02 Oct Acute Respiratory Failure
38434For this assignment, you will provide detailed responses to the following questions.
A 32-year-old man presents to the emergency department with a 2-day history of fever and cough. His chest film shows a right middle lobe infiltrate. His room air ABG showed:
pH: 7.32
PCO2: 32 torr
PO2: 78 torr
HCO3- 18
He was started on antibiotics and admitted to the floor. Four hours later, the nurse calls because she is concerned he is doing worse. On your arrival to the room, his blood pressure is 85/60, his pulse is 120 beats/min and his oxygen saturation, which had been 97% on 2L oxygen via nasal cannula, is now 78% on a non-rebreather mask. The patient is obviously laboring to breathe with use of his accessory muscles and is less responsive than he was on admission. On the lung exam, he has crackles throughout the bilateral lung fields. The chest film now shows increasing bilateral, diffuse lung opacities. An ABG is done while on the non-rebreather and shows:
pH: 7.17
PCO2: 65
PO2: 58
HCO3- 16
Based on the clinical presentation of this patient, discuss how you would address the treatment. Include in your answer the following information: possible diagnosis, and what would be appropriate therapy (invasive vs noninvasive ventilation), and why?
Based on your choice of ventilation for this patient, discuss appropriate initial settings to properly ventilate this patient. Include and explain the following information in your answer:
If you choose noninvasive ventilation be sure to include IPAP and EPAP settings (defend your position). If you choose invasive ventilation be sure to include Mode of ventilation, Tidal Volume (VT), respiratory rate (frequency), oxygen percentage (FI02), Positive End Expiratory Pressure (PEEP) or any other therapy that may be indicated.
Submit your answers in at least 500 words on a Word document. You must cite at least three references in APA format and defend and support your position.
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