Question

:09 AM Thu Nov 21 4 %D Case Study Assignment A 56 year old male presents to the emergency department with shortness of breath. He states he feels most comfortable breathing while he is leaning forward. The patient has a history of COPD and is oxygen dependent at home. Upon assessment you notice the patient is little drowsy, but awakens easily when aroused. His ABG results are as follows: pH= 7.39, PaCO2=52, PaO2=50, HCO3=28, SaO2-85 % with patient currently on 21pm NC 3. What treatment or monitoring recommendations should be made for this patient? Please explain your rationale for treatment choice.

Answer 1

The interventions for this patient with compensated respiratory acidosis include:

• Monitor the respiratory status including HR, breathing and saturation levels to assess the progress.
• Administer 2 L oxygen via nasal cannula and do not hyperoxygenate the patient as hypoxemia trigger respiration in COPD patients.
• Administer Bronchodilator medicines and corticosteroids to reverse some types of airway obstruction
• Assist the patient with non invasive positive-pressure ventilation (sometimes called CPAP or BiPAP) or a breathing machine, if needed
• If the patient condition worsen, mechanical ventilation has to be started
• Monitor pulmonary function tests and do X ray Chest to assess the lung condition
• Treat the underlying condition causing respiratory acidosis in the patient. Here it can be COPD, so manage the COPD using medications
• Observe for any complications, like cardiac dysfunction.