Heidi0902

The patient did have a PRN order for propofol ( I think we should have re-assessed the order), and the resident who came to assess the patient gave the PRN order of Versed. I am not sure about the policy regarding propofol IV push for extubated patients. My preceptor told me that it wasn't a good practice at all, but there was no way to keep the patient under control at that point. I went back checked the chart. The patient had a BM on the following day, but was still agitated, the night nurse had to call a Code white on him on that night... I had 3 shifts in the following week, the patient was still there (total ICU stay>12 days with >10 days post-extubation). I think his ABG may relate to his Lung met. He had shallow breathing pattern with RR around 10-12/min. I will say--R acidosis with metabolic compensation (maybe a little over compensated?)

This reminded me. I did have this patient 3 days ago, and he had not had BM for 3 days at that time, we gave him senna. Maybe I can check it out on the chart next week to see when his last BM was. Good point. any thoughts about his ABG?

I am a 4th year nursing student. Currently I am doing my preceptorship at ICU. Here is the patient's profile (has been modified for patient's confidentiality): Patient X, male, 50 years old. Dx: Hypertensive Emergency Medical history: GIST (GI Stromal Tumor), metastatic to liver, lungs, and spine. Surgery in 2004 &2005. Pt. used morphine for pain control at home. Patient was on PO chemo trial since last month. One week ago, pt was brought to ER for increased BP (200/110), increased HR, altered LOC. Patient C/O loss of vision and increasingly confused during waiting period at ER. MRI revealed bilateral parietal and occipital edema. Pt was intubated and transferred to ICU for BP control. At my shift: Pt was extubated 5 days ago. Night nurse reported that pt. had an episode of coughingà BradyàSaO2 dropped to 86%, was put on 100% O2, SaO2 returned to 96% after. ABG showed PCO2=63. Pt was on 33% FiO2 when we start our shift. We drew another ABG 0730: PH=7.43, PCO2=52, PO2=80, HCO3=35. SaO2=96%. During assessment, pt is not fully oriented, but follows commands, moving all ext., no pain. Pt is only on Diludid infusion for pain control, no sedation. Pt's BP remains stable (MAP at 90's) while sleeping. But once pt is awake, he is agitated, tries to get off from bed, MAP shoot to 130 to 140, SaO2 drops to low 90's. We tried to re-orient the pt, get him on the chair, relaxation music, distraction..., but nothing worked. Pt. has to be restrained to keep him pulling all the lines and tubes. Family said he is never an aggressive person. During our shift, we had to give him a lot of Propofol and versed bolus to calm him. My questions: What are the possible causes for the agitation? My interpretation of the ABG: Metabolic alkalosis with respiratory acidosis (I know the PH is fine, but the numbers are abnormal, right?) . But which one is compensating which one? Are the kidneys trying to compensate the respiratory acidosis? Thank you for reading this long posting. I am just curious to know:heartbeat

hey, i will be 36 next year, and used to feel so old. i know that i am not alone now, so happy... ...