solved

S.K., a 51-year-old roofer, was admitted to the hospital 3 days ago after falling 15 feet from a roof. He sustained bilateral fractured wrists and an open fracture of the left tibia and fibula. He was taken to surgery for open reduction and internal fixation (ORIF) of all fractures. He is recovering on your orthopedic unit.
You have instructions to begin getting him out of bed and into the chair today. When you enter the room to get S.K. into the chair, you notice that he is agitated and dyspneic. He says to you, “My chest hurts really badly. I can’t breathe.” You auscultate S.K.’s breath sounds and find they are diminished in the left lower lobe. S.K. is diaphoretic and tachypneic and has circumoral cyanosis. BP 100/58. HR 110 and irregular.
The physician is notified and orders the following: STAT arterial blood gases (ABGs), continuous oxygen to maintain SpO2 greater than 93%, EKG, and a helical (spiral) CT of the lungs.
Arterial Blood Gases (ABGs)
pH 7.49
PacO2 33 mm Hg
PaO2 65 mm Hg
HCO3 24 mmol/L
Sao2 86%
The results of the CT scan indicate multiple pulmonary emboli obstructing perfusion to approximately 60% of the lung resulting in respiratory failure.
S.K. continues to have trouble breathing even with 100% high flow oxygen therapy. Respirations are shallow at 42 breaths/min. Mechanical ventilation is recommended by the physician to provide more adequate oxygenation and conserve her energy. A heparin drip and warfarin are also ordered. The patient is transferred to ICU.
List 5 priority nursing actions needed based on current status and include a rationale for each. Must be patient specific, no vague interventions.
Interpret S.K.’s ABG results and give the rationale for your interpretation. What type of respiratory failure is indicated by the ABGs? What else would cause this disorder?
What are the best practices to implement when caring for a patient on a ventilator? (ie: VAP prevention measures and care of the ventilator tubing)
What teaching points would be appropriate for the warfarin prescription? Be specific.

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