Gas Exchange Evolving Case StudyMarcus JonesMarcus Jones is a 21-year-old 80-kg construction worker admitted to the intensive care unit after emergency surgery for blunt force trauma sustained from a metal rod being impaled in his abdomen while at work. The surgical procedure was extensive and involved repair of a perforated bowel, splenectomy, and hemostasis. Marcus’s mean arterial pressure (MAP) dropped below 65 mm Hg during resuscitation, and he received 9 units of packed red blood cells and 4 L of Lactated Ringer (LR) solution intravenously (IV) to achieve hemodynamic stability. Clinical AssessmentWithin 24 hours of admission to the unit, Marcus became extremely short of breath with an increase in respiratory rate of 40 breaths/min. Crackles, rhonchi, and bronchial breath sounds are heard bilaterally, whereas on admission, breath sounds were clear with a few crackles in the bases. The nurse performs an ABG per unit based protocol.Arterial blood gas (ABG) analysis reveals pHPaCO2HCO3-PaO2SaO27.5228mm Hg20mEq/L56mm Hg84% Partially compensated respiratory alkalosis with metabolic acidosis (Urden et al., 2022, p. 456). The nurse notifies the physician and Respiratory therapy of Marcus’s ABG and change in respiratory status. The team decides to intubate the patient. While the RT is setting up the intubation equipment and ventilator the nurse grabs the Rapid Sequence Intubation (RSI) kit. Marcus was sedated and intubated and placed on the following ventilator settings.ETT sizeModeFiO2VtRatePEEP#8P-A/C60% 145 Despite sedation, Marcus becomes extremely restless, diaphoretic, and tachypneic at 34 to 42 breaths/min. His breathing is not synchronous with the ventilator, which is causing him to fight, or “buck,” the ventilator. The high-pressure alarm (PIP/Pplat) on the ventilator sounds frequently, and he steadily becomes more hypoxic. The physician orders the following changes to the ventilator settings to keep his PaO2 above 60ETT sizeModeFiO2VtRate PEEP#8P-A/C80% 1410 Diagnostic ProceduresThe current chest radiograph reveals complete opacity of the lungs. The chest radiograph in the emergency department was clear, and the chest radiograph immediately after surgery revealed bilateral patchy infiltrates that had a “ground-glass appearance.” Before Surgery After Surgery/”Ground Glass”pHPaCO2HCO3-PaO2SaO27.3333mm Hg20mEq/L60mm Hg90% Partially compensated metabolic acidosis (Urden et al., 2022, p. 456).Marcus’s current vital signs, assessments, and labs include: blood pressure of 118/76 mm Hg, heart rate of 112 beats/min (sinus tachycardia), respiratory rate of 14 breaths/min, and temperature of 100.8?F. Urine output is 30 mL/h, and peripheral pulses are palpable. Hematocrit is 24%, hemoglobin is 8 g/dL, lactate level is 3 mmol/L, and white blood count is 12,000/mcL. 1. Identify 3 respiratory specific problems Mr. Jones is experiencing. What evidence (be specific) is there to support the identification of these problems? 2. What interventions must be initiated to monitor, prevent, manage, or eliminate the 3 problems identified in the above question? (List a minimum of 2 interventions for each of the 3 problems) Health Science Science NursingNURS H 356
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