with blood, no obvious killer bleed - tells you he feel dizzy - respirations : 28/min - radial pulse : non-palpable 2. lower extremities under wooden debris - tells you she can't move or feel her legs - respirations : 18/min - radial pulse : present 3. patient is face down on the floor - unresponsive - respirations : open airway, not breathing - carotid pulse : weak 4. patient gurgles but can't maintain an open airway - unresponsive - respirations : gasps - radial pulse : absent 5. patient has an open head wound, bleeding controlled - unconscious - respirations : 16/min - CRT : 2Ms. Monstera Peru, 21 year, was brought to the hospital with chief complaint of difficulty of breathing, chest pain, fever and diarrhea. She was admitted with the diagnosis COVID-19 Confirmed. Upon assessment of the admitting nurse, Ms. Peru’s vital signs are as follows: BP = 130/90, PR = 110 bpm, RR = 25 cpm Temperature = 38.9 degrees Celsius. Ms. Peru is using accessory muscle for breathing, have flushed skin and is holding her chest as if massaging it. Ms. Peru, told the nurse that “nahihirapan akong huminga” and “mamatay na baa ko.”Ms. Monstera Peru, 21 year, was brought to the hospital with chief complaint of difficulty of breathing, chest pain, fever and diarrhea. She was admitted with the diagnosis COVID-19 Confirmed. Upon assessment of the admitting nurse, Ms. Peru’s vital signs are as follows: BP = 130/90, PR = 110 bpm, RR = 25 cpm Temperature = 38.9 degrees Celsius. Ms. Peru is using accessory muscle for breathing, have flushed skin and is holding her chest as if massaging it. Ms. Peru, told the nurse that “nahihirapan akong huminga” and “mamatay na baa ko.” List 3 Nursing diagnosis, make a Nursing care plan. Present your nursing care plan according to priority.
- Ms. Monstera Peru, 21 year, was brought to the hospital with chief complaint of difficulty of breathing, chest pain, fever and diarrhea. She was admitted with the diagnosis COVID-19 Confirmed. Upon assessment of the admitting nurse, Ms. Peru’s vital signs are as follows: BP = 130/90, PR = 110 bpm, RR = 25 cpm Temperature = 38.9 degrees Celsius. Ms. Peru is using accessory muscle for breathing, have flushed skin and is holding her chest as if massaging it. Ms. Peru, told the nurse that “nahihirapan akong huminga” and “mamatay na baa ko.” complete the table below.A 40yo male presents to the emergency department with the chief complaint of shortness of breath (SOB). His past medical history (MHx) is remarkable for hypertension (HTN) and diabetes mellitus II (DMII). On examination, his oxygen saturation on room air is 87%, blood pressure 160/100 mmHg, and pulse rate is 93/min. His arterial blood gas on room air shows pH 7.44, PCO2 35 mmHg, PO2 55 mmHg. Assume that the RQ is 0.8. Given arterial pO2 and alveolar pO2, the following disease states are plausible... Group of answer choices Hypoxic hypoxia Ischemic/Stagnant hypoxia Histotoxic hypoxia Normal ventilation/perfusionA 40yo male presents to the emergency department with the chief complaint of shortness of breath (SOB). His past medical history (MHx) is remarkable for hypertension (HTN) and diabetes mellitus II (DMII). On examination, his oxygen saturation on room air is 87%, blood pressure 160/100 mmHg, and pulse rate is 93/min. His arterial blood gas on room air shows pH 7.44, PCO2 35 mmHg, PO2 55 mmHg. Determine the alveolar gas pressure. Assume that the RQ is 0.8. A. 52 B. 22 C. 107 D. 200
- Hemodynamic Monitoring Case Study: A 67-y.o woman is admitted to the ICU with a dx. of hypotension of unknown origin. She is presently unresponsive but is breathing spontaneously on her own. Lungs are clear, urinary output is 15ml in 8 hours, and her skin is cool. A PA catheter is inserted to obtain more information and guide therapy. The following information is revealed: BP 86/54mmHg PAWP 4mmHgP 118/min CVP 2mm/HgRR 30 breaths/min SVR 1393 dynesC.O. 3.5 L/min PVR 195 dynesC.I. 1.9 L/min SvO2 50%PA 24/10mmHg Which Values tell us about this patient's filling pressures/fluid status? Are these values adequate? Which Values tell us about this patient's contractility? Are these values adequate? Which values tell us about this patient’s vascular resistance? What is causing this patient's hypotension? Which initial therapy is appropriate?Case Scenario: John Doe, 53y.o., has a history of Type I diabetes mellitus, cigarette smoking 40 pack-years, CAD, and PVD. Six weeks ago, he developed a wound in his left heel which measured 4cm by 2cm when he discovered it. Despite IV antibiotics and chemical debridement, the wound developed a gangrene infection. He is scheduled for a BKA of the left lower extremity tomorrow at 10:00 am. His meds include daily insulin, aspirin 325mg/day, Pletaal 100mg BID. Question: Mr. Doe was very restless the evening before. He verbalizes to his wife that he is “scared to death” and worried about losing his foot. She asks the nurse what can be done to help him. How will the nurse address the psychological comfort of Mr. Doe? (Discuss in 2-3 sentences only)what is the triage category (red, yellow, green, black) for a 26 year old patient that walks over to me, has obviously mangled arms and crying because of how painful it is, and has a respiration of 22/min, and has 124 radial pulse?
- Case Scenario: John Doe, 53y.o., has a history of Type I diabetes mellitus, cigarette smoking 40 pack-years, CAD, and PVD. Six weeks ago, he developed a wound in his left heel which measured 4cm by 2cm when he discovered it. Despite IV antibiotics and chemical debridement, the wound developed a gangrene infection. He is scheduled for a BKA of the left lower extremity tomorrow at 10:00 am. His meds include daily insulin, aspirin 325mg/day, Pletaal 100mg BID. What preoperative testing is appropriate for Mr.Doe? (Give at least 4 priority examples) Note to Tutor: Thank you so much, Ma'am/SirCase scenario:Maria, a 55 year-old patient, was recently diagnosed with bronchial asthma. Her mother and three brothers also have asthma. In the past year, Maria has had three asthmatic attacks that were treated with prednisone and an albuterol inhaler. At a clinic visit today, prednisone is prescribed for 4 weeks and the order is written as follows:Day 1: 1 tablet four times a dayDay 2: 1 tablet three times a dayDay 3: 1 tablet two times a dayDay 4: 1 tablet in the morningDay 5: ½ tablet in the morningQuestions:1. Explain the purpose for the use of prednisone during the asthmatic attack. Explain why the dosage is decreased (tapered) over a period of 5 days.2. Can Cromolyn sodium be substituted for prednisone during the asthmatic attack? Explain your answer.Case Scenario: John Doe, 53y.o., has a history of Type I diabetes mellitus, cigarette smoking 40 pack years, CAD, and PVD. Six weeks ago, he developed a wound in his left heel which measured 4cm by 2cm when he discovered it. Despite IV antibiotics and chemical debridement, the wound developed a gangrene infection. He is scheduled for a BKA of the left lower extremity tomorrow at 10:00am. His meds include daily insulin, aspirin 325mg/day, Pletaal 100mg BID. Please make 1 intraoperative NCP with 1 diagnosis