Mechanical Ventilation in a Patient with Community
- Subject Code :
NURS6023
Written assignment case study
This assessment comprises 50% of your final mark and will assess your learning in relation to outcomes 1-3 (see course descriptor). The assignment is in the form of a case study. There are two scenarios to choose from and you must write about one of these, incorporating all the steps below.
You are required to:
- Choose one of the scenarios provided
- Briefly discuss the mode of ventilation and its benefits and risks for the patient in the scenario. You must provide rationale. (~500 words)
- Consider the following ventilator settings/parameters:
* Positive end expiratory pressure (PEEP)
* Pressure support (P/S)
* Tidal volume (TV)
* Measured peak inspiratory pressure (PIP)
* Measured plateau pressure (PP)
* Driving pressure (?P)
Briefly explain what each of these mean in reference to normal respiratory physiology in the stable, ventilated patient. (~500 words)
- Based on the clinical and diagnostic information provided in the scenario, critically analyse and explain what this may indicate about the patient status in relation to the current ventilation mode and settings. Link this to the underlying pathophysiology of the patients condition. (~750 words)
- With consideration to the above, provide recommendations and rationale for optimising the patients ventilation to progress the plan of care. (~750 words)
- Utilise current academic literature/sources to support your discussion.
Word limit: 2500 (+ 10%).Assignments must be written according to the Guidelines for Writing Assignments and Essays and be presented and referenced in accordance with the American Psychological Association (APA) 7th edition system
- Assignments submitted over the word count will have 5?ducted from the final mark.
- Download, save, and utilise the provided word document assignment template on Moodle. Do not use pages or any other file type (e.g., PDF) when submitting the assignment. It must be in a word file or it will not be accepted for marking
- Complete the coversheet and declaration
- Add student ID and page numbers to the header and/or footer of the template
- Use the same font throughout. APA recommended fonts: Calibri 11-pt, Arial, 11-pt, Times New Roman 12-pt
- Left align or left justify text
- Double space all pages of the assignment including the reference page. Indent the first line of every paragraph (NB the reference page is the reverse). Do not double space the entire template as this will distort the cover sheet and marking grid
- Headings must be used
- An introduction and conclusion are not required
- You must not use the first-person narrative in your writing
- You may only utilise academic resources and literature such as textbooks, journal articles, professional organisational websites (excluding patient information resources) and course resources. Wikipedia etc is not an acceptable source. If unsure what constitutes an academic source, please speak to the course lecturers or access the resources on Moodle to clarify this
- A guide of 10 references in the reference list from academic sources within the last 10 years is suggested
Scenario 2
The patient is a 65-year-old male admitted to intensive care five days ago with community acquired pneumonia (Streptococcus Pneumoniae). The patient is ventilated and sedated on 150 mgs/hr propofol and 80 mcg/hr fentanyl.
Current clinical information at 0700hr handover:
Ideal body weight:
75kg, actual body weight is 102kg.
Most recent chest x-ray (AP) report:
ETT 2.5cm above carina. Interval resolution of opacification/consolidation in right middle lobe since date of admission. Mild bibasilar atelectasis.
Chest auscultation findings at handover:
Mild bronchial breath sounds across the right base, with fine bibasilar crackles resolving.
0600hrs arterial blood gas result:
FiO2 0.45
pH 7.55
PaCO2 31
PaO2 114
SaO2 98
HCO3 23
Lactate 0.9
Current ventilator settings:
Mode: SIMV Volume Control Ventilation
FiO2: 0.45
PEEP: 7 cmH2O
P/S: 10 cmH2O
Set RR: 12 bpm
Set TV: 500 ml/breath
Current ventilator measured values:
Spontaneous TV: 756-842 ml/breath
PIP: 25 cmH2O
Plateau pressures: 20 cmH2O
Total RR: 22
Driving pressure: 13cmH2O
Ventilator waveform:
