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This Concept Map, created with IHMC CmapTools, has information related to: 9-15 CMAP Caddle, Impaired gas exchange related to edema formation. Intervention Monitor for carbon dioxide narcosis which may occur in clients recieving long-term oxygen therapy, Respiratory 15:30 Tachypneic, equal chest expansion bilaterally. Rhonchi on expiration bilaterally throughout. Rales on inspiration bilaterally throughout. Chest symmetrical bilaterally. SpO2 95% No retractions noted. Trach sutured in place, size 8 Shiley. Vent Settings: AC Rate:20 Vol:450 FI02:50% PEEP:7 Peak flow:70, Ineffective airway clearance related to loss of ciliary action as evidenced by rales and ronchi upon auscultation. Intervention Auscultate breath sounds and assess air movement to ascertain status and note progress., Gen. Chem. Trends and Interpretation Potassium is being replaced in Prisma. Alk phos is elevated, indicating some biiary tree involvement in her systems failure. ALT and AST are grossly elevated, hepatic failure. BUN and Cr elevated, renal failure. However, they are trending down since the patient started Prisma., Gen. Chem. 9/14 Na=139 K=4.8 Cl=102 CO2=27 BUN=47 Cr=1.44 Glu=119 Ca=10 Total Bili=34.1 Alk Phos=156 AST=157 ALT=64, CBC 9/14 WBC=27.7 RBC=3.62 Hgb=10.8 Hct=33.7 Plt=92, Simvastatin Brand Name Zocor, Gen. Chem. 9/15 Na=137 K=4.8 Cl=103 CO2=29 BUN=46 Cr=1.42 Glu=86 Ca=10.2 Protein=5.0 Albumin=3.4 Total Bili=41.6 Alk Phos=233 AST=270 ALT=83, Insulin Drip Hourly Record 18:00 blood glucose=116 Infusion rate=3.5 units/hr No change, Simvastatin Reason for Recieving High cholesterol, CBC Trends and Interpretation White counts elevated d/t infection of unknown location. Decreasing independently, no antibiotics given. RBC and platelets decreased with kidney and liver insufficiency., Insulin Regular Human Nursing Indications Monitor for s/s Hypoglycemia, Ineffective airway clearance related to loss of ciliary action as evidenced by rales and ronchi upon auscultation. Intervention Assist with respiratory treatments., Insulin Regular Human Pertinent Lab Values See hourly insulin drip table in lab section, Insulin Regular Human Reason for Recieving Elevated blood sugar, D.M., Cardiovascular 15:30 HR 88BPM. No JVD. No carotid bruit. S1 and S2 sounds heard. Bilateral radial pulses present, +2. L pedal pulse present, +2. R pedal pulse present, +1. Capillary refill 3 seconds. +3 pitting edema lower extremities. +1 pitting edema upper extremeties. LE very cool to the touch. Current rhythm: NSR, Insulin Regular Human Classification Antidiabetic, pancreatic hormone. Exogenous unmodified insulin, Gen. Chem. 9/13 Na=138 K=3.5 Cl=101 CO2=29 BUN=50 Cr=1.66 Glu=93 Ca=9.5, Simvastatin Classification Antilipidemic, HMG-CoA reductase inhibitor, Decreased cardiac output related to reduction in stroke volume as a result of mechanical/structural problems Intervention Monitor cardiac rhythm continuously to note effectiveness of medications.