2. Patient demographic date
■ Admission data : 16/ 1 / 2021
■ Admission indication :
A. (HTN Hypertension)
B. Chronic kidney disease (CKD)
C. pneumonia
■ Age : 93 years old
■ Sex : Female .
3. Patient history
■ Causes include the MDR bacterial pathogens, such as:
1- MRSA,
2- Pseudomonas aeruginosa,
3- Enterobacteriaceae (e.g., Enterobacter spp., Klebsiella spp., and E. coli)
4. ABG result
■ PH:41
■ Paco2:39
■ PO2:71
■ Hco3:25.2
■ ABG test results showed that patient has normal ABG with normal saturation depends
on patient age .
■ X-ray showed that patient has full collapse of right lung on account of bacterial
■ pneumonia.
5. Disease states
■ Pneumonia
Definition
■ Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs
may fill with fluid .
Etiology
■ Pneumonia are especially life threatening in individuals whose lungs are already
damaged by chronic obstructive pulmonary disease (COPD), asthma, or smoking. The
risk of death from pneumonia is also higher among people with heart disease, diabetes,
or a weakened immune system. Pneumonia may be caused by viral infections, bacterial
infections, or fungi; less frequently by other causes. The most common bacterial type
that causes pneumonia is Streptococcus pneumoniae.
6. Disease states
Symptoms
■ Cough with sputum
■ Fatigue
■ Fever, sweating and shaking chills
■ Nausea, vomiting or diarrhea
■ Shortness of breath
Reference:
■ .Jardins, T., & Burton, G. Clinical manifestations and assessment of respiratory disease
(6th ed.). (2011). Chapter 15 *Pneumonia
7. Current assessment
■ . How many days in ICU / admitted on hospital ?
- 2/2/2021 Over 1 month
■ b. IBW ?
- 52
■ c.Patient on what device ?
- Invasive ventilator > T&u
■ d. Ventilator sittings / flow (include FiO2) ?
- mode = PSV , PEEP = 5 , RR = 16 , PS = 12 , Tidal volume = 327 , Fio2 = 30% , Pco2 = 39 , Po2
= 71 , PH = 7.41 , HCO = 25
8. Current assessment
e. Medication ?
■ - mucamest , asidation
f. Chest physiotherapy ?
■ - Suction > clear airway
g. If the patient is extubated past assessment ( include IBW and ventilator settings) ?
■ - patient still intubated and not in wining position
9. PLAN
■ Preparation for wining and remove the tracheostomy and put T-tube for O2 device
■ Indications of tracheotomy
1-Facilitate weaning from the ventilator
2-Bypass an obstruction of the upper airway
3-Facilitate removal of secretions
4-Facilitate long-term airway management
5-management Prevent gross aspiration from the pharynx or GI tract
10. PLAN
■ Contraindications
1-No absolute contraindications to tracheostomy
■ 2- It should be done once indicated (life saving)
■ 3-A strong relative contraindication is laryngeal carcinoma where laryngectomy (definite
management) should be planned and prior manipulations of the tumor is avoided
→Stoma recurrence
