A postoperative patient complaining of dyspnea is found to have ...

[Mollykgkg]

A postoperative patient complaining of dyspnea is found to have tachypnea and tachycardia, and is somewhat confused. Breath sounds reveal end inspiratory crackles in both lung bases.
 
  An arterial blood gas (ABG) is drawn and reveals the following: pH 7.49; PaCO2 33 mm Hg; PaO2 51 mm Hg; SaO2 87; HCO3 25 mEq/L while on a 30 air entrainment mask. The most appropriate respiratory therapy intervention includes which of the following?
  a. Initiate noninvasive positive pressure ven-tilation (NPPV).
  b. Initiate continuous positive airway pres-sure (CPAP) by mask.
  c. Administer bronchodilator therapy.
  d. Intubate and mechanically ventilate.

Question 2

A 28-year-old man is admitted to the emergency department with suspected drug overdose.
 
  The patient is obtunded and slightly cyanotic. The ABG results obtained while the patient was breathing room air were: pH 7.24; PaCO2 58 mm Hg; PaO2 52 mm Hg; HCO3 24 mEq/L. The most appropriate interpretation of these results is which of the following?
  a. Chronic respiratory failure
  b. Hypoxemic respiratory failure
  c. Hypercapnic respiratory failure
  d. Acute or chronic respiratory failure

[swimkari]

Answer to Question 1

ANS: B
This patient is showing signs and symptoms of hypoxemic respiratory failure due to postoperative atelectasis. This patient's PaO2/FIO2 is below the critical value. Since the patient is still able to move air, intubation and mechanical ventilation, as well as noninvasive positive pressure ventila-tion (NPPV), are not appropriate at this time. This patient is not showing signs of increased work of breathing due to bronchospasm. Therefore, administering bronchodilator therapy is not appro-priate. Initiating continuous positive airway pressure (CPAP) by mask will help to reverse the at-electasis and improve the patient's oxygenation status.

Answer to Question 2

ANS: C
This arterial blood gas shows an uncompensated respiratory acidosis with moderate hypoxemia. A patient with chronic respiratory failure would show an elevated bicarbonate (HCO3) due to the chronic respiratory failure. A patient with acute or chronic respiratory failure would have an elevated partial pressure of carbon dioxide in the arteries (PaCO2) that is higher than what the pa-tient's current HCO3 can compensate for. Hypoxemic respiratory failure will only show a de-creased partial pressure of oxygen in the arteries (PaO2) unless the hypoxemia is so severe that the patient's ventilation is compromised.

[Mollykgkg]

TYSM

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