R.B. is a 55-year-old woman who presented to the emergency d…

R.B. is a 55-year-old woman who presented to the emergency department (ED) via ambulance for acute shortness of breath. Her daughter called an ambulance after finding her mother with an increased respiratory rate and shortness of breath. Upon arrival to the ED, R.B.’s respirations were 40 and shallow with wheezing in the lower lobes and rhonchi in the upper lobes bilaterally. She had positive jugular vein distention and a heart rate of 128. After treatment with albuterol nebulizer via mask, her vital signs were temperature 96.8˚F, pulse 98, respirations 28, blood pressure 148/84, and O2 saturation 94% with 15 LPM via mask. Arterial blood gasses showed her pH 7.19, pCO2 90, PO2 92%, HCO3 38. R.B. was intubated for hypercapnia. After an echocardiogram showed an ejection fraction less than 50%, she had an emergency left heart catheterization done with 2 stent placements into the left anterior descending artery. A pulmonary artery catheter was placed, and the initial hemodynamic readings show elevated left ventricular preload. R.B. is now being transferred to the intensive care unit (ICU).  Subjective Data Lives with her single daughter, who cares for D.B. full time Daughter is not present at bedside Smokes 1 pack of cigarettes per day No longer active outside of the home because of her chronic illness Does not drink alcohol  Objective Data Physical Assessment Orally intubated #8 endotracheal (ET) tube taped at 26 cm to lip Ventilator settings: FIO2 60%, tidal volume 600, assist control (A/C), rate 16, PEEP of 5 Height 5’5″, weight 117 kg Alert and oriented to person, place, and time Fine crackles and wheezes bilateral lower lobes 2+ pitting edema bilateral lower extremities Diagnostic Studies Chest x-ray postintubation: ET tube 4 cm from carina. Infiltrates in both bases; left base is worse than right 12-lead ECG: ST elevation Troponin: 41.94 Lung V/Q scan negative for pulmonary embolism Urinalysis: dark yellow and cloudy, protein 28 mg/dL, positive for casts, positive for red blood cells and white blood cells, positive for glucose and ketones Question; what nursing interventions are needed to prevent ventilator associated pneumonia (VAP)? Choose ALL that apply.

On admission to the burn unit, a patient with an approximate…

On admission to the burn unit, a patient with an approximate 25% total body surface area (TBSA) burn has the following initial laboratory results: Hct 56%, Hb 17.2 mg/dL (172 g/L), serum K+ 4.8 mEq/L (4.8 mmol/L), and serum Na+ 135 mEq/L (135 mmol/L). Which action will the nurse anticipate taking?

R.B. is a 55-year-old woman who presented to the emergency d…

R.B. is a 55-year-old woman who presented to the emergency department (ED) via ambulance for acute shortness of breath. Her daughter called an ambulance after finding her mother with an increased respiratory rate and shortness of breath. Upon arrival to the ED, R.B.’s respirations were 40 and shallow with wheezing in the lower lobes and rhonchi in the upper lobes bilaterally. She had positive jugular vein distention and a heart rate of 128. After treatment with albuterol nebulizer via mask, her vital signs were temperature 96.8˚F, pulse 98, respirations 28, blood pressure 148/84, and O2 saturation 94% with 15 LPM via mask. Arterial blood gasses showed her pH 7.19, pCO2 90, PO2 92%, HCO3 38. R.B. was intubated for hypercapnia. After an echocardiogram showed an ejection fraction less than 50%, she had an emergency left heart catheterization done with 2 stent placements into the left anterior descending artery. A pulmonary artery catheter was placed, and the initial hemodynamic readings show elevated left ventricular preload. R.B. is now being transferred to the intensive care unit (ICU).  Subjective Data Lives with her single daughter, who cares for D.B. full time Daughter is not present at bedside Smokes 1 pack of cigarettes per day No longer active outside of the home because of her chronic illness Does not drink alcohol  Objective Data Physical Assessment Orally intubated #8 endotracheal (ET) tube taped at 26 cm to lip Ventilator settings: FIO2 60%, tidal volume 600, assist control (A/C), rate 16, PEEP of 5 Height 5’5″, weight 117 kg Alert and oriented to person, place, and time Fine crackles and wheezes bilateral lower lobes 2+ pitting edema bilateral lower extremities Diagnostic Studies Chest x-ray postintubation: ET tube 4 cm from carina. Infiltrates in both bases; left base is worse than right 12-lead ECG: ST elevation Troponin: 41.94 Lung V/Q scan negative for pulmonary embolism Urinalysis: dark yellow and cloudy, protein 28 mg/dL, positive for casts, positive for red blood cells and white blood cells, positive for glucose and ketones Question; while you are charting, you hear vent alarms going off. You see the patient struggling, there is no obvious cause. What is your priority action?