Mild hypoxemia with a fully compensated respiratory acidosis

Mild hypoxemia with a fully compensated respiratory acidosis92% 100%The following 5 ABG analyses were formulated using Pierces (2007) systematic analyses (p.55 60). traffic pattern values according to Pierce are listed as followsThe systematic synopsis is done by first looking at each come individually and labeling it. Second describing the adequacy of oxygenation by assessing PaO2 and SaO2. Pierce (2007) lists hypoxemia as sonant (ABG 1FiO20.21pH7.40 standardPaCO250AcidemiaPaO271HypoxemiaHCO330.9AlkalemiaBE5.0AlkalemiaSaO295.1NormalHb12.9Mr. Puffins PaO2 of 71 surfaces mild hypoxemia, with a SaO2 within normal limits. His pH of 7.40 is neutral and shows that his acid base status is within normal limits but his PaCO2 of 50 demonstrates that he is acidotic and his wondrous HCO3 foreshadows wages is occurring. These results suggest Mr. Puffin has a mild hypoxemia with a fully compensated respiratory acidosis. His normal pH indicates full compensation is occurring,ABG2FiO20.5 0pH7.14AcidemiaPaCO2127AcidemiaPaO244.2HypoxemiaHCO341.6AlkalemiaBE7.1AlkalemiaSaO269.2HypoxemiaHb14.1Mr. Puffins PaO2 and SaO2 show he has a pure(a) hypoxemia. His pH of 7.14 is indicative that he is acidotic. His PaCO2 is elevated which shows the acidemia is respiratory in origin. The elevated HCO3 of 41.6 shows that metabolic compensation is occurring, therefore these results indicate Mr. Puffin has flagitious hypoxemia with a partially compensated respiratory acidosis.ABG 3FiO20.40pH7.22AcidemiaPaCO299.6AcidemiaPaO245.3HypoxemiaHCO339.9AlkalemiaBE8.3AlkalemiaSaO2HbABG 3 shows Mr. Puffins respiratory acidosis has improved due to BiPAP therapy. thither is a slight increase in his PaO2 although it cool off shows severe hypoxemia. His pH has improved but still shows acidemia. PaCO2 has decreased due to BiPAP therapy but carcass elevated and indicates respiratory be his primary cause of acidosis. Mr. Puffins HCO3 is also still elevated indicative of partial compensation occurrin g. ABG 3 shows Mr. Puffin still remains severely hypoxic, with a partially compensated respiratory acidosis.ABG 4FiO20.40pH7.32AcidemiaPaCO271.9AcidemiaPaO255.6HypoxemiaHCO336.1AlkalemiaBE8.0AlkalemiaSaO2HbABG 4 shows further improvement in Mr. Puffins severe hypoxemia and respiratory acidosis. His PaO2 has increased further but still shows a severe hypoxemia. His pH although increased still suggests mild acidosis, as well as his PaCO2 of 71.9, although it has decreased, still indicates a respiratory origin. HCO3 remains elevated showing compensation is occurring therefore Mr. Puffin still has severe hypoxemia with a partially compensated respiratory acidosis.ABG 5FiO20.28pH7.00AcidemiaPaCO259.1AcidemiaPaO262.4HypoxemiaHCO318AcidemiaBE-7.8AcidemiaSaO292%Hb14.2Mr. Puffins fifth ABG PaO2, indicates moderate hypoxemia. His pH is low and shows he is acidotic. An elevated PaCO2 suggests acidemia respiratory in nature. HCO3 is also low which also shows acidemia metabolic in nature. Mr. Pu ffin in ABG 5 has a moderate hypoxemia with a mixed respiratory and metabolic acidosis affirm by the decreased BE. dubiousness TwoWhat type of respiratory nonstarter does Mr. Puffin have?Provide a rationale for your answer based on the clinical information supplied.Differentiate between fount 1 and caseful 2 Respiratory tribulation.Respiratory loser as described by Pierce (2007) is the absence of the normal homeostatic state of public discussion as it relates to acid base status of the blood and the exchange of oxygen and blow dioxide (p.181).Type 1 respiratory mischance, Pierce (2007), describes as a visitation to oxygenate or hypoxemic respiratory failure, categorized by a PaO2 of less(prenominal) than 60mm Hg on an FiO2 of more than 0.5, and Type 2 respiratory failure as failure to ventilate, also called ventilatory failure, hypercapnic respiratory failure, or respiratory pump failure, as a PaCO2 of greater than 50mm Hg, with a pH of 7.25 or less (p.181-182).In contras t to Pierces definition Hennessey Japp (2007) define respiratory failure as respiratory outrage. Hennessy Japp define type 1 respiratory impairment as low PaO2 with normal or low PaCO2 which implies defective oxygenation scorn adequate ventilation and the PaCO2 is low due to compensatory hyperventilation (p.20). Hennessey Japp (2007), define type 2 respiratory impairment as a high PaCO2 (hypercapnia), and is due to inadequate alveolar ventilation, and since oxygenation also depends on ventilation, the PaO2 is usually low, but may be normal if the patient is on supplemental oxygen (p.22).Type 1 respiratory failure is most commonly caused by VQ mismatch, pneumonia, pulmonic embolism, pneumothorax, pulmonary edema, shunt and lancinate respiratory distress syndrome and initial treatment is aimed at achieving an adequate PaO2 and SaO2 with supplemental O2 while attempting to correct the underlying cause, Hennessey Japp (2007) p. 20.Type 2 respiratory failure is commonly caused b y chronic obstructive pulmonary disease, exhaustion, flail chest injury, opiate/benzodiazepine toxicity, neuromuscular disorders and obstructive sleep apnea, with clinical signs that hold confusion, drowsiness.Based on the case study information it is evident Mr. Puffin has Type 2 respiratory failure. The diagnosis of type 2 respiratory failure could be made through and through and through the interpretation of ABG 2 as he has a decreased pH and elevated PaCO2 with hypoxemia. His presentation of his difficulty breathing, productive green cough, drowsiness and confusion are consistent with the presentation of an acute exacerbation of chronic obstructive pulmonary disease due to his old diagnosis made by his doctor of emphysema.Question ThreeWhat is BiPAP?BiPAP (Bi take Positive airline Pressure) is a form of non invasive mechanical ventilation commonly administered to patients with exacerbations of type 2 respiratory failure, that delivers two airway impels through passion, (IPAP), and expiration, (EPAP) measured in cm H20. IPAP is the abbreviation for Inspiratory Positive Airway Pressure and EPAP is the abbreviation for Expiratory Positive Airway Pressure.BiPAP is delivered to the patient through an appropriate bilevel ventilator eg Vision BiPAP, or Respironics BiPAP, through a nasal mask, full face mask, or total face mask.Describe the personal effects of BiPAP.In your answer consider its effects on airway pressures, the alveoli, the lung,and the cardiovascular and neurological systems.When BiPAP is administered to a patient with type 2 respiratory failure, during inspiration (IPAP) a higher level of positive airway pressure is delivered, increase breath size, which helps to clear out carbon dioxide and assumes a fatigued patients playact of breathing, and during expiration (EPAP) prevents atelectasis, recruits collapsed alveoli and enables gas exchange between breaths (Woodrow 2003). The difference between IPAP and EPAP is termed pressure foul so for example if Mr. Puffin was commenced on 12 cm H20 IPAP and 6 cm H20 EPAP he would have 6 cm H20 organism the being the difference between 12 and 6 of pressure support. Pressure support decreases the work of breathing by initiating breathing and increasing tidal volume.Question FourOutline the clinical indications for the use of BiPAP in Mr Puffins case.Discuss the monitor that would be required for the safe application ofBiPAP.List the possible complications of BiPAP that may occur in Mr Puffins case.