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What factor is contributing to Mr. P.’s worsening condition the day after hospital admission?

What factor is contributing to Mr. P.’s worsening condition the day after hospital admission?

Mr. P., age 65, was transferred to the ICU from the emergency department after successful resuscitation from a cardiac arrest sustained out of the hospital. Initial diagnosis based on laboratory results and electrocardiography is acute anterior myocardial infarction. It is suspected that Mr. P. aspirated gastric contents during the cardiac arrest. He is orally intubated and receiving mechanical ventilation. His is on assist-control ventilation, respiratory set at 12 breaths/min, FiO2 of .40, PEEP 5 cm H2O. He opens his eyes to painful stimuli. An arterial blood gas is drawn upon arrival to the ICU and shows the following values: pH, 7.33; PaCO2, 40 mm Hg; HCO3-, 20 mEq/L; PaO2, 88 mm Hg; and SaO2, 99%. A decision is made to maintain the initial ventilator settings. The following day, Mr. P.’s chest radiograph shows progressive infiltrate. His oxygen saturation is dropping below 90% and he is demonstrating signs of hypoxemia: increased heart rate and premature ventricular contractions. Arterial blood gas analysis at this time shows pH, 7.35; PaCO2, 45 mm Hg; HCO3-, 26 mEq/L; PaO2, 58 mm Hg; and SaO2, 88%. The physician orders that the respiratory rate on the ventilator be increased to 16 breaths/min, FiO2 increased to .50, and PEEP increased to 10 cm H2O.What were the results of Mr. P.’s first arterial blood gas analysis? What factors are contributing to these results?
What factor is contributing to Mr. P.’s worsening condition the day after hospital admission?
Interpret the arterial blood gases done the day after the arrest.
Why did the physician change the ventilator settings after the second set of arterial blood gases?
What must the nurse assess after the addition of the PEEP? Why is this especially important for Mr. P.?

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