Please help me to understand this case

Please help me to understand this case as this will help me prepare better for my exam. P.R., a 66-year-old woman who has no history of respiratory disease, is being admitted to your intensivecare unit (ICU) from the emergency department (ED) with a diagnosis of pneumonia and acute respira-tory failure (ARF). The ED nurse tells you that PR. was stuporous and cyanotic on her arrival to the ED. Herinitial vital signs were 90/68, 134, 38, 101° F (38.3° C) with an Spo, of 53%. She was endotracheally intu-bated orally and placed on mechanical ventilation and has equal breath sounds. Her ventilator settingsare synchronized intermittent mandatory ventilation of 12/min, tidal volume (V-) 700 mL, Fio, 0.50, posi-tive end-expiratory pressure (PEEP) 5 cm H,O. The nurse tells you P.R. had an initial chest x-ray (CXR) exam-nation that confirmed the diagnosis of pneumonia, but she needs an additional CXR examination stat. 1. Describe the pathophysiology of ARF. 2. How does the underlying pathophysiology relate to PR.’s presenting signs and symptoms? 3. Describe each of PR.’s ventilator settings and the rationale for the selection of each. 4. Why does P.R need a second CXR cxamination?Chart ViewArterial Blood Gases (ABGs)ph7.28Pacity62 mm HgHOO26 mmol/LPad.48 mm HgSpo5395. The ABG results from the sample drawn in the ED before intubation are sent to you,Interpret PR.$ ABG results. 6. List eight collaborative care interventions that would be implemented for PR. and therationale for each. 7. What is your priority nursing goul at this time? 8. Describe six interventions you will perform over the next two hour based on this priority. 9. PR. is not heavily sedated and seems anxious about all that is going on. Describe how youcan help her.Chart ViewArterial Blood GasespH730Pach52mm HEHCO,22 mmol/LPad,70mm He5p0,80% 10. ABGs are redrawn after PR. has been on mechanical ventilation for 2 hours. What ventilatorsetting changes do you anticipate based on your interpretation of these values? Select all thata Increasing the PEEP to 10 cmb. Increasing the rate on the ventilator to 16/minc. Increasing the V, to 850 mL.d. Changing to continuous mandatory ventilation 11. Evaluate ench of the following statements about caring for P.R. or a similar patient receivingmechanical ventilation with an endotracheal tube (ETT). Enter T for true or F for false.Discuss why the false statements are incorrect.1.Administer muscic-paralyzing agents to keep PR. from “fighting the vent.”2. Check ventilator settings at the beginning of each shift and then hourly.3. When suctioning the ETT, each pass should not exceed 15 scconds.4. Assign experienced nursing assistive personnel (NAP) to take vital signs every 2 to4 hours,5. Perform a respiratory assessment once per shift.6. Empty excess water as it collects in the ventilation tubing back into the humidifier.7. Keep a resuscitation bag at the bedside.8. Monitor the cuff pressure of the ETT every 8 hours.9. Keep ventilator alarms silenced when in the room to maintain a quiet environment10. Change the ventilator tubing every 12 hours. 12. You hear the high pressure alarm sounding on the mechanical ventilator and sce that P.R.’sSao, is 80%. What are the potential causes of this problem?* 13. You determine that PR. needs to be suctioned. Place in order the steps for safely performingin-line or closed suctioning,1. Hyperoxygenate patient.2. Use 5 to 10 ml of saline to rinse the catheter clear of secretions.3. Insert catheter until reslstance is met or patient coughs.4. Assess patient’s status and document procedure.5. Put on clean gloves and face shicld; attach suction.6. Apply suction as you withdraw the catheter, not exceeding 10 seconds.7. Reassess patient status and suction again as needed. As PR.’S primary nurse, you are responsible for her nursing care plan. Although the primary concern isher respiratory status, you are concerned about hydration, nutrition, oral hygiene, and skin integrity anddecide to address each of these areas in PR’s plan of care. 14. Discuss five indicators you can use to assess ber fluid status. 15. Write a nutrition-related outcome for PR. 16. Describe five interventions that could assist In meeting PR.’s nutrition goals. 17. The goals for PR’s mouth care are to preserve the oral mucosa and dentition and preventPR. from developing a secondary ventilator assisted pneumonia. Identify three strategies forproviding oral hygiene with an ETT in place. 18. Identify three treatment goals related to skin and positioning. 19. You plan to asses P.R.’s skin every 4 hours. What are four other strategies that will incilitatethe expected outcome of maintaining skin integrity?

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