Complex Care Nursing Case Study

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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 breaths/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:
A. Please answer the questions systematically and in order.
B. Please use APA format.
C. Please use minimum 4 references (use reliable sources only).

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

Sample Solution

Marimekko is now in a place of wide-spread success after their downfall during Finland’s recession. Paakkanen reworked this company from the ground up and now finds herself at the head of a successful company. The company has created value through their attention to detail along with ability to recognize incremental opportunities. For example, “Paakkanen boosted the role of the individual designers by giving them profit responsibility on their designs, […] emphasizing the profitability of their designs” (Mitchell 5). Clear roles and value is created when a unit connects practices, processes, and systems with growth objectives. She has done trainings with the designers in the past, maintaining her control over her workers and the company. Marimekko exhibits qualities of a control quadrant company since they have clear roles, they work in a timely fashion, and they have one head manager, Paakkanen (CVA 11). Paakkanen runs the company with the mentality of a red quadrant since she is the coordinator the fabric companies Marimekko works with, she monitors the entire company, and she is the organizer among the designers. Everyone in the company is a diligent worker, since Paakkanen made it clear, “[…] there was one condition: the designs had to be profitable” (Mitchell 6). This gave the designers a sense of accountability, which pushed them to have a best-in-class focus. Also, the company has regained their consistency of brand image under Paakkanen’s management style. The company is always improving upon their innovation of designs or the products they produce. Paakkanen also utilizes systems and stable project management, “In managing designers, we have to make the controls to ensure that they are well briefed about what we want. The briefing process is one of the most vital parts of what we do” (Mitchell 8). Marimekko falls into the control quadrant, also known as the optimize quadrant, due to the control of Paakkanen and the work proc

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