Do you need to change the patient’s dosing regimen why or why not?   If changing what would a new regimen be? Remember to explain your answer.  

A patient on a high flow nasal cannula is on a flowrate of 35L/min and an fi02 of 1.0.  The sp02 is 88%.  What changes do you recommend?

A 30 week gestational age neonate is currently on the following settings:  Jet Ventilation with a rate of 420/min (7 Hz), I-time .02 seconds, PIP 22cmH20, conventional ventilation setting of SIMV 20/min, fi02 .30, PEEP 5cmH20.  CXR shows atelectasis of the right lung along with a broncho pleural fistula.  A chest tube is in place.  ABG’s reveal pH 7.21, paC02 70 mmHg, pa02 60 mmHg, HC03- 24meq/L.  Which of the following changes would you recommend?           I.       Decrease rate to 360 to allow more time for exhalation           II.      Increase backup SIMV rate to 24/min           III.     Decrease backup SIMV rate to 4/min           IV.     Increase PEEP to 8 cmH20            V.  Increase the amplitude to 24 cmH20  

A patient on the Servo U is connected to NAVA via the Edi catheter and the catheter is showing the correct position.  The current Edi reading is 20 microvolts.  What can you conclude from this reading?

You are caring for a Motor Vehicle accident patient who has sustained rib fractures on the right (8) and left (2). It is his 2nd day in the ICU, his input is 9500 and output is 2500 ml.  The patient is intubated and the ventilator settings are PRVC mode, rate of 12/min, VT 500ml, fi020.50, PEEP 5 cmH20.  The patient weighs 104 kg and is 6 feet tall.  Patient is being infused with a neuromuscular blockage agent (norcuron). Abg’s on these settings: sp02 93%; pH 7.20, paC02 68 torr, pa02 56 torr, HC03 20 meq/L, Base Deficit -7.  What is your recommendation? I.   Recommend a diuretic II.   Increase the tidal volume to 700 ml          III.  Increase the PEEP to 8 cmH20 IV.  Keep the set rate at 12/min V.   Increase the rate to 20/min  

Male patient IBW 70 kg with Guillian Barre Syndrome is trached with a 7.0 mm Trach tube and has been vented for the past 2 weeks.  Current vent settings:  PRVC 12/min, VT 450ml, fi02.28, PEEP 5 cmH20.  PIP 20 cmH20, static pressure is also 20 cmH20.  VE 5.4 L/min.  Total RR 12/min and Abg’s are within normal limits. Weaning parameters were performed with a NIF -15cmH20, VC 500ml, RSBI on CPAP with 5 cmH20 pressure support is 70.  There are no signs of respiratory distress when placed on CPAP:  RR 8/min, VT on pressure support of 5 cmH20 is 350ml.  Abg’s are the following:  pH7.30, paC02 53torr, pa02 78 torr, HC03 24 meq/L. How should you approach liberating this patient from the ventilator?

A chronic lung patient is in the ER, suffering from severe SOB.  He is currently on a 1.0 Liter Nasal Cannula, is diaphoretic, using accessory muscles to breathe and is wheezing.  The patient is very anxious and states that he can’t breathe and it has been two hours since he used  his inhaler.  Abg’s reveal:  sp02 87%, pH 7.35, paC02 86torr, pa02 44, HC03 40 meq/L, Base Excess +13.  What would you do for this patient? Recommend a diuretic be given Prepare for intubation with an 8.0 endotracheal tube and institute mechanical ventilation Begin BiPAP with an IPAP of 10 cmH20 and an EPAP of 4 cmH20 and keep sp02 88% – 90% Administer a nebulizer treatment with albuterol and atrovent using compressed air

Which of the following strategies are utilized to ventilate a patient with ARDS:    Allow for prolonged exhalation.   Use tidal volumes of 6 – 8 ml’s/kg IBW.   Allow permissive hypercapnea to reduce barotrauma.   Ventilate with tidal volumes of 4 – 6 ml’s/kg of IBW.

Patient #2   Jenny Harper is a 65-year-old female admitted to Parks Hall Hospital with an intra-abdominal infection. The prescriber has ordered gentamicin to treat her infection and has consulted pharmacy for dosing and monitoring. The patient was started on the order below. You have obtained a random gentamicin level and are now following up on the patient to determine if she needs a dose adjustment. Using the patient’s information answer the following questions.     Patient information:   Weight – 54 kg Height – 5’3’’ Allergies – NKDA   Problem list   Intra-abdominal infection  Hypothyroidism HLD HTN Anxiety   Current Labs   BUN – 19 mg/dL CO2 – 29 mmol/L SCr – 0.83mg/dL Glucose 96 mg/dL  Cl – 110 mmol/L K – 5.0 mEq/L Na – 142 mEq/L  Current gentamicin regimen: 360 mg (7 mg/kg) in 100 mL 0.9% NaCl Q36H (infused over 30 mins)  The above order is what the patient was started on and has been getting since admission. After closely monitoring the patient, you ordered a gentamicin random level. See the administration information and lab values below.    Gentamicin administration record:    Date Given Time Given 10/24 1810 Gentamicin random level: 4.5 mcg/mL drawn on 10/25 at 0310.      All the other labs you ordered are stable.  

What is this patient’s creatinine clearance? (Using the Cockcroft-Gault equation, round to the nearest hundredth, except no trailing zeros)   mL/min