nursingitup9

In a patient with a history of COPD who comes into the hospital and is diagnosed with Acute Respiratory Failure and pneumonia... ABG 1: CO2 54, HCO3 30, O2 52, pH 7.25. Pt is given 28% with a venturi mask. ABG 2 30 minutes later: CO2 48, HCO3 30, O2 58, pH 7.42 Based on these results, the patient is intubated. 2 hours after intubation, mode SIMV at 14, 50% FIO2, TV 750, and 5 PEEP: pH 7.30 PO2 60 PCO2 64 HCO3 30 I realize these results are not what is expected after 2 hours on the vent. The pH is still acidic, the O2 is low, the PCO2 is high and acidic, and the HCO3 is increased and trying to compensate. My question is....What ACTIONS would you take to correct this ABG? Would you increase the RR? Increase the FIO2? Increase the PEEP? I would imagine you wouldn't increase the tidal volume? What else? THANKS!