Mr Pitt is a 72 year old male who presented to hospital post trauma.
Mechanism of injury: Low speed pedestrian vs car.
DAY 5 after admission his observations are as follows
A – own airway, speaking in single words
B – RR 34 BPM, unable to deep breath/cough, SpO2 89%. Increased work of breathing noted. Noted to have intercostal, substernal and supraclavicular retractions.
C – HR 140 BPM, BP 85/45, peripherally cool
D – GCS E 3, V 4, M 6
E – Temperature 38.6
F – Urine output less than 30mls/hr. IV NaCl running at 100mls/hr
G – BGL 12.2mmol/l
Explain the pathogenesis of his deteriorating Breathing.
What is your nursing strategy to improve his Breathing?
C – HR 140 BPM, BP 85/45, peripherally cool
Explain the pathogenesis of his deteriorating Circulation.
What is your nursing strategy to improve his Circulation?
D – GCS E 3, V 4, M 6
Explain the pathogenesis of his deteriorating GCS.
E – Temperature 38.6
Explain the pathogenesis of his fever.
What is your nursing strategy to relieve his fever?
F – Urine output less than 30mls/hr. IV NaCl running at 100mls/hr
Explain the Renin-Angiotensin-Aldosterone System (RAAS) that led to his oliguria.
What is your nursing strategy to improve his Fluid status?
F – Urine output less than 30mls/hr. IV NaCl running at 100mls/hr
Explain the pathogenesis of his high Glucose level.
What is your nursing strategy to improve his Glucose level?
What is his metabolic status? (respiratory/metabolic/mixed and acidosis/alkalosis)
What caused his PaCO2 to be high?
What caused his HCO3 to be low?
Why is his PaO2 low?
Why is his Lactate level high?