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Case NR 341 Complex Adult Health Nursing (NR341)
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CHAMBERLAIN COLLEGE OF NURSINGNR 341 Complex Adult Health Nursing
CASE STUDY EXERCISE
Ventilatory Assistance & ARF 1
CASE STUDY: Ventilatory Assistance & Acute Respiratory Failure 1
Mr. R is a 66-year-old man who has smoked 1.5 packs of cigarettes a day for 40 years. He is admitted with
an acute exacerbation of COPD. His baseline ABGs drawn in the ER showed: pH, 7.36; PaCO2, 55mmHg;
PaO2, 69mmHg; Bicarbonate, 30 mEq/L; SaO2, 92% on 4Lvia NC. In the critical care unit, Mr. R has
course crackles in his left lower lung base and a mild expiratory wheeze bilaterally. His cough is productive
of thick yellow sputum. His skin turgor is poor; he is febrile, tachycardic, and tachypneic requiring 6L via
NC to keep Sats >88%.
1. What is your interpretation of Mr. R’s baseline ABGs from the ER? Did his symptoms improve
on admission to CCU? What may have caused his exacerbation? What assessment findings lead
you to this conclusion? What ventilatory assistance may improve his symptoms? How?
According to the patient’s report, Mr. R’s baseline ABGs shows that his pH is within the normal range,
but the rest of his ABG levels reveal compensated respiratory acidosis. Mr. R did not show improvement
of symptoms upon admittance to the CCU. Mr. R’s history of chronic smoking; being 1.5 packs of
cigarettes a day for 40 years has caused extensive damage to his lungs and could be what caused the
exacerbation of COPD. Mr. R could benefit from the use of a BiPAP machine, which provides
pressurized air to help open up the lungs and alveoli. Another option would be noninvasive positive-
pressure ventilation. Noninvasive positive-pressure ventilation is beneficial for COPD patients, in
helping to reduce inspiratory muscle activity in return allows for better gas exchange in the alveoli. It is
also the least invasive form of ventilation to start treatment.
1
, CHAMBERLAIN COLLEGE OF NURSING
NR 341 Complex Adult Health Nursing
CASE STUDY EXERCISE
Ventilatory Assistance & ARF 1
2. Per physician order, Mr. R is placed on NPPV via face mask with PEEP of 15 and FiO2 50% with
sats 92%. The doctor also orders blood and sputum cultures and antibiotics IV to be initiated
ASAP. What technique is maintained during blood cultures? During sputum cultures? When
should nurse administer antibiotics? What organisms are commonly seen in respiratory
infections?
Clean technique should be practiced when receiving a blood culture and the site should be sterilized.
The best time to get a sputum sample from the patient would be in the morning right after patient wakes
up. It is imperative that both blood and sputum specimens should be sent to the lab immediately
following their collection as samples that are a few hours old in various climate conditions could result
in positive/negative results. It is also important for the lab to receive the samples right away so antibiotic
therapy can be started immediately as needed. Antibiotics should not be taken before obtaining the
samples as in doing so could result in skewed results of the samples. Some common organisms found in
respiratory infections include Streptococcus pyogenes, Haemophilus influenza, Streptococcus
pneumoniae, and Legionella pneumophila.
3. One hour post-NPPV ABGs results showed: pH 7.3, PaCO2 67, PaO2 45, HCO3 26, SaO2 85%
on PEEP of 20 and FiO2 60% NPPV. What is your interpretation of his current ABG results?
What ventilatory assistance does Mr. R require? What lab findings indicate this? What airway is
optimal for him and why?
Recent ABG levels indicate uncompensated respiratory acidosis. Mr. R. requires endotracheal
intubation. The patient’s lab results show a decrease in pH,PaCO2, and SaO2 which supports the
2
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