Assignment

Length: 2500 Words

Participants are required to adhere to the following points:

• An introduction and conclusion is not required

• Keep to the recommended word limit for each question

• Support your assignment with a minimum of twenty contemporary (< 5 years old)

medical and nursing articles

• Reference all work using either American Psychological Association (APA) or modified

Harvard for academic writing

• A pass in all questions is required to gain an overall pass mark

• Refer to the marking criteria for allocation of marks.

__________________________________________________________

Kerry, a 68 year old female weighing 76kg, is admitted to the Intensive Care Unit (ICU)

with Community Acquired Pneumonia (CAP).

On admission her initial observations were:

 

• Temperature 386 degrees Celsius

• Heart rate 110b/min

• Blood Pressure 110/60mmHg

• Respiratory Rate 36b/min

• Oxygen saturation 89% on a non-rebreather oxygen mask

• Auscultation of lung sounds revealed decreased air entry on the left

• Arterial blood gas: pH 7.25, PaCO2 62mmHg, PaO2 70mmHg, HCO3 26mEq/L, SaO2

92%.

• GCS 11 (E3 V3 M5)

 

Question One (500 words)

Refer to Kerry’s assessment findings above, and outline the rationale for the decision to

intubate and mechanically ventilate. Your answer must include a systematic analysis of the

arterial blood gas and a discussion of the pathophysiology of community acquired

pneumonia.

 

Question Two (650 words)

Outline the mechanical ventilator settings that

might be suitable for Kerry. Provide rationales for your choice of settings. Your outline

must include the following headings:

 

• Mode (e.g: Synchronised Intermittent Mandatory Ventilation; Spontaneous; Controlled

Mandatory Ventilation)

• Breath Type (e.g: Volume Controlled Ventilation)

• Rate

• Tidal Volume / Minute Ventilation

• FiO2

• Positive End Expiratory Pressure/ Pressure Support

• Triggering / Sensitivity Mechanism

• Alarms

Kerry was commenced on 0.9% Sodium Chloride infusion at 100mls/hour and a

Noradrenaline infusion. Her current observations are:

• Temperature 39 degrees Celsius

• Heart rate 128 b/min

• Monitoring sinus tachycardia

• Blood Pressure 85/55 mmHg

• Central venous pressure 7 mmHg

• Capillary refill > 2 seconds

• Urinary output 20mls in the last hour.

 

Question Three (750 words)

Rationalise Kerry’s assessment data and her intravenous therapy provided above, in

relation to the determinants of cardiac output.

 

Question Four (600 words)

Discuss the nursing management of Kerry using only two of the following headings:

• Oral care and eye care

• Positioning

• Communication

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• Co-ordination of care to allow rest and sleep