Question

On admission, a patient presents as follows: pH, 7.38; respiratory rate, 24 breaths/min, regular, pursed-lip breathing; PaO2, 66 mm Hg; heart rate, 112 beats/min, sinus tachycardia; PaCO2, 52 mm Hg; blood pressure, 110/68 mm Hg; HCO3–, 24 mEq/L; and SpO2, 90% on O2 2 L/min nasal cannula. What treatment would the physician or nurse practitioner likely order for this patient?

Answer 1

The patient is tachypneic (increased respiratory rate, normal is 12 to 20 breaths/minute) and tachycardic (increased heart rate, normal is 60 to 100 beats per minute, and decreased oxygen saturation (SpO2) even with oxygen supplementation, wherein the normal is beyond 95%; and based on the following laboratory exams, the patient has increased arterial carbon dioxide (PaCO2), the normal range should be at 38 to 42 mmHg. All other clinical data is normal. The patient possibly has COPD because of the vital signs, pursed-lip breathing, and deranged laboratories. The physician or the nurse practitioner may request nebulization with a bronchodilating agent (i.e. Salbutamol + Ipratropium) as well as increasing the oxygen supplementation from 2 lpm to 5 lpm.