MA, a 67-year-old male, had been complaining of persistent chest pain and was delivered to the intensive care unit (ICU). Initially, the patient was brought to the hospital due to community-acquired pneumonia, and his condition worsened on the fifth day of the clinic stay

MA, a 67-year-old male, had been complaining of persistent chest pain and was delivered to the intensive care unit (ICU). Initially, the patient was brought to the hospital due to community-acquired pneumonia, and his condition worsened on the fifth day of the clinic stay. On arrival at the ICU, MA exhibited difficulty breathing, drowsiness, and inability to complete sentences. Some results of the physical exam for MA were as follows:

• Blood pressure: 126/71 mmHg

• Heart rate: 120 beats per minute

• Respiratory rate: 29 breaths per minute

• Oxygen saturation: 76% on room air

• Temperature: 37,7 °C

Furthermore, the patient indicated hypoxia, worsening confusion, and memory loss. MA tested negatively for COVID-19, had no sick contacts, did not travel recently, and was retired. The patient reported smoking cigarettes on a daily basis for the past several years alongside increased alcohol consumption but denied using recreational drugs. MA exhibited signs of acute respiratory failure and was kept in the ICU until full recovery through oxygen therapy.

Acute Respiratory Failure

Prior to discussing the care management of the patient, one must comprehend the nature of acute respiratory failure (ARF) identified in MA. ARF is a life-threatening condition associated with a variety of clinical signs, gas exchange alterations, and radiographic findings (Azoulay et al., 2018; Parcha et al., 2020). Such an illness can be seen in all acute care settings and can be hypoxaemic or hypercapnic (Robinson and Scullion, 2021; Rolfe and Paul, 2018). ARF is often caused by acute respiratory distress syndrome (ARDS), which can be characterised by impairment in gas exchange due to fluids leaking into the alveolar spaces (Parcha et al., 2020; Robinson and Scullion, 2021). Similar to several other respiratory problems, ARDS and ARF can be induced by pneumonia, as the disease leads to breathlessness and can result in rapid deterioration in a short time frame (Peate and Dutton, 2021). Notably, the rates of ARDS and subsequent ARF have raised because of the spread of COVID-19 (Carter, Aedy, and Notter, 2020). Accordingly, the case study suggests that MA experienced ARF due to pneumonia.

Assessment

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People admitted to hospitals are at risk of becoming acutely ill, and patients representing the older population require special attention. An acute care setting can be considered an unfamiliar environment for older adults who face considerable challenges as their condition changes (Guidet et al., 2018; Potter et al., 2021). Individuals whose health is deteriorating experience major physiological transformations since the body attempts to maintain homeostasis and activates compensatory mechanisms associated with additional physiological demands on the person (Peate and Dutton, 2021). Therefore, patients who are likely to become critically ill, especially those of older age, like MA, need comprehensive care management, which begins with assessment procedures.

ACVPU

Healthcare professionals can start the examination of patients whose health may be deteriorating by utilising the ACVPU (Alert, Confusion, Voice, Pain, and Unresponsive) scale. The approach is an extension of the previous version that did not consider the Confusion parameter (Grant, 2018). The ACVPU assesses an individual’s consciousness level based on how they react to different triggers (Grant, 2018). The Alert indicator determines if the patient is fully awake, whereas Confusion displays any new change to mentation (Grant, 2018). Voice detects a response to a verbal stimulus, and Pain shows whether the person is reactive to a pain impulse (Grant, 2018). Finally, the Unresponsive scale signifies that the individual does not respond to either of the influences (Grant, 2018). Consequently, the ACVPU demonstrates if a patient functions in a normal way or requires medical assistance.

Furthermore, although the case study does not mention if the ACVPU was applied to MA, it appears that he was not completely responsive. In particular, on his arrival at the ICU, MA was drowsy, meaning that he was not quite awake, and could not complete sentences, signifying that he probably could not adequately react to verbal stimuli. In addition, while it is not clear if MA was affected by a pain trigger, his worsening confusion and memory loss can be considered relevant for the Conf