Interpretation of the Arterial Blood Gasses Results
Acute respiratory acidosis; significantly lower Pao2 (norm 80-95 mm Hg); 68% Spo2 does not present high risks of a complete loss of breathing.
Ventilator Settings
SIMV of 12/min means that the patient is getting twelve mandatory breaths provided by the ventilator per minute; it is important to note that she can take spontaneous breaths independently from the ventilator. Tidal volume refers to the amount of air between inhalation and exhalation without the application of extra effort. Since an average tidal volume in a healthy patient is 500ml, the increased tidal volume of 700ml will allow the patient to get the air out of her lungs before the next breath during mechanical ventilation. FiO2 at 60% and PEEP of 5 cm H2O points to the patient’s mild hypoxemia.
Ways to Verify ET Tube Placement
Recommended lab tests include the following:
- End-tidal carbon dioxide detectors evaluate the position of an endotracheal tube among patients with regular perfusion of tissue;
- Esophageal detector devices and a bronchoscopy in cases when capnography is inconclusive;
- Ultrasound can be performed to verify ET tube placement (only by experienced personnel).
Lab Tests
Lung function tests (FEV1 and spirometry); chest x-ray to rule out other conditions; arterial blood gas test (measures oxygen, carbon dioxide, and acid concentrations); oximetry (measures oxygen saturation in the patient’s blood); transfer factor for carbon monoxide (determines whether the lungs were damaged).
The Disease Process and Pathophysiology
COPD is a life-threatening disease that affects the ability to breathe and thus affects the lungs. Regarding its pathophysiology, first physical changes start when the airways and sacs in the lungs become damaged, progressing into a mucous cough and complications during breathing. It is highly likely that the cause of the patient’s COPD was smoking, which caused her airways to accumulate chemicals and make her vulnerable to the disease (Roland, 2016).
Additional Medications
Bronchodilators (e.g., tiotropium, salmeterol, arformoterol) can be used to relax the patient’s muscles around the airways, contributing to the relief in coughing, breath shortness, and make overall breathing easier. Long-acting bronchodilators are recommended in the patient’s case. Inhaled steroids (e.g., fluticasone, budesonide) are recommended to reduce inflammation in the patient’s airways and contribute to the overall prevention of further exacerbations (Mayo Clinic Staff, 2017). Short-term prescription of oral steroids (e.g., for several days) can reduce severe exacerbations and prevent COPD from developing further. Lastly, phosphodiesterase-4 inhibitors can be prescribed to decrease airway inflammation and relax the patient’s airways (Mayo Clinic Staff, 2017).
The Potential Causes of the Ventilator’s High-Pressure Alarm
High-pressure alarms may go off during coughing, secretion, or gagging, which cause condensation to collect in the tubing. Increased resistance and decreased compliance (pulmonary edema) can also contribute to the ventilator sending alarms for high pressure.
The Goals of the Therapy
The patient’s COPD management goals include prevention of the disease’s progression and relief of symptoms, treatment of exacerbations and complications, and improvement of the patient’s overall health status.
The Interventions to Help Prevent VAP
Interventions targeted at VAP prevention focus on stopping “the aspiration of secretion, the use of contaminated equipment, and the colonization of the aerodigestive tract” (American Sentinel University, 2013, para. 8). First, it is essential to use positive-pressure ventilation that will be non-invasive to the patient. Second, nurses should follow strict guidelines on hygiene before being in contact with the patient. Third, the patient’s oral hygiene should be maintained to prevent bacteria from gathering in the endotracheal tube. Fourth, the patient can be kept in a semirecumbent position to prevent aspiration (American Sentinel University, 2013).
Interventions to Address the Plan of Care
- Administration of prescribed medications such as bronchodilators, antibiotics, and corticosteroids;
- Promotion of infection control by encouraging the patient to obtain appropriate vaccines;
- Improvement of breathing patters (e.g., purse lip or diaphragmatic breathing);
- Administration of oxygen to maintain the patient’s flow rate at 2 to 3 L per minute;
- Elimination of smoking habits and avoidance of second-hand smoke;
- Implement pulmonary rehabilitation programs to educate the patient, give nutrition advice, recommend exercise training, and offer counsel if needed;
- Recommendation to visit a healthcare provider regularly to monitor the patient’s lung function (Mayo Clinic Staff, 2017).
References
American Sentinel University. (2013). How to prevent ventilator associated pheumonia (VAP). Web.
Mayo Clinic Staff. (2017). COPD. Diagnosis.
Roland, J. (2016). What is the pathophysiology of COPD?