Patient Profile Z.Q., 74-year-old Hispanic male, came to theemergency department (ED) 7 days ago with complaints of shortnessof breath. His wife stated that he had a history of hypertension,depression, and chronic obstructive pulmonary disease (COPD). Theadmission chest x-ray revealed dense consolidation of the leftlower lobe. An arterial blood gas (ABG) at that time showed: pH7.60, PaCO2 29 mm/Hg, HC03 32 mmol/L, and PaO2 75 mm/Hg. Z.Q.quickly deteriorated and subsequently was intubated. He has been inthe intensive care unit for 3 days. B. Subjective Data • Z.Q. andwife have been married 45 years and live with a daughter and 2grandchildren • Z.Q. and his wife speak both English and Spanish C.Objective Data Physical Examination • Blood pressure 167/98, pulse112, temperature 102.0° F, respirations 14, oxygen saturation 72% •Height 5 feet 6 inches, weight 75 kg • Patient localizes toendotracheal tube (ETT) and is intermittently aroused, makingseveral attempts to pull ETT • Orally intubated #7.5 ETT, taped at27 cm to lip • Volume cycled ventilator at FIO2 – 60%, in assistcontrol mode of 14 breath per minute, tidal volume 450, positiveend-expiratory pressure PEEP 5 cm H2O • Breath sounds decreased inbases with bilateral crackles that do not clear after suctioning •Brown/yellow secretions returned with suctioning • Peripheralpulses weak at 1/4 with capillary refill greater than 4 seconds •2+ pitting edema in the bilateral lower extremities Newly ObtainedDiagnostic Study Results • Arterial blood gas (ABG) pH 7.31, PaCO258 mm/Hg, HC03 28 mmol/L, PaO2 54 mm/Hg, EtCO2 38 mm/Hg • Chestx-ray reveals diffuse white out in middle and lower lobes;endotracheal tube present with tip well above the carina; leftsubclavian central venous catheter is located in the superior venacava • CT scan reveals alveolar opacities with increasing effusionsin the gravity-dependent areas of the lungs
5. Based on the assessment data, what are the nursing prioritiesfor Z.Q.? 6. What measures should be part of Z.Q.’s care to promoterespiratory function? 7. List three potential adverse complicationswith mechanical ventilation. 8. You are concerned about Z.Q.’snutritional status and approach the physician for a dietaryconsult, thinking that Z.Q. is a candidate for enteral feedingswith Pulmocare. What is your reason for making thisrecommendation?
