Question

Mrs. Hernandez is a 72-year-old Hispanic female who was admitted to the medical unit yesterday afternoon with a diagnosis of pneumonia in her right lobe. Chest X-ray shows infiltrates in right lower lobe, indicative of pneumonia. She was started on antibiotics after a sputum specimen for Gram stain culture was obtained. We are monitoring her respiratory status closely

Background: Mrs. Hernandez was experiencing symptoms of dry cough, fever, and malaise, and was diagnosed with influenza 10 days prior to admission. Her symptoms got progressively worse, and yesterday she had a temperature of 38.4 °C (101.2 °F), shaking, chills, and a productive cough of rust-colored sputum. Her primary care provider saw her yesterday and decided to admit her for treatment of pneumonia.

Assessment: Mrs. Hernandez is alert and oriented ×3, but appears tired. She reports sharp chest pain with coughing and shortness of breath with activity. She rated the pain as a 6 on a scale of 0–10 and was given acetaminophen 650 mg at 1400. Vitals signs were taken at 1200. Her temperature has been elevated since this morning and was 38.1 °C (100.6 °F). Pulse is 104/min, respirations 24/min, and blood pressure 112/72 mm Hg. Her saturation was 95% on nasal cannula with oxygen at 3 L/min. Her respirations were labored when she came back from the bathroom, but improved when she settled back in bed.

Recommendation: You should make sure to maintain saturation levels above 94%. Mrs. Hernandez needs encouragement to cough and deep breathe, and to use incentive spirometry. She only uses her incentive spirometer after much encouragement. You should also start patient education on disease process and management.

Provide a RATIONALE for the following abnormal diagnostics noted in Mrs. Hernandez’s chart:

1. ABG results: pH = 7.3, HCO3 = 22 mEq/L, PCO2 = 58 mm Hg, PO2 = 72 mm Hg), SaO2 = 94%

1. What abnormal pH condition is shown in this ABG (list causing system and pH abnormality)?

2. Give rationale for this finding for Mrs. Hernandez:

3. Is there any compensation occurring?  

4. If your above answer is “YES” what system is compensating?

2. Blood Analysis: WBC = 18 * 1,000,000,000/L

3. Electrolytes: Creatinine = 0.76 mg/dl

Answer 1

NORMAL ABG VALUES ARE

PH-7.35 TO 7.45  

PARTIAL PRESSURE OF OXYGEN -75 TO 100 MM HG

PARTIAL PRESSURE OF CARBONDIOXIDE -35 TO 45 MMHG

BICARBONATE 22 TO 26MEQ/L

the patient is experiencing a condition of respiratory acidosis[ uncompensated] Mainly because of his pneumonia

in respiratory acidosis it is used to have these laboratory changes

-decrease pH - patient had low ph -7.3

, normal [bicarbonate] HCO3-patient had normal bicarb -22

pao2 [partial pressure of oxygen]-usually decreased [pao2] -patient had decressed pao2- 72

usually partial pressure of carbon di oxide increased [paco2]-patient had increased paco2- 58

serum potasium used to increase

therefore it is clear that patient is experiencing respiratory acidosis

TO CHECK COMPENSATION  

check for the level of ph -it should be normal

Hco3 and paco2 should be increased in respiratory acidosis compensation

IN THIS PATIENT ph is decreased ,HCO3is normal and paco 2 is increased ,so there is no compensation

COMMON CAUSES OF RESPIRATORY ACIDOSIS ARE

ASTHMA,ATELECTASIS,BRAIN TRAUMA,BRONCHITIS,HYPOVENTILATION,PNEUMONIA