Discuss appropriate assessment of Ben at this stage and rationalise appropriate non-invasive respiratory management to improve Ben’s acid base status and oxygenation.

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Discuss the physiological effects of either CPAP or BiPAP./Discuss and rationalise Ben’s current assessment findings in relation to the pathophysiology of cardiogenic shock. In your discussion explain these findings in relation to the:

•effect on preload, afterload and contractility, and

•ramifications of cardiogenic shock on:

This assignment is marked against the case analysis rubric

Mr Ben Long’s ongoing status:

Ben is deteriorating. His respiratory rate has increased to 32 per breaths per minute and on auscultation there are increased, crackles audible in the midzones bilaterally.

A chest x-ray was ordered which confirmed pulmonary oedema. Arterial blood gases were taken, with the following results documented;.

•pH………………… 7.22

•PaCO2…………… 55 mmHg
•HCO3……………. 20 mmol/L

•PaO2…………….. 83 mmHg

•SaO2…………….. 91%

•BE………………… – 4

Ben continues to receive 6 L/minute O2 via a face mask

Further medical review

Ben’s fraction of inspired oxygen FiO2 was increased and non-invasive ventilation CPAP was commenced at 7.5 cm H2O with FiO2 0.4.

Following further medical review, and in view of Ben’s increasing respiratory rate and decreasing SaO2, it was decided to increase his respiratory support- (no high dependancy bed currently available) he was commenced on CPAP at 7.5cms H20 with an Fi02 0.4 (If in your clinical area you use BiPAP the settings are: IPAP 12 cm H2O, EPAP 7 cm H2O with FiO2

0.4.)

Question 1 (850 words)

Discuss appropriate assessment of Ben at this stage and rationalise appropriate non-invasive respiratory management to improve Ben’s acid base status and oxygenation. Discuss the physiological effects of either CPAP or BiPAP.

Include in your discussion:

•assessment

•advantages and disadvantages of CPAP or BiPAP

•nursing implications for patient care

•effects on acid-base status and oxygenation.

Ben’s ongoing clinical status:

Despite commencement of CPAP/BiPAP, Ben’s condition deteriorates further. He is now cold and clammy and severely short of breath.

Clinical assessment reveals:

•Heart rate………………….135 beats per minute (irregular)

•Blood pressure…………..78/47 mmHg

•Respirations………………36 per minute and shallow

•SpO2……………………….. 86%

•CPAP………………………..7.5cm H2O FiO2 0.5

•Capillary refill……………. >3 seconds
•JVP………………………….. +5 cm above normal

•chest auscultation……….Bilateral midzone crackles.

His clinical assessment now reveals decreased level of consciousness and confusion.

Question 2 (word count 1050)

Discuss and rationalise Ben’s current assessment findings in relation to the pathophysiology of cardiogenic shock. In your discussion explain these findings in relation to the:

•effect on preload, afterload and contractility, and

•ramifications of cardiogenic shock on:

•coronary perfusion
•coronary perfusion

•gastrointestinal perfusion

•cerebral perfusion

On going patient status

Ben’s condition continues to deteriorate despite treatment. Escalation of management including mechanical ventilation and inotropic support will be required.

This assignment is marked against the case analysis rubric