It is written in the file. Choose one case study?5/16/2021 Assessment 4: Written assignment...

Question

It is written in the file. Choose one case study?5/16/2021 Assessment 4: Written assignment https://canvas.lms.unimelb.edu.au/courses/104418/assignments/161846 1/8 Assessment 4: Written assignment  Due  May 24 by 18:00  Points  100  Submitting  a file upload  Available  Mar 29 at 0:00 - May 24 at 18:30 about 2 months Start Assignment Due date: Monday, Week 9, 6.00pm AEDT/AEST Word count: Equivalent to 2000 words Weighting: 40% Submission: Use the 'Submit assignment' at the top of this page. Feedback: Tutor feedback provided after the end of term. Introduction For this assessment, you will complete a written assignment about the assessment, ventilation and nursing considerations of a critically unwell person presented in a case study. Skills in analysing and interpreting the key features presented in the case study will help you make informed clinical decisions about critically unwell people. By completing this assessment, you will demonstrate your ability to: Integrate core principles covered in this subject and its prerequisite, Applied Pathophysiology, to establish specialist knowledge of the impact of treatment on the disease trajectory, acute illness, and management of patients with a range of acute health problems (LO1) Incorporate knowledge learnt in the subject to recognise and plan an evidence-based intervention for patients experiencing alterations to health and wellness that occur in the specific context of critical care (LO2) Demonstrate the capacity to problem-solve, think critically and promote rational inquiry when provided with a clinical scenario (LO3) Demonstrate skills in communication as it applies to critical care nursing (LO4) Identify the role of resilience, effective communication, and patient and family education on the outcomes of care (LO5). Instructions 1. Select a case study:  Joe is a two-month-old boy (actual = predicted weight), admitted generally unwell with a cough and pyrexia, reduced appetite and minimally wet nappies for two days. Over the past 4 hours Joe has been tachypnoeic with lengthy dips in his SpO  and HR. He has required frequent nasal suctioning and is on 2 L/minute oxygen via nasal catheter. Due to poor capillary refill and decreased urine output he has also had an IV fluid bolus for likely dehydration. Lab results suggest this is bronchiolitis related to Respiratory Syncytial Virus (RSV). His CXR shows generalised broncho-vascular markings around the hilar region but no consolidation or collapse.   Case study 1: Joe (bronchiolitis)+ 2 5/16/2021 Assessment 4: Written assignment https://canvas.lms.unimelb.edu.au/courses/104418/assignments/161846 2/8 Figure 1. Joe's chest X-ray Source Jones, 2015 Jones, J. (2015). Bronchiolits [X-ray]. Radiopaedia. Retrieved from https://radiopaedia.org/cases/bronchiolitis-2  (https://radiopaedia.org/cases/bronchiolitis-2) Over the next 24 hours, his vital signs deteriorate with an increase in his respiratory rate (76 breaths per minute), heart rate (188 beats per minute) and further temperature (39.4 degrees Celsius). He has also required an increase in his FiO  due to persistently low oxygen saturation level (23.0 pts Outstanding Outlines and justifies appropriate and/or accurate ventilation mode and/or, settings and/or alarms for the patient case study. 23 to >21.0 pts Very high standard Outlines and justifies appropriate and/or accurate ventilation mode and/or, settings and/or alarms for the patient case study. Minimal clarifications or corrections required. 21 to >18.0 pts High standard Outlines and justifies mostly appropriate and/or accurate ventilation mode and/or, settings and/or alarms for the patient case study. However, some important mode and/or, settings and/or alarms for the patient case study may not have been considered and/or some corrections required. 18 to >16.0 pts Sound Outlines and justifies mostly appropriate and/or accurate ventilation mode and/or, settings and/or alarms for the patient case study. However, some important mode and/or, settings and/or alarms for the patient case study may not have been considered and/or frequent corrections may be required. 16 to >12.0 pts Satisfactory (PASS) Outlines and justifies mostly appropriate and/or accurate ventilation mode and/or, settings and/or alarms for the patient case study. However, some important mode and/or, settings and/or alarms for the patient case study may not have been considered and/or significant clarification may be needed, and/or significant corrections may be required. 12 to >0 pts Unsatisfactory (FAIL) No or insufficient outline and/or justification of appropriate and/or ventilation mode and/or, settings and/or alarms for the patient case study. Important mode and/or, settings and/or alarms for the patient case study may have been omitted and/or not have been considered and/or significant clarification may

Anju Lata · Accepted Answer

Running Head: Assessment 4
Assessment 4                                                                                                                           9
	Assessment 4
	Case Study 2
Student Name:
Student Number:
1. JAX has been provided ventilation support at SIMV-VC mode. He was ventilated for 30 minutes and he started feeling tachycardic and hypotensive. He also started triggering the low minute ventilation alarm. Hypotension occurs after the intubation due to reduced level of central venous blood return towards the cardiac muscles.  We can treat it through ventilator settings to reduced intrathoracic pressure, low tidal volume, lowering down the PEEP and low respiratory rate. This mode lets the muscles of lungs to work and may improve the cardiac output. It provides a predefined number of breaths in coordination with the patient’s respiratory efforts to facilitate spontaneous breathing. 
After 30 minutes of ventilation on SIMV-VC mode, Jax became tachycardic and hypotensive.  He had been triggering low minute ventilation alarm. This alarm shows the patient is not able to maintain sufficient number of Minute Ventilation (VE).  In such condition, Jax may be switched to Pressure Support Ventilation to assist him in each and every effort in breathing spontaneously as made by the patient.  This mode reduces the work of breathing and improves the oxygenation levels.  Jax must be immediately switched to CMV (Continuous Mandatory Ventilation) mode.
 (
Decreasing mean arterial pressure 
pre intubation
) (
Administration of Neuromuscular Blockers
)
 (
Complications of Intubation
)
 (
Jax’s Hypotension & Low minute Volume
) (
Elderly 
Age of 
73 years 
)
 (
Diagnosis of 
Pleural Efflusion
 (Protective effect)
)
	
Jax is an old age man 73 year old, weight 70 kg. He got admitted for SOB and lower respiratory tract infection due to pneumonia. He had tachypnea which is high rate of breath due to shortage of oxygen, due to pneumonia. The high risk factors for Jax to incept pneumonia include high frequency of smoking, pH of 7.30 shows left lateral pleural efflusion. Excessive amount of fluids get accumulated in pleural space due to imbalance between the removal and formation of fluids. He was given rapid sequence induction and intubation to prevent the risk of pulmonary aspiration.
Interventions for the identified causes:
1. Decreasing mean arterial pressure pre intubation:  Blood transfusions and Intravenous fluids are administered to raise the Blood Pressure and avoid any further damage of organs (Williams & Sharma, 2020). When the Mean Arterial Pressure lowers down, the vital organs do not get adequate oxygen. It may lead to shock or damage to these organs. The medications like vasopressors are given to increase BP and fasten the heart beat.
2. Pleural Efflusion:  Administration of antibiotics and treatment for curing infection. In addition to antibiotics, the patient would be provided IV fluid resuscitation and positive inotropes for maintaining the mean arterial pressure (Lian,2020). He was given rapid sequence induction and intubation to prevent the risk of pulmonary aspiration. Relief is provided to the patient by removing the fluid from pleural space and perform the treatment of pneumonia. It is necessary to identify whether the fluid is transudate or exudates. In this case, the patient has pneumonia infection, so it is due to exudate. The amount and characteristic of fluid is also examined.
3. Administration of Neuromuscular Blockers: Oxygenation may be improved by increasing the FiO2 and manage the imbalance between acid base. He had low PaO2 (52) and High PaCO2 (64). He had high HCOs (33) and BE (+10). It shows metabolic alkalosis.
4. Complications of Intubation: Ventilation is improved through increasing Pressure Support and lowering down the airway resistance through administration of large diameter ET tube, suctioning the airway secretions and providing bronchodilators (Haribhai & Mahboobi, 2021).
While the patient is being sedated, intubated and ventilated, the nurse needs to review communications to promote the optimal outcomes for the patients (Corredor & Jaggar, 2013). The nursing professionals need to communicate effectively with the patient to identify his needs and requirements either verbally or non verbally. The nurses need to review patient’s vital signs oxygen saturation and breathing sounds.  During communication, the sedation needs of the patient must be identified correctly and his pain assessment must be done. 
The ventilator Associated complications generally occur due to fluid overload, acute respiratory distress due to pneumonia (Yu, 2011).

5/16/2021 Assessment 4: Written assignment https://canvas.lms.unimelb.edu.au/courses/104418/assignments/ XXXXXXXXXX/8 Assessment 4: Written assignment Due May 24 by 18:00 Points 100 Submitting a file...

Answer To: 5/16/2021 Assessment 4: Written assignment...

Answer To This Question Is Available To Download

Related Questions & Answers

Submit New Assignment