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Your patient had an exacerbation of COPD. The rapid response team was
called and is currently intubating the patient and preparing him for
transfer to ICU. When the family visits, they are shocked to see the
people working with the patient. No one had told them the patient had
deteriorated and required intubation. After the patient is intubated and is
being wheeled past them, family members try to communicate verbally
with the patient, but he does not respond except to gesture. The nurse
should tell the family members:
-They must leave the area because they are exciting the patient.
-The tube used for breathing prevents the patient from speaking
-They must speak with the doctor, who will explain why the patient
cannot speak
-The patient is very ill and may die. - ANS - The tube used for breathing
prevents the patient from speaking
This is a case where communication is clearly the problem. The family
should have been informed by someone that the patient needed
assistance with breathing and that they should expect a transfer. It
should also have been mentioned how the patient might look in the ICU.
,In addition, it could have been communicated about the patient's
inability to speak.
The other answers are all non-theraputic responses. The family is clearly
distressed, so a simple explaination in best.
Ben was just transferred to the PCU. He had been in ICU for 2 weeks. Ben
was intubated for a time because of his ARDs. On arrival to your unit, you
note that he is tachycardic and restless. Ben states, "I can't be here now.
What if something like this happens to me again?" The nurse's best
response would be:
-The nurses in our unit can take care of you
-We are not very far away at the nurses' station
-Your insurance will not cover another day there
-You sound concerned about leaving the ICU - ANS - You sound concerned
about leaving the ICU
Theraputic communication occurs when the patient's feelings are
validated. This response allows for the patient to express the concerns he
has about the transfer. The other answers are closed and judgmental and
do not allow for any expression of feeling from the patient.
Ben was just transferred to the PCU. He had been in ICU for 2 weeks. Ben
was intubated for a time because of his ARDs. On arrival to your unit, you
note that he is tachycardic and restless. A set of blood gases drawn just
prior to his transfer show:
,pH 7.52, PaCO2 31, HCO3 22, PaO2 87.
These results would indicate:
-Respiratory acidosis
-Respiratory alkalosis
-Metabloic acidosis
-Metabolic alkalosis - ANS - Respiratory alkalosis
Ben was quite anxious and tachycardic. His RR probably was increased
because of both anxiety and his condition.
He would blow off CO2.
His pH is below normal, so it is uncompensated.
The HCO3 is low, indicating alkalosis
The interpretation would be:
Uncompensated Respiratory Alkolosis
Ben was just transferred to the PCU. He had been in ICU for 2 weeks. Ben
was intubated for a time because of his ARDs. On arrival to your unit, you
note that he is tachycardic and restless. Ben is finally released from the
hospital. He plans to visit his family in Denver. Part of the patient
teaching for Ben should include information on the effects of high
altitude on his ability to oxygenate effectively. Which of the following
changes would be expected on his blood gas results?
, -The pH would decrease
-No effect
-The O2 saturation would decrease
-The PaO2 would increase - ANS - The O2 saturation would decrease
At higher altitudes, there is decreased atmospheric pressure to force
oxygen into the lungs. To compensate for the lower pressure, the person
must breathe faster. The percentage of oxygen remains the same, but the
partial pressure of the oxygen decreases. Aterial PaO2 decreases, as does
O2 saturation. The rapid breathing will result in hyperventillation, raising
the pH and lowering the PaCO2 level.
SaO2 values account for what % of O2 carreid within the bloodstream?
-2-3%
-10-24%
-97-98%
-100% - ANS - 97-98%
The % of total oxygen carried within the bloodstream attributed to the
SaO2 is 97-98%.
SaO2 is the arterial saturation of hemoglobin. The % corresponds to the %
of hemoglobin on the red blood cells that carries O2. Typically this % is
documented as normal when within 93-99%.