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Question 6:What is the priority nursing diagnosis for M.B. and why?Decreased cardiac outputIneffective airway clearanceAltered tissue perfusionRisk for infectionAnxietyCase Study:M.B. is admitted to the critical care unit (CCU) in acute respiratory failure. M.B. has a 15-year history of chronic obstructive pulmonary disease (COPD). She smoked 2 packs of cigarettes/day for over 50 years. She quit just 4 years ago after suffering a myocardial infarction (MI) and undergoing a triple coronary artery bypass graft (CABG) surgery. Her past medical history is positive for hypertension, glaucoma, type 2 diabetes, and coronary artery disease. She also suffers from atypical musculoskeletal chest pain occurring after her CABG surgery. Her current medications include metoprolol 100 mg bid, fluticasone/salmeterol (Advair) one inhalation bid, albuterol/ipratropium (Combivent) 3 mL via nebulizer every 4 hours prn, metformin 500 mg bid,codeine 30 mg PO prn pain, lorazepam (Ativan) 1 mg PO prn anxiety, and betaxolol ophthalmic drops (Betoptic).Question 7:On M.B.'s admission to the CCU, you review lab work obtained in the emergency department (ED). Baseline (pre-intubation) arterial blood gas (ABG) results on 4 L of O2were as follows: pH 7.28, PaO260 mm Hg, PaCO262 mm Hg, HCO332 mEq/L, and O2saturation 84%. What other diagnostic studies would you also expect the health care provider to have ordered in the ED? There are 7 correct answers.
CBCCMPLFTs12 lead EKGCT scan of the brainUASputum cultureAlk phosCXRBlood cultureQuestion 8:M.B. was intubated in the ED and placed on positive pressure ventilation (PPV). What other interventions would you anticipate to be ordered for M.B.? Place an X in the correct boxChoicesAppropriateInappropriateAntibiotic therapyIV solumedrolFluid restrictionBronchodilator therapyIV sedationPosition patient with good lung upPosition patient with HOB above 30 degreesChest physiotherapyIV analgesiaHeated, humidified airDry, cool airQuestion 9:With initial application of PEEP, which assessment will be of highestpriority and why?Heart rateUrinary outputBlood pressurePeripheral pulsesWhy: Question 10:Instructions: Fill in the blank using choices below
M.B.'s high pressure alarm sounds. You assess M.B. for possible causes for this alarm, including bronchospasm, secretions, water in tubing, biting the endotracheal tube, and1. __________the ventilator.Choices:Disconnection ofFightingMalfunction of1.Question 11:After you suction M.B. and clear the ventilator tubing of fluid, the high pressure alarm continues to sound, and the patient's respiratory rate increases to 32 breaths/minute. Lung sounds reveal bibasilar crackles and her oxygen saturation is 95%. Which drugs would be appropriate to give atthis point(Select/circle all that apply, there are 2 correct answers)?