Classmates Simulations

You are the therapist assigned to the pulmonary unit at a 350-bed hospital. A patient is being admitted to your floor after having bariatric surgery 24 hours earlier. She did well in the post anesthesia care unit and is on a 50% air-entrainment mask at 12 LPM. She is 5 feet 5 inches tall and weighs 248 kg, (545 lbs.). \n \n Upon entering the room, you find the patient sitting up in bed, with her 50% air-entrainment mask on, talking with family. What would you recommend to be assessed at this time?

\-Pulmonary compliance

\-Pain level

\-Bedside thoracic ultrasound

\-Breath sounds

\-Intraocular pressure

\-Past medical history

\-Chest radiograph

\-SpO2

\-Moro reflex

\-Diagnostic percussion

\-Flow-volume loop

\-ECG monitor

\-Gag reflex

\-Peak flow

\-Vital signs

vital signs, SpO2, past medical history, pain level, diagnostic percussion, chest radiograph, breath sounds, ECG monitor

As you talk with the patient, she admits that she doesn’t wear her CPAP much at all. But she agrees to try it for just 30 minutes. Upon returning to her room, after the 30 minutes have passed, you find she has already removed the nasal mask. She is complaining that she can’t sleep with it on because it makes her feel like she can’t breathe. She also states that it is blowing in her eyes and out her mouth. What would you recommend at this time?

\-Add humidity to the CPAP

\-Change the head gear

\-Decrease her CPAP pressure

\-Change the machine mode

\-Change the type of patient interface

\-Change to IPAP and EPAP

change the type of patient interface

Two hours later, you enter the patient’s room to check on how she is tolerating the changes you have made. You find her asleep, wearing her CPAP. As you are leaving the room, the CPAP machine starts to alarm and it wakes the patient. After fixing the alarm, the patient asks you if there is anything you can do so that it’s easier for her to fall asleep with her CPAP. What would you recommend?

\-Use lower pressures

\-Use a ramp time

\-Apply CPAP once asleep

\-Add humidity

\-Use higher pressures

use a ramp time

Before your shift ends, you check on the patient one more time. When you enter the room, she asleep and wearing her CPAP. You note that the pulse oximetry is reading 88% even though the patient is wearing her CPAP mask correctly. What do you recommend?

\-Repeating polysomnography

\-Decreasing the pressure

\-Increasing the FiO2

\-Overnight pulse oximetry study

\-Maintain current therapy

overnight pulse oximetry study