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Admitting History
A 68 year old retired geologist arrived in the emergency room with his daughter.
Well known to the respiratory care consult team, he has a 40 year history of smoking 1.5
packs of cigarettes a day, is widowed, lives alone, and has difficulty managing his daily
activities. For the past week the man has experienced increased dyspnea and cough and
has been unable to care for himself. On observation, his personal hygiene appeared to
have deteriorated. The man stated that he has been unable to get his breath or inhale deep
enough to cough up secretions. He complained of mild nausea without abdominal pain or
vomiting. His physician had given him an unknown oral antibiotic 3 days before this
admission.
The man was diagnosed with severe chronic bronchitis approximately 6 years ago and
had an acute myocardial infarction 2 years ago. His pulmonary function studies 1 year
before this admission showed severe airway obstruction and air trapping. He has a
history of high blood pressure, congestive heart failure, chronic dyspnea on exertion, and
chronic cough and he experienced two episodes of pneumonia within the last year. In
recent months, according to a neighbor, he has become increasingly depressed.
According to his daughter, his physical activity is minimal. He generally spends
most of his days watching television, smoking, and napping. All his children, none of
whom live in the immediate area, have tried to coax him to move to a boarding house
environment, but he has adamantly refused. During his last admission, the advantages of
pulmonary rehabilitation were discussed with him. The patient said that he had no need
for pulmonary education, nor for the services of other agencies or organizations to check
up on him in his home.
Physical Examination (Time: 1730)
Inspection revealed a barrel chest, clubbing of his fingers and toes, cyanotic skin,
and pitting edema (2+) around his ankles. His breathing was labored; he was pursed-lip
breathing, using his accessory muscles of respiration, and he appeared weak. He had a
frequent, weak cough productive of large amounts of thick, yellow sputum.
Vital signs were as follows: blood pressure 190/115, heart rate 125 bpm,
respiratory rate 30/min, and oral temperature 37 C (98.6F). Tactile fremitus was present
over both lung fields, and hyperresonant perussion notes were produced both anteriorly
and posteriorly. Bilateral rhonchi were auscultated. His abdomen was soft and not
tender. Bowel sounds were active.
On room air his arterial blood gas values were as follows: pH 7.53, PaC02 56
mmHg, Pa02 64 mmHg, HC03 33 mmol/L. review of his chart showed that on his last
hospital discharge, his baseline ABGs on 2 L/min 02 were as follows: pH 7.39, PaC02
85, mmHg, Pa02 64 mmHg, HC03 38 mmol/L. His carboxyhemoglobin level was 6%.
His chest x-ray on this admission showed severe hyperinflation with depressed
hemidiaphragms (refer to page 183 for reference). No acute infiltrates were apparent.
His heart size was normal. His CBC values were all normal except for hct of 58% and
hgb of 16.5. The attending physician ordered a respiratory care consult. The following
order was written in the patients chart: All efforts should be made to keep the patient
off the ventilator.
Using the terms from chapter 4 of your Respiratory Disease textbook, which term would
be used to describe his current ABG?
Are the clinical manifestations of cough and sputum production characteristic of this
disorder? If so, why?
patients vital signs were as follows: blood pressure 185/135, heart rate 130 bpm,
respiratory rate 28/min, and oral temperature 37 C. Bilateral rhonchi were auscultated
over the lung bases. His ABGs were as follows: pH 7.55, PaC02 53 mmHg, Pa02 41
mmHg, HC03 32 mmol/L. His Sp02 was 83%.
Classify his recent ABG.
Using the terms from chapter 4 of your Respiratory Disease textbook, which term would
be used to describe his recent ABG?
Using the terms from chapter 4 of your Respiratory Disease textbook, which term would
be used to describe his recent ABG?