{"id":21080,"date":"2020-12-10T11:05:25","date_gmt":"2020-12-10T11:05:25","guid":{"rendered":"http:\/\/onlineclassesguru.com\/?p=21080"},"modified":"2020-12-10T11:05:25","modified_gmt":"2020-12-10T11:05:25","slug":"mrs-breathless-is-a-43-year-old-female-just-getting-off-the-late-shift-she-reports-to-the-er-in-the-early-morning-with-shortness-of-breath-she-has-cyanosis-of-the-lips","status":"publish","type":"post","link":"https:\/\/onlineclassesguru.com\/index.php\/2020\/12\/10\/mrs-breathless-is-a-43-year-old-female-just-getting-off-the-late-shift-she-reports-to-the-er-in-the-early-morning-with-shortness-of-breath-she-has-cyanosis-of-the-lips\/","title":{"rendered":"Mrs. Breathless is a 43-year-old female, just getting off the late shift. She reports to the ER in the early morning with shortness of breath. She has cyanosis of the lips."},"content":{"rendered":"<style type=\"text\/css\"><\/style><h3>Mrs. Breathless is a 43-year-old female, just getting off the late shift. She reports to the ER in the early morning with shortness of breath. She has cyanosis of the lips.<\/h3>\n<p>&nbsp;<\/p>\n<p>Case Study 1: Respiratory System<br \/>\nMrs. Breathless is a 43-year-old female, just getting off the late shift. She reports to the ER in the early morning with shortness of breath. She has cyanosis of the lips. She has had a productive cough for 2 weeks. Her temperature is 102.2, blood pressure 110\/76, heart rate 108, respirations 32, rapid and shallow. Breath sounds are diminished in both bases, with coarse rhonchi in the upper lobes. Chest X-ray indicates bilateral pneumonia.<br \/>\n\u2013 ABG (Arterial Blood Gases) Lab results are:<br \/>\no pH= 7.44 Note: rhonchi are continuous low pitched rattling lung sounds<br \/>\no PaCO2= 28 that often resemble snoring or wheezes.<br \/>\no HCO3= 24<br \/>\no PaO2= 54<br \/>\nProblems:<br \/>\n\u2013 PaCO2 is low.<br \/>\n\u2013 pH is on the high side of normal, therefore compensated respiratory alkalosis.<br \/>\n\u2013 Also, PaO2 is low, probably due to mucous displacing air in the alveoli affected by the pneumonia.<br \/>\nSolutions:<br \/>\n\u2013 Mrs. Breathless most likely has ARDS along with her pneumonia.<br \/>\n\u2013 The alkalosis need not be treated directly. Mrs. Breathless is hyperventilating to increase oxygenation, which is incidentally blowing off CO2. Improve PaO2 and a normal respiratory rate should normalize the pH.<br \/>\n\u2013 High FiO2 can help, but if she has interstitial lung fluid, she may need intubation and PEEP, or a BiPAP to raise her PaO2.<br \/>\n\u2013 Expect orders for antibiotics, and possibly steroidal anti-inflammatory agents.<br \/>\n\u2013 Chest physiotherapy and vigorous coughing or suctioning will help the patient clear her airways of excess mucous and increase the number of functioning alveoli.<\/p>\n<p>Normal Results for ABG (Arterial Blood Gases)<br \/>\nValues at sea level:<br \/>\n\u2013 Partial pressure of oxygen (PaO2): 75 \u2013 100 mmHg<br \/>\n\u2013 Partial pressure of carbon dioxide (PaCO2): 38 \u2013 42 mmHg (Respiratory)<br \/>\n\u2013 Arterial blood pH: 7.38 \u2013 7.42<br \/>\n\u2013 Oxygen saturation (SaO2): 94 \u2013 100%<br \/>\n\u2013 Bicarbonate \u2013 (HCO3): 22 \u2013 28 mEq\/L (Metabolic)<br \/>\nNote: mEq\/L = milliequivalents per liter; mmHg = millimeters of mercury<br \/>\nAt altitudes of 3,000 feet and above, the oxygen value is lower.<br \/>\nROME<br \/>\nThe nursing mnemonic RO-ME.<br \/>\nRespiratory Opposite<br \/>\nWhen pH is up, PaCO2 is down = Alkalosis<br \/>\nWhen pH is down, PaCO2 is up = Acidosis<br \/>\nMetabolic Equal<br \/>\nWhen pH is up, HCO3 is up = Alkalosis<br \/>\nWhen pH is down, HCO3 is down = Acidosis______________________________________________________________________________<br \/>\nFiO2 \u2013 Fraction of inspired oxygen; it is the amount of oxygen a patient is inhaling produced by a oxygen device (i.e.) oxygen mask.<br \/>\nPEEP \u0083?? Positive end expiratory pressure (It opens alveoli through exhalation, even when interstitial fluid (ARDS) is trying to collapse them.<br \/>\nBiPAP \u0083?? is a machine that blows air at the mouth and nose. It increases Tidal Volume like the IPPB but it also provides resistance during exhalation. It keeps the alveoli inflated even when the patient is exhaling. Bi \u0083?? Both phases of breathing. PAP \u0083?? Positive Airway Pressure.<br \/>\nIPPB \u0083?? is intermittent positive pressure breathing (i.e.) Positive pressure when the patient inhales.<\/p>\n<p>Discussion Questions:<br \/>\n1. 1. Explain what ARDS is.<br \/>\n2. Explain what is significant with her lab results using the ABG normal values and the nursing mnemonic ROME which I have included.<br \/>\n3. Explain why the solution or treatment is appropriate.<br \/>\n4. Explain what you learned from this exercise.Currently 1 writers are viewing this order<\/p>\n<p><center><a href=\"http:\/\/onlineclassesguru.com\/orders\/ordernow\"><img decoding=\"async\" src=\"https:\/\/encrypted-tbn0.gstatic.com\/images?q=tbn:ANd9GcTyj99p60XCLyLk1htB7-1neRt8-2QdnenNlQ&usqp=CAU\"target=\"_http:\/\/onlineclassesguru.com\/orders\/ordernow\"\/><\/center><p>","protected":false},"excerpt":{"rendered":"<p>Mrs. Breathless is a 43-year-old female, just getting off the late shift. She reports to the ER in the early morning with shortness of breath. She has cyanosis of the lips. &nbsp; Case Study 1: Respiratory System Mrs. Breathless is a 43-year-old female, just getting off the late shift. She reports to the ER in&#8230;<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-21080","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v17.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Mrs. Breathless is a 43-year-old female, just getting off the late shift. She reports to the ER in the early morning with shortness of breath. She has cyanosis of the lips. - onlineclassesguru<\/title>\n<meta name=\"description\" content=\"Mrs. Breathless is a 43-year-old female, just getting off the late shift. She reports to the ER in the early morning with shortness of breath. 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