You are called to the ICU where you do a routine assessment on a patient you extubated about 2 hours ago. She was originally intubated for a CAP, complicated by being immunodeficient due to a drug used to treat her rheumatoid arthritis.

She is on 2L NC, HR 86, Mean BP 82, SpO2 97%. She is currently resting. You perform an exam and note her GCS to be 13, auscultation slightly diminished in her left base, and she is slightly anxious.

What do you recommend?

A) Increase Oxygen flow to 4L NC and re-assess in 20 minutes.
B) Reintubation as pt is failing extubation.
C) Administration of Lopressor.
D) Review of Deep Breathing exercises or Incentive Spirometer.

The patient with a history of rheumatoid arthritis and a recent extubation requires non-aggressive intervention to aid respiratory recovery; therefore, deep breathing exercises or an incentive spirometer are recommended.

Explanation:

The patient who has been recently extubated after being treated for community-acquired pneumonia (CAP) and also has a history of immunodeficiency due to treatment for rheumatoid arthritis is showing signs of respiratory discomfort. Given the current vital signs like adequate oxygen saturation (SpO2 97%) on 2L nasal cannula (NC), absence of severe hypoxemia, and a Glasgow Coma Scale (GCS) of 13, which suggests mild impairment, aggressive measures such as reintubation (option B) are not immediately indicated. However, the slightly diminished breath sounds at the left base and slight anxiety hint at potential respiratory compromise. Therefore, recommending the review of Deep Breathing exercises or use of an Incentive Spirometer (option D) would be beneficial to improve pulmonary function and prevent atelectasis.

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