Discussion – Arterial blood gas Interpretation

Interpret arterial blood gas analysis (acid-base, ventilation, oxygenation) of mechanically ventilated patients Background Monitoring arterial blood gases (ABG’s) is vital to the proper care and management of patients receiving mechanical ventilation. The patients that primarily require mechanical ventilation suffer from acute respiratory failure. Respiratory failure is a condition in which respiratory activity is completely absent or is inadequate to maintain oxygen uptake and carbon dioxide clearance. There are two types of respiratory failure: Type I acute respiratory failure also known as hypoxemic respiratory failure and Type II acute respiratory failure also known as hypercapnic respiratory failure. Type I respiratory failure is failure of the lungs and heart to provide adequate oxygenation. This type of respiratory failure is often associated with restrictive lung disease and occurs when oxygen consumption, due to increase work of breathing, exceeds the amount of oxygen available in the blood (CaO2). Patients who experience Type I respiratory failure hyperventilate in an attempt to increase oxygen intake. The rapid and sustained increase in the patient’s respiratory rate can abruptly lead to apnea if not treated promptly and effectively. The primary goals of mechanical ventilation in the patients with Type I acute respiratory failure are restoring oxygenation, preventing oxygen toxicity, and preventing lung damage. Restoring oxygenation in patients with Type I respiratory failure is done as follows: Increase concentration (FiO2) Use caution with COPD patient’s during weaning An FiO2 greater than .60 will risk oxygen toxicity Increase lung diffusion area (inspiratory time or PEEP PEEP may negatively impact cardiac output Increased I time will be uncomfortable to patient and may result in auto PEEP Type II respiratory failure is failure of the lungs to eliminate adequate carbon dioxide. Type II respiratory failure is often associated with obstructive lung disease, hypoventilation, and hypoxemia. Patients in Type II respiratory failure due to obstructive lung disease suffer from high resistance in the airways, which causes most of the pressure required to breathe to be exhausted in the airways and not to expanding the alveoli. The consequence of less pressure in the alveoli is smaller volumes of gas available for gas exchange. The primary goal of mechanical ventilation in the patient with Type II acute respiratory failure is to prevent intubation whenever possible and implement the use of noninvasive positive pressure ventilation (NPPV) promptly and correctly; cautious use of oxygen, treating with bronchodilators, pulmonary hygiene and steroids and ventilation to baseline PaCO2 and pH levels. Refer to the information below when interpreting arterial blood gas reports. pH < (less than) 7.35 = acidosis pH > (greater than) 7.45 = alkalosis PaCO2 < (less than) 35 = alkalosis PaCO2 > (greater than) = acidosis HCO3 < (less than) = acidosis HCO3 > (greater than) = alkalosis pH Represents patient’s “homeostasis, otherwise known as “balancing or equilibrium zone”                  Low pH = acidosis High pH = alkalosis Out of normal range = acute episode Within normal range = chronic condition PaCO2 ~ arterial carbon dioxide tension in the blood Represents the lungs or respiratory function Low PaCO2 = alkalosis or hyperventilation High PaCO2 = acidosis or hypoventilation HCO3 ~ bicarbonate or base Buffer system of the body Represents the kidneys or metabolic function Low HCO3 = acidosis High HCO3 = alkalosis PaO2 ~ arterial oxygen tension in the blood Represents degree of patient’s oxygenation Low PaO2 = hypoxemia High PaO2 = hyperoxemia Prompt For this assignment, you will provide detailed responses to the following questions regarding each case study. Provide an interpretation for each ABG Identify the problem  Provide your recommendation for correcting the problem. 1.  A patient is on SIMV – 6, VT – 700, FIO2 – .85, PEEP +5. The ABG results are as follows: PH                7.44 PaCO2          36 torr HCO3           23 mEq PaO2            229 torr 2.  A patient is being ventilated follow an exploratory abdominal surgery. His lean body weight is 110 lb. He is on AC mode, 550ml, and a mandatory rate of 14 without any spontaneous respiratory efforts, FIO2 .40. ABG results are as follows: pH                7.51 PaCO2           31 torr HCO3            24 mEq PaO2            100 torr 3.  A 68 Kg patient has the following ABG results on SIMV mode, rate of 12, VT 550, FIO2 of .30, PEEP 0. No spontaneous breaths are noted. PH                7.23 PaCO2           68 torr HCO3            24 mEq PaO2            83 torr 4.  A 12-year- old female weighing 40kg (88 lb) is receiving continuous mechanical ventilation following an accidental drug overdose. The respiratory care practitioner notes the following: Mode – SIMV Set rate – 12br/min Total rate –12br/min Vt – 750 ml FiO2 – 0.30 Arterial blood gases are as follows: Ph – 7.58 PCO2 – 23mmHg PO2 – 141mmHg HCO3 – 22mEq/L 5.  A 70 kg (154 lbs) post-cardiopulmonary arrest patient is on a volume-cycled ventilator in the assist/control mode. The respiratory care practitioner notes the following data: Set rate        8 br/min Total rate      8 br/min FiO2             0.65 VT                850 ml The arterial blood gas results are as follows: pH                7.30 PCO2            56 mmHg PO2              78 mmHg HCO3-           21 mEq/L Submit your answers in at least 500 words on a Word document with at least 1 citation. You must cite your references in IWG format where appropriate to defend and support your position.

Write an article review that simply presents a summary of the primary article along with an analysis of how the primary article was used in the second article.

Write an article review that simply presents a summary of the primary article along with an analysis of how the primary article was used in the second article.  All the details and instructions of how the paper should be written is provided in the attached file. Please follow it exactly since it contains everything that needs to be done in a concise way.

Describe how operating systems manage memory

About this Assignment In this project, you will use the what you have studied in the chapter Memory Management & Operating Systems to emulate how operating systems manage memory paging, allocation, deallocation and replacement. Upon completion of this project you will be able to: Describe how operating systems manage memory Use simple codes to emulate basic functionalities of operating systems Sources This assignment covers material presented in the chapter ‘Memory Management & Operating Systems’. You can refer particularly to the following lessons in order to help you working through your solution: Memory Allocation Schemes: Definition & Uses Paged Memory Allocation: Definition, Purpose & Structure Memory Deallocation:

Differences and Similarities between Presidential and Parliamentary Systems

Discuss the differences and similarities between the presidential and parliamentary systems, including the executive and legislative branches.  Which system do you feel serves its citizen better?  Why?  Use evidence (cite sources) to support your response from outside scholarly source.  This is a short discussion paper for students to respond and discuss.

Discuss how the organization YMCA has used research to successfully shape a consumer narrative and marketing communication plan.

This course is all about deriving insight through research and analysis of both your market and potential market. Those who buy your product, to whom you deliver a service, whom you want to join your church or donate to your mission—the process is the same. Look closely at your affiliates and potential affiliates and design a campaign, not just reach them, but to touch them at a deeper level. For the purpose of this assignment, you will mirror the book and refer to them as consumers. Whether you work for a for-profit or non-profit, the most effective messages are shaped by insight into the individuals and groups you need to attract to become your customers, donors, or members—those who consume your services or are moved to action by your communications. It all begins with insight, and insight starts with actionable research. We use research to generate insight into the most effective creative messaging to reach consumers, using a creative understanding of the story we need to tell to touch the personality and shape the perceptions of a target audience regarding a product, brand, service, and/or organization. Your Challenge: YMCA Discuss how the organization YMCA has used research to successfully shape a consumer narrative and marketing communication plan. What was the research done? How did it shape the strategic product, narrative, creative messaging, and/or tactics that resulted in successfully expanding market share and growing the organization? How did the research provide insight into how to successfully approach the market? How did that insight, in turn, shape the strategic communication campaign? The Project Paper will be written following current APA 7 style, including a title page, abstract and references. The Project Summary will also follow current APA 7 style but does not need a title page or abstract. These are TWO distinct papers. Notice that the section requirements and the deliverables are different. Do not just copy and paste paragraphs from the Summary into the Project Paper. Course Project Summary THE YMCA You are to submit a summary presenting your choice of product, organization, or service that has used the insights derived from research to drive a growth strategy. During succeeding modules/weeks, you will then research your choice, thoroughly connecting a particular type(s) of research to insight and then action on the part of the organization/product/service selected. For example, you might choose the organization that employs you, if it has used research and analysis of the market effectively, or a consumer goods company that has revitalized its products and industry with insights derived from research (Dove, for example, comes to mind—but you may choose any product that has had clear insights generated through research), etc. To complete this assignment your summary should resemble a traditional APA 7th ed paper with a cover page, headings and page numbers. You should open your paper with a one paragraph introduction arguing your campaign and research justification. Each section of your paper should use the four topics below and must include at least 4 paragraphs (and a minimum of 2 articles justifying each topic) for each section below. A reference page is required and intext citations should be evident: (Use the numbered list below as the sections for your paper) Chosen organization/product/service. THE YMCA Explain the challenge facing your choice, the role that research played in generating an insight(s) to meet that challenge, and resulting success (we want to write about successes here. That gives us the most insight from this paper). Research. What kind(s) of research was undertaken? What were the results? How did the insights derived produce the foundation for a creative communication campaign, and—if appropriate—the revamping of both the product/organization/service and the message to the market? Consumer Insight. How did this research provide a greater and more unique understanding of the users and potential users of this product? How did this then shape subsequent action? Result. What were the specific results over what period of time. For example, was market share increased, and by how much? Was more product sold? How many more members did that megachurch put in the seats? How many souls saved, units sold of that new brand of chocolate milk, etc. To be clear: you are expected to write a MINIMUM of 18 paragraphs (and at least 8 sources), which should include an introduction, 4 paragraphs per each section above (16 total), and a conclusion.