Lee Ann Wenner- Classmate Sims
After thirty minutes your instructor asks you to evaluate Mrs. Wenner during the spontaneous breathing trial. Which of the following would you now choose to assess?
-Ventilator graphics: No leaks, air trapping, or obstructions noted. -Vital signs: Temperature 37.2◦ C( 98.96◦ F ), pulse 120/min, spontaneous respirations 28/min, BP 133/88mm Hg -Color: Flush with some perspiration -Respiratory Pattern: Rapid and shallow -Pulse oximetry: 92% Gag reflex Serum electrolytes Lateral Chest radiograph -Breath Sounds: Vesicular breath sounds with late inspiratory crackles. Complete Blood count -Spontaneous VT: 145 ml Bedside spirometry -General Appearance: Tachypnic, diaphoretic, anxious.
Mrs. Wenner was successfully liberated from the ventilator after three days. The next phase in her rehabilitation is to wean her from her 7.5 mm ID tracheostomy tube. The instructor asks you to choose a replacement airway for the patient to facilitate this process. What would you now recommend?
6.0 mm ID Metal Tracheostomy tube 8.0 mm ID Standard Tracheostomy tube -7.5 mm ID Fenestrated Tracheostomy tube 7.0 mm ID Foam cuffed Tracheostomy tube Tracheostomy speaking valve
Mechanical ventilation is reinstituted on the following settings: VC, SIMV; VT 400 mL; f 10/min; FIO2 30%; 5 cmH2O PEEP. The next day you note that the Peak Inspiratory Pressure (PIP) is 27 cmH2O, the Plateau Pressure (PP) is 15 cmH2O, Spontaneous VT - 235 ml, SpO2 - 96%, bedside ECG shows normal sinus rhythm, BP 124/83 mmHg, Breath Sounds - Bilateral Vesicular, SVC 600 ml. The physician would like to attempt another Spontaneous Breathing Trial (SBT). The instructor asks you if there is anything that could be done on this attempt to promote a better outcome than yesterday. Which of the following would you now recommend?
Add Pressure Support of 20 cmH2O. Increase PEEP to 10 cmH2O. Change mode to NPPV. Increase FIO2 to 0.50. Increase the Inspiratory Time. Increase the Inspiratory Flow. Replace trach tube with CASS tube. Perform a "Huff" maneuver Perform before and after bronchodilator Spirometry. -Add Pressure Support to achieve Volume of 280cc.
The instructor asks you to make a recommendation for the patient care plan. You would now recommend:
Increase PEEP to 7 cmH2O -Begin spontaneous breathing trial (SBT) Maintain current settings Increase FIO2 to 0.40 Administer Albuterol Change mode to PC, AC
Based on your previous assessment, what action should you now perform?
Draw a STAT Arterial Blood gas Obtain a STAT Chest x-ray Increase FIO2 to 0.50 Add Pressure Support of 5 cmH2O -Reinstitute Mechanical Ventilation
You are a respiratory care student on a clinical rotation at an 88 bed Long Term Care Facility that specializes in weaning ventilator dependent patients. The staff respiratory therapist working there will be your preceptor for the day. You will be taking care of Mrs. Wenner who is 59 years old and is recovering from Guillain-Barre Syndrome. Mrs. Wenner weighs 110 lbs(49 Kg), and is 5' 3"(160 cm) tall. She has a tracheostomy and is presently on a volume ventilator. You now proceed to the bedside.Mrs. Wenner is presently being mechanically ventilated on the following settings: VC, SIMV; VT 400 mL; f 10/min; FIO2 30%; 5 cmH2O PEEP . The instructor asks you to evaluate the patient for a possible weaning trial. Which of the following would you now assess?
Edrophonium Challenge -AP Chest radiograph: few scattered infiltrates otherwise clear. 12 Lead electrocardiogram -Vital signs: Temperature 37.2◦ C( 98.96◦ F ), pulse 93/min, spontaneous respirations 15/min, BP 127/84mm Hg MRI of the head -Sensorium: Alert and oriented x 3 Ventilation perfusion scan Urinalysis -Maximum Inspiratory Pressure: 20 cmH2O -SVC: 560 ml Intracranial pressure -Serum Electrolytes: Na 138 mEq/L, K 3.8 mEq/L, Cl 101 mEq/L -Complete Blood Count: normal Sputum Culture and Sensitivity -Breath Sounds: Vesicular breath sounds with late inspiratory crackles. -Arterial Blood gas: pH 7.40, PaCO2 42 torr, PaO2 83 torr, SaO2 96% , HCO3 25 meq/L. P50 level Qs/Qt
