Question

Patient Profile

Jordan Washington, age 64, has chronic obstructive lung disease caused by a long history of smoking cigarettes. She is currently hospitalized because she complains of shortness of breath. His arterial blood gases are pH 7.24, PaCO2 68mmHg, PaO2 55mmHg, BE +10 mEq/L.

Discussion Questions:

1. What acute and chronic conditions contributed to her acid-base imbalance?

2. Explain how her lab values are used to determine the type of acid-base imbalance.

3. Explain how her lung condition affects alveolar gas exchange, thus causing the problem.

4. Explain how her body will compensate for her acid-base imbalance.

A chest x-ray was completed. Mrs. Washington is diagnosed with pneumonia and an antibiotic was ordered.

Mrs. Washington states she is unsure if she has any known allergies. Her past medical history indicates she had asthma as a child and had one occurrence of contact dermatitis. She tells you she is not sure if she has drug allergies.

You start Mrs. Washington's IV and perform a saline flush. You begin infusing the intravenous (IV) antibiotic. Within three minutes, she states that her IV site itches, and a few minutes later she begins to complain of tightness in her throat.

Subjective Data

States IV site itches

States throat and neck feel tight and says “I feel like I can’t breathe”

Objective Data

Vital signs: Temp 98.8° F, Heart rate 120, Respiratory rate 32, Blood pressure 100/60

Oxygen saturation 85%

Wheezing in all lung fields

Restless

Swelling and redness at the IV insertion site

Discussion Questions

5. What type of altered immune response is Mrs. Washington experiencing?

6. What is the apparent causative factor and what were the potential sources of exposure?

7. What were her risk factors for this type of reaction?

8. How would you explain the pathophysiologic response of allergic reaction to Mrs. Washington's family? Use language the family will understand.

Answer 1

1. In COPD patients , an elevated residual carbon dioxide level and did not repond to high carbon di oxide concentrations as the respiratory stimulant ; client respond instead to a drop in oxygen concentration in the blood. Respioratory acidosis due to hypercapnia is a common and severe complication.Both metabolic acidosis and metabolic alkalosis can coexist with respiratory acidosis.

2. Her lab values helps to dertermine the acid - base balance. Measurements of blood pH and of arterial oxygen tentions are obtained when managing the patient. The arterial oxygen tention indicates the dregree of oxygenation of bloob and the arterial carbon dioxide indicate the adequacy of alveolar ventilation.

3. Expiratory reserve volume is decreased and the residual volume may be increased in this condition. Tidal volume may not vary, with severe disease.

- A decrease vital capacity may be found and a decrease in inspiratory capacity may indicate .

- Functional residual capacity may be increased.

- Total lung capacity is increased .

4. Elderly people have a decreased ability to move air rapidly in and out of the lungs. The alveoli begin to lose elasticity. A decrease in vital capacity occurs with loss of chest wall mobility, thus restricting the tidal flow of air. The amount of repiratory dead space increase with age.These changes reult in a decreased diffusion capacity for oxygen producing lower levels in the arterial circulation.

5. In this condition, patient will be experiencing inflammation in the lungs, mucus hypersecretion in the airways, chronic bronchitis alveolar air space enlargement, airway or parenchymal destruction.

6. The main causative factor is the cigarette smoking and long exposure to pollutants will be the main causes.

7. The main risk factor may be she was having asthma and cigarette smoking ,also may be before in the working place she will be expose to chemical pollutants.

8. Encourage the client and family to take an active role in planning therapy.

- Educate about the cessation of smoking and avoidance of exposure to chemical pollutants .

- Assist to cope with lifelong activity restrictions.

- Encourage to continue with health care supervisions.

- Teach how to prevent complications of immobility when activity is severely restricted or bed rest becomes necessary.

- Teach to avoid crowds and people with respiratory tract infection.

- Teach to maintain higher resistance possible by attaining adequate rest , eating nutritious food, dressing appropriately for weather conditions, maintaining fluid intake, receiving pnuemococcal and influenza vaccinations.

- Teach them to avoid sedatives or hypnotics which may compromise respirations.

- States methods for reducing / controlling feelings of anxiety / fear.

- Encourage to express feelings about disease and therapy.

- Encourage fluids to maintain hydration.

- Teach to adjust activities to avoid overexertion and exposure to cold.