Question

1) 24 year-old female anxiety attack due to exam in RSP-119. HR = 130, RR 32, B/P 130/90, T 98.6

02 Sat on 21% 98%

What 02 device?

•What diagnostic tests should be ordered?

•Follow up assessments?

2) 38 year-old female admitted for R/O pneumonia, complaining of chest pain on r side and persistent coughing

•HR 90, RR 24, B/P 125/90, T 103F

•B/S fine rales (crackles) @ R base posterior

•02 Sat on 21% = 91 %

•what 02 device?

•Follow up assessments?

Pneumonia patient continued

•6 hours later on N/C 3LPM, pain in base of lung worse, tachypneic, dyspneic, diaphoresis,

•Accessory muscle use, RR =30, HR 120, B/P 136/90, T 103.9F

•Non-productive cough remains

•ABG = 7.55/29/72/24/92% on N/C 3 LPM. Why this values would show?

•Doctor wants 60% 02 mask

•30 minutes later:

•7.54/28/68/28/89% on 60% mask. Why would this values show???

Answer 1

1. (a) With a saturation of 98% on room air oxygen concentration of 21% is under normal range( 95%-100%). So, no device is required for oxygen support. It's just because of the anxiety related to exam causing tachycardia and syncope

1.(b) Diagnostic tests ordered will be :-

- basic blood investigation ( to find whether syncope related to anemia ,etc)

- ECG ( to find whether there is some defect in heart)

1.(c) Follow up assessment include assessment of vital signs and general health status

2.(a) The saturation of patient is 91% along with fever and fine base crackles indicate presence of secretions due to pneumonia. Oxygen has to be delivered with the nasal cannula at 2 to 4 l/min to maintain normal saturation and also expectoration of secretions has to be done because secretions will lead to blockage of the respiratory airway which leads to decreased airflow and cause dyspnea

2(b) Follow up assessment include assessment of vital signs ,( Temperature, respiratory rate ,heart rate, blood pressure and SPO2) , ABG ,chest X-ray ,general health condition ,lung sounds, and response to antibiotics for pneumonia .

3. ABG shows pH- 7.55 , pO2- 29mmhg, pCO2 - 72mmhg ,HCO3 - 24mEq/l ,saturation of 92% ,on nasal cannula 3l/min indicates respiratory acidosis due to accumulation of carbon dioxide due to excess secretions which is hindering the flow of air and the oxygen -carbon dioxide exchange mechanism. Dr. prescribes 60 % oxygen mask to maintain saturation hence to prevent respiratory failure.

30 mins later ABG shows pH - 7.54, pO2- 28mmhg, pCO2- 68mmhg, HCO3 - 28mEq/l, and saturation -89% on 60% oxygen mask means there is a mild decrease in the CO2 level and respiratory acidosis on application of oxygen mask at 60% .