A 28-year-old female was admitted last night for weakness and ...

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A 28-year-old female was admitted last night for weakness and what appears to be ascending muscle paralysis.
 
  The patient is alert and oriented. Physical findings reveal: pulse 96 beats/min, regular; blood pressure 134/83 mm Hg; temperature 37 C; respiratory rate 24 breaths/min shallow with bilateral decrease in air entry; and no adventitious breath sounds. The patient's ABG results on room air are: pH 7.46; PaCO2 39 mm Hg; PaO2 80 mm Hg; Sat 97; and HCO3 26 mEq/L on room air. The most appropriate suggestion that the respiratory therapist should make for this patient in-cludes which of the following?
  a. Vital capacity every 2 hours
  b. Continuous positive airway pressure
  c. Noninvasive positive pressure ventilation
  d. Peak expiratory flow rate

Question 2

An 80-year-old female with a diagnosis of pneumonia was admitted to the hospital 2 days ago from a nursing home.
 
  The patient is responsive only to painful stimuli. She has a peripheral IV and a feeding tube in place. Physical examination reveals: pulse 98 beats/min; respiratory rate 24 breaths/min and shal-low; blood pressure 100/48 mm Hg; and temperature 39.2 C. Auscultation reveals decreased breath sounds with crackles in the bases. The patient has an occasional weak, nonproductive cough. Arterial blood gas on NC 4 L/min is pH 7.42, PaCO2 38 mm Hg, PaO2 40 mm Hg, SaO2 76, HCO3 24 mEq/L. A portable chest X-ray shows patchy basilar infiltrates in both lungs. The most appropriate action to take at this time is which of the following?
  a. Intubate and initiate mechanical ventila-tion.
  b. Administer a bronchodilator and muco-lytic.
  c. Initiate noninvasive positive pressure ven-tilation.
  d. Change the nasal cannula to a nonre-breather mask.

[zacnyjessica]

Answer to Question 1

ANS: A
Although this patient is suffering from a neuromuscular disease, the patient's arterial blood gas results are within normal limits and therefore do not warrant the use of continuous positive air-way pressure (CPAP) or noninvasive positive airway pressure (NPPV). Peak expiratory flow rate is most frequently used to assess airway resistance for patients with acute asthma. This patient requires frequent monitoring to assess her respiratory muscle strength, and that would be within the vital capacity.

Answer to Question 2

ANS: D
According to the arterial blood gas (ABG) this patient has a normal acid-base balance; therefore intubation and artificial ventilation are not necessary. The patient does not seem to have evidence of requiring a bronchodilator and mucolytic. The patient does not require noninvasive positive airway pressure ventilation (NPPV), because he is breathing. The patient does, however, have severe hypoxemia that warrants a high oxygen concentration.

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Gracias!

[Sarahjh]

TYSM