[Verified Answer]: A 62 y/o patient with PMH significant for…

A 62 y/o patient with PMH significant for obesity, DM Type II and hypertension presents to the ED with a 2 week history of worsening shortness of breath and productive cough. His VS are significant for a fever of 102F, HR 110 (ST), BP 120/80, O2 saturation 80% on room air, and RR 30. Chest x-ray reveals a new area of consolidation in his right lower-lobe, and the patient was subsequently prescribed IV antibiotics for community-acquired pneumonia. 1.) Please describe the pathophysiology of type 1 (hypoxic) respiratory failure, and contrast this with type II (hypercarbic respiratory failure). What conditions can contribute to each? 2.) What (if any) VS are concerning in your initial assessment of your patient? 3.) In addition to appropriate antibiotic selection, what strategies will be helpful to improve your patient’s respiratory status, and prevent further decompensation? 4.) What oxygen delivery options are available in the hospital setting for patients with hypoxic respiratory failure, and what are benefits/ drawbacks to each? Despite the above measures, the patient’s respiratory status continues to worsen over the next several days, and his oxygen requirements have increased dramatically. The patient is now requiring NIV with BiPap, and his ABG is as follows: 7.42/ 44/ 50/ 24/ 84% despite maximal FiO2 (100%). STAT Chest CTA reveals diffuse interstitial infiltrates in addition to his known RLL consolidation, and repeat COVID 19 testing (negative on admission) is now positive. The decision is made to transfer this patient from the Step-Down Unit to the ICU for a higher-level of care, anticipating further decompensation. 5.) Based on the patient’s imaging and ABG results, what new diagnosis can be made? 6.) Why was CTA the indicated imaging modality for this patient, as opposed to a non-contrast CT scan? 7.) What equipment should the RN have at the bedside for this patient, and what members of the care team should be included in discussions of his management moving forward? Despite maximal support with BiPap, the patient continued to decompensate, requiring intubation. The patient is sedated for comfort and ventilator compliance, and repeat ABG is as-follows: 7.40/ 40/ 100/ 24/ 95% on the following ventilator settings: RR 16, VT 500, FiO2 50%, PEEP 10. 8.) What is the patient’s current P/F ratio? What strategies can be employed to optimize oxygenation/ ventilation for the patient with ARDS secondary to COVID? 9.) What are potential complications of mechanical ventilation, and how can the care team prevent them? 10.) The RN notes elevated peak airway pressure alarms. What can contribute to this finding, and what steps can the RN take to intervene? After 1 week on the ventilator and periodic adjustments of the patient’s ventilator settings, his oxygenation has improved markedly, but he continues to require mechanical ventilation to support his work of breathing. 11.) What are important considerations for patients requiring mechanical ventilation over the long term (> 10-14 days), and what are implications for their support persons and the care team?