Question

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 7.39, PCO2 52, PO2 53.6, HCO3 24, and oxygen saturation 90% on room air.

1. What is your interpretation of the ABG results?

2. Based on the findings, what is the clinical diagnosis?

3. What medication would you anticipate the health care provider ordering?

4. What is the difference between Bipap and CPAP?

Answer 1

1. The pH is normal and paCo2 is increased. HCO3 is normal and oxygen saturation decreased

2. the interpretation is that of Respiratory acidosis

3.

Treatment is aimed at the underlying disease, and may include:

• Bronchodilator medicines and corticosteroids to reverse some types of airway obstruction
• Noninvasive positive-pressure ventilation (sometimes called CPAP or BiPAP) or a breathing machine, if needed
• Oxygen if the blood oxygen level is low
• Treatment to stop smoking
• For severe cases, a breathing machine might be needed
• Management of obesity as obesity can also lead to difficulty in breathing

4. Difference between cpap and bipap

The main difference between BiPAP and CPAP devices is that BiPAP machines have two pressure settings: one pressure for inhalation (IPAP), and a lower pressure for exhalation (EPAP), while CPAP have a single pressure delivered by CPAP machine. People with nerve and muscle problems may better benefit from the BiPAP machine rather than the CPAP machine. BiPAP machines can be set to make sure that users breathe a set number of times per minute. The difference in inhalation and exhalation pressures reduces the work of breathing breathing, and allows the person to have a more restful sleep. These are some reasons BiPAP machines are sometimes used as a treatment method when CPAP has failed to adequately treat their sleep disordered breathing. Patients requiring high levels of CPAP pressure are often more comfortable using BiPAP. The CPAP machine is usually used to treat mild to moderate sleep apnea.