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Chapter 15 MR. R is a 66 year old man who has smoked 1.5 packs of cigarettes a day for 40 years (60 pack-years). He is admitted with an acute exacerbation of COPD. His baseline ABGs drawn in the clinic 2 weeks ago showed the following: pH 7.36; PaCo2 55 mm Hg; PaO2 69 mm Hg; bicarbonate 30 mEq/L; SaO2 92%. In the critical care unit, MR. R has coarse crackles in his left lower lung base and a mild expiratory wheeze bilaterally. His cough is productive of thick yellow sputum. His skin turgor is poor; he is febrile, tachycardic and tachypneic. Currently, MR. R’s ABG’ while receiving 02 at 2L/min via a nasal cannula as follows: pH 7.32; PaCo2 64 mm Hg; PaO2 50 mm Hg; bicarbonate 30 mEq/L; SaO2 86%
a) What is your interpretation of Mr. R’s baseline ABG findings from the clinic?
b) What is the probable cause of MR. R’s COPD exacerbation, and what treatment is indicated at this time?
c) What ABG changes would indicate that MR. R’s respiratory status is deteriorating? MS.T is a 41 year old woman who was admitted to the critical care unit and mechanically ventilated for acute asthma. She was extubated yesterday and will be transferred out of the critical care unit tomorrow. What are the important points you must cover in your teaching with Ms. T? Get Nursing Help Today
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