How to Answer Image Transcription Text Questions (Complete Guide)

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Use appropriate theories and support your answer with clear reasoning.

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This topic involves image transcription text. A strong answer should include explanation, application, and examples.

Original Question

Image transcription text chapter 2 Pulmonary Disorders Case Study 27 Case Study 27 1::1….1451 12. Name Class/Group Date Group Members INSTRUCTIONS All questions … Show more Scenario P.W., a 33-year-old woman diagnosed v: with Guillain-Barré syndrome (GBS), is being cared for on a special ventilator unit of an extended care facility because she requires 24-hour-a-day nursing coverage. She has been intubated and mechanically ventilated for 3 weeks and has shown no signs of improvement in respiratory muscle strength. Her ventilator settings ere assist-control (A/C) of 12 breaths/min, tidal volume (VT) 700 ml, Fi02 0.50, positive end-expiratory pressure (PEEP) 5 cm 1-120. Her vital signs (VS) are 108/64, 118, 12, 38.1 0 C. She is receiving enteral nutrition by PEJ (percutaneous endoscopic gastrostomy with a transjejunal limb) tube (2800 kcal/24 hr). P.W.’s 3 children, ages 3, 4, and 6, are staying with her sister because her husband has to keep working his full-time job to maintain their medical insurance. Why is P.W.’s ventilator mode on A/C? P.W. is receiving lorazepam (Ativan) 1 mg slow IV push (IVP) q4h to reduce her anxiety. Identify two factors that should be considered when choosing lorazepam for P.W. Identify nine nonpharmacologic strategies that you could use to reduce P.W.’s anxiety, increase her comfort, and reduce the need for lorazepam. Be creative! PART ONE Medical-Surgical Cases You give P.W. a bath and note that her cheeks billow outward each time the ventilator delivers a breath. What could cause this phenomenon? You try repositioning P.W, place a stopcock in the inflation valveNuscultate the lungs, check the length of the tube at the lip (the tube had not moved), check the cuff, and note the air pressure is low. You insert more air in the cuff to seal the leak. Over the next 24 hours, the leak becomes worse and the ventilator’s low exhaled volume alarm repeatedly sounds. What action should you take? The physician elects to insert a no. 8 Shiley tracheostomy tube with a disposable inner cannula. P.W. becomes increasingly anxious after receiving the news. How would you prepare P.W. and her husband for the tracheostomy? P.W. undergoes the tracheostomy procedure without complications. When you return in the morning and assess the new tracheostomy, you note that the trach tape looks tight. You are unable to insert one finger between P.W.’s neck and the trach tape. Discuss whether or not this is problematic. 140 Copyright 0 2009, 2005, 2001, 1996 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. chaptera Pulmonary Disorders Case Study 27 8. What should your next actions be? 9 You note that the tissue surrounding the incision is edematous. As you palpate the area, your fingers sink into the skin and you auscultate a popping sound through your stethoscope. Is this to be expected? 10. Based on your findings in question 9, what action should you take? ll. That afternoon, a powerful storm causes a power failure. What should you do? You evaluate P.W.’s activity tolerance and note that she desaturates when turned to her right side. You auscultate tubular breath sounds in the entire right lung posteriorly. Based on your knowledge of pathophysiology, explain the probable cause of the desaturation. Copyright 0 2009, 2005. 2001, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 141 PART ONE Medical-surgical Cases CASE STUDY PROGRESS You notify the physician of the change in P.W,’s breath sounds. The paramedic unit transports P.W. to the hospital, where she is readmitted for recurring pneumonia. P.W.’s husband anåves shortly after the paramedics transport P.W. to the hospital. He collapses into the nearest chair, tears begin to roll down his cheeks, and he says, “It has been almost a month now. Are you sure she will recover?” • How would you respond? CASE STUDY PROGRESS P.W. undergoes aggressive antibiotic therapy and is discharged to an extended care facility 5 days later. She progresses slowly. It takes nearly 8 months ‘for her to recover, but recovery is complete. 142

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