Assignment – Jax

Assignment – Jax

with reference to the 2000-word limit, literature (aim for last 5 years),

1) a plain font (e.g., Arial, Calibri, Times New Roman), 2) size 12, 3) 1.5 line spacing.

The evidence of your three-best contributions should be provided after the reference list in your written assignment. This is not included in your word count.

A written response about ventilation mode, settings and alarms

A concept map, submitted as an image, and

A written response about nursing considerations for the patient.

Reference your sources in 6th APA style.

Jax is a 73-year-old, 70 kg man (actual = ideal weight; height 175 cm), who has been admitted following a two-day history of increasing shortness of breath (SOB) at rest, following a recent lower respiratory tract infection identified as a community acquired pneumonia. He has a past medical history of emphysema and is a previous smoker of 30 cigarettes/day. Jax is currently receiving oxygen via a reservoir (non-rebreather) mask at 10 L/minute.

Despite oxygen therapy, antibiotics and steroids, Jax has become persistently tachypnoeic, tachycardic and increasingly confused. He is changed to high flow nasal cannula and his oxygen saturation at FiO2 0.4 is 82%.

His ABG showed pH 7.38, PaCO2 64 mmHg, PaO2 52, HCO3– 33 mmol/L, BE +10, while his chest X-ray shows the presence of multiple bronco-pneumonic bilateral infiltrates and a left lateral pleural effusion.

Jax was unable to tolerate a trial of non-invasive ventilation and so underwent rapid sequence induction and intubation followed by mechanical ventilation due to increasing fatigue. He has been commenced on synchronised intermittent mandatory ventilation – volume control (SIMV-VC) mode.

1. Given Jax’s weight, outline and justify the ventilator mode, settings and alarms you would recommend in his case.

He has been ventilated for 30 minutes over which time he has become hypotensive and tachycardic. He also begun triggering the low minute ventilation alarm.

2. Draw a concept map which illustrates:

a. The likely pathophysiological processes underpinning the development of Jax’s hypotension and low minute ventilation after he was recently intubated and ventilated; and

b. One nursing intervention related to each of the reasons for the hypotension and low minute ventilation you have identified.

Or

The likely pathophysiological processes underpinning the development of Joe’s bradycardia and low minute ventilation alarm after he was recently intubated and ventilated; and

One nursing intervention related to each of the reasons for the bradycardia and low minute ventilation you have identified.

Jax has now stabilised and remains sedated, intubated and ventilated, but is now spontaneously breathing.

Citations should be included as a bibliography beneath your concept map but in text citations are not required in the map itself.

3. Identify and explain five key nursing considerations related to this sedated, intubated and ventilated patient to minimise complications associated with mechanical ventilation and that contribute to improving patient outcomes. Justify your explanation with supporting evidence.