You are a new graduate nurse on your second rotation in a 30-bed medical ward. It is 0800hrs on your morning shift and you have been allocated the care of a 69-year-old female who has been on your ward for that last week recovering from an acute infective exacerbation of CAL.
Past Medical History: IHD and Severe CAL with Type II respiratory failure.
You are assisting the patient with breakfast and notice she has become increasing breathless, only answering in single words and not interested in eating. A set of observations are taken: SpO2 88% on NP at 2L/min , BP 160/90, HR 144, Resp rate 45 b/min and temperature 37.2. Auscultation of the lung fields reveals wide spread expiratory wheeze bilaterally.
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Lab Results: ABG
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UEC's
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FBC
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pH 7.33
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Na 144mmol/L
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Hb 155 g/L
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Pa02 55 mmHg
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K 4.5 mmol/L
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WCC 11 x 109/L
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PaC02 70 mmHg
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Cl 109 mmol/L
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PLT 400 x 109/L
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HC03 36 mmol/L
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Urea 8 mmol/L
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Creat 90 μmol/L
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Questions
1. Based on the information given in the (above) case study start by prioritising and justifying your immediate care of this patient?
2. You also need to interpret both clinical and lab results, and
3. What physiological processes may be responsible for the abnormal clinical or lab results?