Case Study: After getting W.S. settled, admission

Case Study: After getting W.S. settled, admission orders can now be reviewed and are as follows. Provider Orders Admit to the intensive care unit Condition: Critical Vital signs: every 1 hour Suctioning: As needed Mechanical ventilation: Per respiratory therapy weaning protocol Propofol (10mg/mL) 8 mg/kg/hr. continuous IV infusion Dexmedetomidine (4 mcg/mL) 0.5 – 0.7 mcg/kg/hr. continuous IV infusion, titrate to maintain SBP > 120 mmHg Midazolam (1 mg/1 mL) 1 mcg/kg/min continuous IV infusion Vancomycin (50 mg/mL) 1 g IV Q12 hr., infuse over 90 minutes Ceftriaxone (50 mg/5 mL) 1 g IV every 12 hr. over 30 minutes Soft restraints to bilateral upper extremities D5LR continuous IV infusion at 100 mL/hr. Place NGT to LIWS NPO Strict I/O’s CBC with diff Qam ABG prn per respiratory therapy protocol Blood Culture x 2 Qday with T > 38.0⁰C Chest X-ray Qam Wt: 168 lbs. Ht: 5’6″ 2. What rate should the IV pump be programed for each of the following medications? Continuous infusion rate Propofol: Dexmedetomidine (start at 0.5 mcg/kg/hr.): Midazolam: Infusion rate/dose Vancomycin: Ceftriaxone: 3. The ABG was obtained by respiratory therapy and resulted as follows. Based on the blood gas results what ventilator settings would need to be changed to improve W.S.’s blood gas results? Arterial Blood Gases pH 7.28 Pacoâ‚‚ 62mm Hg HCO₃ 26mmol/L Paoâ‚‚ 48mm Hg Saoâ‚‚ 53% 4. When would you recheck an ABG once any ventilator settings are changed? 5. The morning chest x-ray shows worsening pneumonia. The provider requests chest tube supplies be provided at the bedside. Provide a list of specific items you will obtain in preparation for chest tube placement if a chest tube tray is not available? 6. Once the chest tube is placed, a large quantity of purulent liquid drains into the drainage system. W.S. appears to be breathing more comfortably. The provider then requests a care conference be scheduled with client’s family to discuss placement of a tracheotomy and percutaneous gastric tube. Why would a tracheotomy be used in a client like W.S.? 7. Provide at least 3 risks and 3 benefits of tracheotomy placement for W.S. 8. Following the care conference, you returned to check on W.S. to find the chest tube on the ground. What are 3 priority actions you should take? Would this occurrence require reporting to the hospitals incident reporting system related to patient safety? Provide a rationale with this answer.

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