Read the case study. Then answer the questions at the end of the case study.
The patient is a 60-year-old Caucasian female presenting to the emergency department with acute onset shortness of breath. Symptoms began approximately 2 days before and had progressively worsened with no associated, aggravating, or relieving factors noted. She had similar symptoms approximately 1 year ago requiring hospitalization. She uses BiPAP ventilatory support at night when sleeping.
She denies fever, chills, cough, wheezing, and sputum production but does get short of breath easily.
There are no known ill contacts at home. Her family history includes significant heart disease and prostate malignancy in her father. Social history is positive for smoking tobacco use at 30 pack years. She quit smoking 2 years ago due to increasing shortness of breath. She denies all alcohol and illegal drug use. There are no known foods, drugs, or environmental allergies.
Physical Exam
Initial physical exam reveals temperature 97.3 F, heart rate 74 bpm, respiratory rate 24, BP 104/54, BMI 40.2, and O2 saturation 90% on room air.
Pulmonary/Chest: No respiratory status distress at this time, tachypnea present, (+) wheezing noted, bilateral rhonchi, decreased air movement bilaterally. Patient barely able to finish a full sentence due to shortness of breath.
ABG: Initial arterial blood gas with pH 7.491, PCO2 27.6, PO2 53.6, HCO3 20.6, and oxygen saturation 90% on room air.
1. According to the ABG interpretation ,the patient is having respiratory alkalosis because the pH is increased , pCO2 is decreased and HCO3 is also decreased.
2. Medical Management include :-
- want breathing to slow down
- correct rapid respiratory rate
- breath in a bag or cupped hands; to rebreathe blown off CO2 (treats hyperventilation)
- use of e-breather mask
- sedation
- decrease rate of resp on ventilator
- monitor VS & ABGs
- monitor electrolytes (could need to be replaced)
- removing causative agent
- if salicylate poisoning, stop meds
- if anxiety, pt may need sedative or antianxiety agent
- if pain, treat it with analgesics
3. Difference between CPAP and bipap :-
Bipap- Bi level positive airway pressure .
Pressures are different between inhalation and exhalation .
Not commonly used in the field or at home due to the complexity of devices .
Needs monitoring of delivered pressure .
Expensive
CPAP - continuous positive airway pressure
Same pressure at inhalation and exhalation
Used in the filed and at home
Less complicated device for delivery
Needs less monitoring
Cheaper
Read the case study. Then answer the questions at the end of the case study. The...
Read the case study. Then answer the questions at the end of the case study. The patient is a 60-year-old Caucasian female presenting to the emergency department with acute onset shortness of breath. Symptoms began approximately 2 days before and had progressively worsened with no associated, aggravating, or relieving factors noted. She had similar symptoms approximately 1 year ago requiring hospitalization. She uses BiPAP ventilatory support at night when sleeping. She denies fever, chills, cough, wheezing, and sputum production but...
Read the case study. Then answer the questions at the end of the case study. The patient is a 60-year-old Caucasian female presenting to the emergency department with acute onset shortness of breath. Symptoms began approximately 2 days before and had progressively worsened with no associated, aggravating, or relieving factors noted. She had similar symptoms approximately 1 year ago requiring hospitalization. She uses BiPAP ventilatory support at night when sleeping. She denies fever, chills, cough, wheezing, and sputum production but...
Read the case study. Then answer the questions at the end of the case study. The patient is a 60-year-old Caucasian female presenting to the emergency department with acute onset shortness of breath. Symptoms began approximately 2 days before and had progressively worsened with no associated, aggravating, or relieving factors noted. She had similar symptoms approximately 1 year ago requiring hospitalization. She uses BiPAP ventilatory support at night when sleeping. She denies fever, chills, cough, wheezing, and sputum production but...
Read the case study. Then answer the questions at the end of the case study. The patient is a 60-year-old Caucasian female presenting to the emergency department with acute onset shortness of breath. Symptoms began approximately 2 days before and had progressively worsened with no associated, aggravating, or relieving factors noted. She had similar symptoms approximately 1 year ago requiring hospitalization. She uses BiPAP ventilatory support at night when sleeping. She denies fever, chills, cough, wheezing, and sputum production but...
Read the case study. Then answer the questions at the end of the case study. The patient is a 60-year-old Caucasian female presenting to the emergency department with acute onset shortness of breath. Symptoms began approximately 2 days before and had progressively worsened with no associated, aggravating, or relieving factors noted. She had similar symptoms approximately 1 year ago requiring hospitalization. She uses BiPAP ventilatory support at night when sleeping. She denies fever, chills, cough, wheezing, and sputum production but...
Read the case study. Then answer the questions at the end of the case study. The patient is a 60-year-old Caucasian female presenting to the emergency department with acute onset shortness of breath. Symptoms began approximately 2 days before and had progressively worsened with no associated, aggravating, or relieving factors noted. She had similar symptoms approximately 1 year ago requiring hospitalization. She uses BiPAP ventilatory support at night when sleeping. She denies fever, chills, cough, wheezing, and sputum production but...
Read the case study. Then answer the questions typed at the end of the case study. The patient is a 60-year-old Caucasian female presenting to the emergency department with acute onset shortness of breath. Symptoms began approximately 2 days before and had progressively worsened with no associated, aggravating, or relieving factors noted. She had similar symptoms approximately 1 year ago requiring hospitalization. She uses BiPAP ventilatory support at night when sleeping. She denies fever, chills, cough, wheezing, and sputum production...
Read the case study. Then answer the questions at the end of the case study. The patient is a 60-year-old Caucasian female presenting to the emergency department with acute onset shortness of breath. Symptoms began approximately 2 days before and had progressively worsened with no associated, aggravating, or relieving factors noted. She had similar symptoms approximately 1 year ago requiring hospitalization. She uses BiPAP ventilatory support at night when sleeping. She denies fever, chills, cough, wheezing, and sputum production but...
The patient is a 60-year-old Caucasian female presenting to the emergency department with acute onset shortness of breath. Symptoms began approximately 2 days before and had progressively worsened with no associated, aggravating, or relieving factors noted. She had similar symptoms approximately 1 year ago requiring hospitalization. She uses BiPAP ventilatory support at night when sleeping. She denies fever, chills, cough, wheezing, and sputum production but does get short of breath easily. There are no known ill contacts at home. Her...
The patient is a 60-year-old Caucasian female presenting to the emergency department with acute onset shortness of breath. Symptoms began approximately 2 days before and had progressively worsened with no associated, aggravating, or relieving factors noted. She had similar symptoms approximately 1 year ago requiring hospitalization. She uses BiPAP ventilatory support at night when sleeping. She denies fever, chills, cough, wheezing, and sputum production but does get short of breath easily. There are no known ill contacts at home. Her...