Patricia D.

Braga September 30, 2022

BSN 4-NCM 118

Question: What is the most likely mechanism of hypoxemia in this patient? Explain.

Answer 1. Based on the data and ABG analysis of the patient, the possible and most likely mechanism
of hypoxemia is the Ventilation/Perfusion (V/Q) mismatch. Hypoxemia refers to a lower than normal
arterial blood oxygen level, measured either as oxygen saturation (SaO2) or partial pressure of oxygen
(PaO2). The ABG analysis presents a reduced oxygen tension or saturation (6.6) and increased carbon
dioxide tension (9.4). Ventilation Perfusion mismatch happens when one or more areas of the lungs
receive oxygen but no blood flow or they receive blood flow but no oxygen. Lung auscultation revealed
normal breathing sounds but the history of hypertension and smoking and a body mass index of 28kg
triggers the mismatch. Obesity may decrease lung volumes during normal breathing and can also
cause the onset of hypercapnia which is one of the manifestations presented. Patient snoring heavily
may also contribute to the mechanism of hypoxemia because of the alterations in the gas exchange
and oxygenation. The clinical signs of hypoxemia vary with age.

Question: Which of the following disorders is most likely to be the cause of hypoventilation in our
patient? Explain.

Answer 2. Patient complained of exertional dyspnea, asthenia or weakness and intermittent daytime
sleepiness. Respiratory failure could be the possible cause of hypoventilation. Respiratory failure
occurs due mainly either to lung failure resulting in hypoxemia or pump failure resulting in alveolar
hypoventilation and hypercapnia. The progressive breathing difficulty, snoring heavily and even obesity
all contributes to the onset of hypoventilation or the increased amount of carbon dioxide in the blood.
Sleep related problems like intermittent daytime sleepiness as complained by the patient is also more
common to develop due to obesity. Hypoventilation is most severe during REM sleep. The symptoms of
hypoventilation vary depending on the severity of the condition.