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Prior Additional Diagnostic Assessment: AM ABG Analysis: pH 7.27, PaCO2 65 mmHg, PaO2 63 mmHg, HCO3 30 mEq/L, +4 mEq/L BE Electrocardiogram: Sinus tachycardia CBC: Hb 19 g/dl, Hct, 52%, WBC 8,000 Electrolytes: Normal Chest radiograph: Light infiltrate bilaterally Urine output: 50 ml/Hr Recent assessment Breathsounds: Clear bilaterally PIP and Plateau pressures: 26 cm H2O, 20 cm H2O   Based on the above data, what should be done now? Choose only ONE

The endotracheal tube was withdrawn until bilateral breath sounds were heard. and secured at 24 cm at the lip. The physician would like you to recommend appropriate CMV setting for this 6’0″ male patient who weighs 110 kg.   Choose only ONE

Assessment reveals: Positive color change in the colorimetric capnometer No positive pressure sounds in the stomach Unilateral chest rise to the right Absent breathsounds to the left Condensation present in the ETT   What should be done now?   Choose only ONE

The physician agrees and writes an order for antibiotic therapy. The patient is on 0.50 FIO2 air-entrainment mask and receiving bronchodilator therapy every four hours. Four hours had past and you return to the patient’s room to give a bronchodilator treatment. The patient  is demonstrating SOB and is wheezing bilaterally on auscultation. What should be done now?   Select as MANY as indicated

The patient was placed on 10 LPM simple O2 mask and his SpO2 increased to 95% but the patient is still breathing at a rate of 35 breaths/min with use of accessory muscles for breathing. What should be done next?   Choose only ONE

The patient has just been intubated to be placed on CMV. Before securing the endotracheal tube, what must be assessed immediately?   Select as MANY as Appropriate

Clinical Simulation 3   You are a respiratory therapist starting your shift in the ICU. Your first patient is a 5’8″ 65 y/o male patient intubated on CMV due to respiratory failure secondary to COPD exacerbation. Current ventilator settings are AC rate of 12, VT 550 ml, +5 cm H2O PEEP and 60% FIO2. What  ventilator parameters should you assess at this time?   Select as MANY as indicated

What happens to the temperature when liquid oxygen is converted into a gaseous oxygen?

After three hours you check on Mrs. Watson and she appears to be unresponsive breathing at a rate of 4 breaths/min with SpO2 75%. What should be recommended at this time?   Choose only ONE

Further assessment reveals: – ECG: Sinus tachycardia – Sputum C&S: Gram negative bacteria found  – Electrolytes: Na 138, Cl 99, CO2 25, K 4.0 – CBC: WBC 15,000, Hct 45%, Hb 15, Plt 210 – CXR: Consolidation with infiltrates present in the RML and RLL – ABG: pH 7.46, PaCO2 33 torr, PaO2 65 torr, HCO3 24 mEq/L   What should you recommend at this time?   Choose only ONE