Question

THIS IS A RESPIRATORY THERAPY CASE STUDY.

62-year-old male.69 inches tall. Weighing 148lbs. Pt admitted yesterday

with exacerbation of COPD. The patient is currently difficult to arouse. THIS IS

A CHANGE IS HIS CONDITION. The patient is on a general medical floor with

IV fluids running. You are charged to see him for therapy ordered.

Physical findings: pulse 120bpm and thread, BP 100/52, temperature

38.5°C, RR 26 bpm-slightly labored and shallow, breath sounds are

decreased throughout with rhonchi in the bases bilaterally, cough-

frequent, weak, productive small amounts of thick yellow sputum.

Labs: pH 7.29, CO2 70, PaO2 46, SpO2 85% on nasal cannula at 2lpm; Hgb

14; last peak flow was 80lpm, EKG shows sinus tachycardia

Considerations: Pt is currently on 2lpm with nebs ordered albuterol q4hr

and Atrovent puffs QID.

1. Would you recommend placing this patient on mechanical

ventilation?

2. If so, what initial settings would you recommend?

3. Is this an oxygenation or ventilation problem? Is the pH acidotic or

alkalotic? Is the PaCO2 acidotic or alkalotic? What does the PaO2

indicate (technical/medical term)?

4. What are your additional recommendations, changes or additions to

the patient’s treatment?

5. What additional tests would you order and why?

Answer 1

1. Yes, the patient needs to be placed on mechanical ventilation.

Its because his PaO2 is very low, he is on respiratory acidosis, low saturation and patient is unconscious. each of these conditions indicating the need for mechanical ventilation.

2. The patient needs volume control mode, with high peep, low tidal volume, and high RR rate. Its because to avoid lung injury at the same time to maintain saturation and high RR is for carbon dioxide washout.

3. The patient has both oxygenation and ventilation problems.

It is ventilation because pH is acidic because of high PCO2, I.e 70(Carbon-dioxide is in acidic range). it is called respiratory acidosis.

It is an oxygenation problem because his PO2(It means partial pressure of oxygen) is very low I.e 40 and his oxygen saturation is also low.

4.

The patient is having pneumonia which is evidenced by breath sounds are decreased throughout with rhonchi in the bases bilaterally, cough-frequent, weak, productive small amounts of thick yellow sputum and high-grade fever so, the patient needs antibiotics and symptomatic treatment of fever.

The patient also needs mechanic ventilation to correct the pH of blood balance.