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Chronic Obstructive Pulmonary Disorder

Emphysema and chronic bronchitis, termed chronic obstructive pulmonary disease


(COPD), are characterized by bronchospasm and dyspnea... Oxygenation is affected by the increased
work of breathing and the loss of alveolar tissue The tissue damage is not reversible and increases
in severity over time, eventually leading to respiratory failure (Ignatavicuis 2013). Respiratory
failure is defined as inadequate gas exchange such that PaO2 is less than or equal to 50 mm Hg or
PaCO2 is greater than or equal to 50 mm Hg with pH less than or equal to 7.25. If the respiratory
failure is primarily hypercapnic, it is the result of inadequate alveolar ventilation and the individual
must receive ventilatory support (Huether 2012). The patient was intubated and put on a mechanical
ventilator because she was deteriorating and treatment was not able to keep up with her oxygenation.
The purposes of mechanical ventilation are to improve gas exchange and to decrease the work need
for effective breathing. It is used to support the patient until lung function is adequate or until the
acute episode has passed (Ignatavicuis 2013). Soft wrist restrains have been initiated to keep her
from pulling the endotracheal tube out. She is receiving Ativan and Morphine to help keep her
sedated while she is intubated.
According to Huether, hypercapnia, or increased carbon dioxide concentration in the arterial
blood (increased PaCO2), is caused by hypoventilation of the alveoli (2012). The patients most
recent arterial blood gases (ABGs) showed that she was definitely hypercapnic with the PCO2 at 62
mm Hg, her bicarbonate at 35.2 mmol/L with a pH of 7.36. Hypercapnia and the associated
respiratory acidosis result in electrolyte abnormalities that may cause dysrythmias. Individuals also
may present with somnolence and even coma because of changes in intracranial pressure associated
with high levels of arterial carbon dioxide, which causes cerebral vasodilation (Huether 2012). This
may explain why the patient came in with increasing confusion.

This patient was maintained with oxygen at home via nasal cannula at 2 liters per minute (Lpm)
before her exacerbation. Apparently when the patient was home experiencing shortness of
breath, her roommate had increased her oxygen to 4 Lpm hoping it would help. This patient is a
significant CO2 retainer, so this only exacerbated the problem. Due to the fact that she is a
marked CO2 retainer, treatment with the mechanical ventilator needs to be conducted carefully
in order to not have her blow off too much CO2 to the point where her body cannot balance.
The ideal treatment goal for her pH is 7.38, and no greater than 7.4. The ultimate goal is to
wean her off of the ventilator and restore her respiratory function to baseline. Considering she is
on a ventilator, her nutrition status needs to be monitored and possibly be started on parenteral
nutrition. Infection prevention is also a major focus of care considering she has an artificial
airway.

References
Huether, S., & McCance, K. (2012). Understanding pathophysiology (5th Ed.).
St. Louis: Elsevier Saunders
Ignatavicuis, D. D., & Workman, M. L. (2013). Medical-surgical nursing: Patient
centered collaborative care (7th Ed.). St. Louis: Elsevier Saunders