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Mr. Hayato is a 65 year old male brought to ER with severe SOB resp rate 40 pulse ox 93%. Past History of emphysema and longstanding chronic obstruction pulmonary disease (COPD) secondary to tobacco use and still smokes 2 PPD (packs per day) for 50 years.

Acute respiratory distress

COPD

Peripheral vascular disease

Hospital Stay: ABG’s ph 7.32 PCO2 60.6 PO2 56.2

In ER, endotracheal intubation  with a # 8 endotracheal tube occurred and patient was placed on ventilator at 15 breath/min with FiO2 at 100%, peep + 5, Tidal volume 400. His CXR showed right lower pneumonia and ETT was at 5 cm above the carina. ABGs were used each morning to guide setting on ventilator setting. His ETT was 21 cm at the lip. His arterial blood gases continue to deteriorate. !00 % was decreased to 80% and peep was increased to +8. The nurse then notices that the patient is getting more tachypneic with tracheal deviation to the right and absent breath sounds on the left with subcutaneous emphysema present.  Please answer questions below:

1. What is the difference between COPD and emphysema? 

2. What is lung compliance and resistance? How are these lung functions affected by COPD?

3. Is this an acceptable placement of the ETT? 

4. What does his initial arterial blood gases indicate?

5. What other type of external ventilation could have been used prior to intubation? 

6. Why can’t the patient stay on 100% oxygen for long periods of time? 

7. What is peep and why is it important for the lungs? What happens when peep is increased and the barometric pressure is changed in the lungs? 

8. What has occurred and what action does the nurse need to take?

9. What has caused the tracheal deviation and what precautions does the nurse need to know about chest tubes? 

10. What is subcutaneous emphysema?

Placement of ETT -https://www.radiologymasterclass.co.uk/tutorials/chest/chest_tubes/chest_xray_et_tubes_anatomy

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3237149/

https://www.medicalnewstoday.com/articles/322161.php#types

Oxygen- https://science.howstuffworks.com/question4931.htm

Chest tubes- wps.prenhall.com/wps/media/objects/737/755395/chest_tubes.pdf