Question

Case Study

Amnah is a 55-year-old female patient who has been admitted to the medical ward with acute shortness of breath, chesty cough, wheezing and chest discomfort. Amnah’s vital signs were: SpO2 82% on room air, BP 150/90 mmHg, Pulse 110 beats/min, RR 28 breaths/min, and Temperature 38.7 °C. Amnah has a history of COPD and hypertension for 15 years. She was also diagnosed with heart failure 2 years ago. While doing the physical examination, the patient seemed to use her accessory muscles and have cyanosis in the lips and nose. She also started to get mixed up during the nursing assessment as she could not figure out that she was in the hospital. Amnah also complaint of weakness and fatigue and her lower limbs were very edematous. After a medical review, ABG was taken, CXR was done and venous blood samples were sent for complete blood count, chemistry and culture and sensitivity. Amnah’s lab results were as follows:

Chemistry	Patient Value	Normal Values	ABG & CXR
Sodium	148	136-146 mmol/L	pH 7.25 PaO2 49mm Hg PaCo2 58mm Hg HCO3 27mEq/L
Potassium	4.4	3.5-5.3 mmol/L
Chloride	106	98-108 mmol/L
BUN	68	7-22 mg/dl
Creatinine	1.66	0.7-1.5 mg/dl
Blood culture and sensitivity	streptococcus pneumoniae		CXR: opacity of right lower loop with consolidation and pleural effusions with cardiomegaly
Calcium	7.8	8.9-10.3 mg/dl
Phosphorus	10.4	2.6-6.4 mg/dl
Alkaline Phosphatase	321	30-110 IU/L
Hemoglobin	14.5	14-17 gm/dl

Based on the medical review and the diagnostic tests results, Amnah was mainly diagnosed with impaired respiratory functions. She was also found to have some cardiac and renal abnormalities. The doctor ordered immediate treatment and requested very close monitoring of Amnah.

1. You are the nurse looking after Amnah whose ABG results were significantly abnormal.

A. Give a name of a medical treatment used to correct Amnah’s ABG results?

       B. Explain why would you have chosen to use this treatment?                                  

  

C. Identify two clinical symptoms that support the ABG results of Amnah?

Answer 1

Ans 1-As it is a case of respiratory acidosis bronchodilator and steroids are given to ensure bronchodilation for improved breathing.And noninvasive positive pressure o2 ventilation therapy is needed .

Ans 2-As patient is unable to respire efficiently due to pneumonia co2 is unable to exchange efficiently and o2 is unable to reach alveoli efficiently.And so bronchodilator and steroids are used to improve breathing and o2 therapy to provide proper oxygen.

Ans 3 -Clinical symptoms of shortness of breathing,chest discomfort and mental confusion are signs of respiratory acidosis.