The patient is admitted for treatment with oxygen, inhaled bronchodilators, and oral pred- nisone (60 mg/day initially, followed by a slow taper to discontinuation over 10 days). However, the patient becomes increasingly dyspneic and more agitated despite treatment. Heart rate increases to 125 bpm, pulsus paradoxus increases to 30 mm Hg, respiratory rate increases to 35/min, and breathing becomes more labored. Wheezing becomes loud through- out both inspiratory and expiratory phases of the respiratory cycle. Signs of early cyanosis become evident. The extremities become cold and clammy and the patient no longer is alert and oriented. Repeat ABG are: pH 7.35, PaO2 = 45 mm Hg, and PaCO2 = 42 mm Hg (40% oxygen by mask). Patient Case Question 7. What do this patient’s mental state, heart rate, pulsus para- doxus, respiratory rate, and wheezing suggest?
Patient Case Question 8. Why are the patient’s extremities cold?
Patient Case Question 9. Why is the patient no longer alert and oriented?
Patient Case Question 10. Why is the patient becoming cyanotic?
Patient Case Question 11. Why has the skin become clammy?
Patient Case Question 12. What do the patient’s arterial blood gases indicate now?
Patient Case Question 7
The patient’s worsening mental state, increased heart rate, increased pulsus paradoxus, increased respiratory rate, and loud wheezing throughout both inspiratory and expiratory phases suggest that the patient is experiencing severe respiratory distress and may be developing respiratory failure. The findings of decreased oxygen saturation and increased carbon dioxide levels on repeat ABG further support this. Inspiratory and Expiratory Phases of the Respiratory Cycle Essay Discussion Paper
A heart rate of 125 bpm, pulsus paradoxus of 30 mm Hg, and a respiratory rate of 35/min are all elevated and suggest that the patient is in a state of metabolic acidosis and compensation due to hypoxemia. The signs of early cyanosis and cold, clammy extremities suggest that the patient’s circulation is being affected, possibly due to decreased oxygenation.
The patient’s condition is concerning and requires immediate intervention. The healthcare team should reassess the patient’s airway and breathing, consider supplemental oxygen, and reassess the patient’s response to treatment. The healthcare provider should be notified immediately, and further diagnostic tests, such as chest x-ray or CT scan, may be ordered to determine the underlying cause of the patient’s respiratory distress.
This step explains the interpretationof various signs seen inthe patient.
Patient Case Question 8
The patient’s cold and clammy extremities are likely a result of decreased circulation, which can occur when the body is not getting enough oxygen. When oxygen saturation decreases, blood flow to the extremities can become decreased, leading to cold and clammy skin. This can also be a sign of early cyanosis, which is a bluish tint to the skin and mucous membranes caused by a decrease in oxygen saturation.
In this patient’s case, the low PaO2 (45 mm Hg) and elevated PaCO2 (42 mm Hg) levels on repeat ABG support that the patient is experiencing hypoxemia, or low oxygen levels in the blood. The worsening respiratory distress, increased heart rate, and increased pulsus paradoxus also suggest that the patient’s body is compensating for decreased oxygenation and trying to increase oxygen delivery to the vital organs. The cold and clammy extremities may be a sign that the patient’s compensatory mechanisms are not enough to maintain adequate circulation, and the patient may be developing respiratory failure.
This is due to hypovolumic shock.
This step explains the reason for cold skin.
Patient Case Question 9
The patient is no longer alert and oriented due to hypoxia (low oxygen levels), which can cause confusion and disorientation. The low PaO2 level of 45 mm Hg, as indicated in the repeat ABG results, suggests that the patient’s body is not getting enough oxygen. Additionally, the high PaCO2 level of 42 mm Hg suggests that the patient may be retaining carbon dioxide, which can also contribute to confusion and disorientation. The increased heart rate, respiratory rate, and wheezing further indicate that the patient is in a state of respiratory distress, which can also cause confusion and disorientation.
This step explains the reason for loss of alertness and orientation in the patient.
Patient Case Question 10
The patient is becoming cyanotic due to a lack of oxygen (hypoxia) in the bloodstream. This can be seen by the low PaO2 (partial pressure of oxygen) value of 45 mm Hg. This could be due to the patient’s respiratory distress and worsening breathing, which could be causing the blood to not be fully oxygenated. Inspiratory and Expiratory Phases of the Respiratory Cycle Essay Discussion Paper
This step explains the reason for patient becoming cyanotic.
Patient Case Question 11
The patient’s skin becoming clammy could be due to decreased circulation caused by reduced oxygenation and increased respiratory effort leading to increased heart rate and metabolic demand. This could result in decreased perfusion to the extremities, leading to cold and clammy skin.
This step explains the reason why the skin is clammy.
Patient Case Question 12
The patient’s repeat arterial blood gases (ABG) results indicate a low pH of 7.35, a low oxygen saturation represented by a PaO2 of 45 mm Hg, and an elevated carbon dioxide levels represented by a PaCO2 of 42 mm Hg. These results suggest that the patient has a severe respiratory distress with hypoxemia (low oxygen levels) and respiratory acidosis (elevated CO2 levels). The low oxygen levels could be due to an underlying respiratory issue such as worsening asthma, pneumonia, or acute respiratory distress syndrome (ARDS). The high CO2 levels suggest that the patient is having difficulty breathing and exhaling CO2.
This step explains what the ABG of the patient indicates.
The above case is a depiction of a patient going into respiratory distress because of which the patient has developed hypoxemia, and ultimately landed into shock because of which the above mentioned signs could be seen in the patient. Inspiratory and Expiratory Phases of the Respiratory Cycle Essay Discussion Paper