You are working in a Neuro-Critical Care Unit of a hospital where Mrs. Kelly was admitted five days ago with a subarachnoid hemorrhage. She was taken to surgery, and the head bleed was corrected with a craniotomy. The craniotomy included placement of an internal drain to correct the hemorrhage. She remained intubated for a day and a half while you monitored her care on a mechanical ventilator. You extubated her and she seemed fairly stable on a 2L nasal cannula at the end of your day. You returned to work the next day to find her on a 5L nasal cannula, confused, with a CXR revealing moderate bilateral atelectasis. You and the attending physician agreed that she might benefit from Q4hr IPPB treatments. She receives the treatment for two days.
You return later to find she is alert with an improving CXR and preparing to ambulate for the first time after surgery with the physical therapist; she is also back on the 2L nasal cannula with an SpO2 of 95%. The physician approaches you for a recommendation of how to treat Mrs. Kelly.
Respond to the following:
- What do you feel caused the change in her condition on the day you returned to work when you found her confused and with moderate bilateral atelectasis?
- What recommendations would you make now that she is more alert and has an improving CXR? Why?
- Provide a plan of care you feel will deliver the best patient outcome in her case. Support your decision with solid indications, risk and benefits, and contraindications.
Submit your answers in at least 500 words on a Word document. You must cite at least three references in APA format to defend and support your position