Sarah is a 69-year-old female who presented to the emergency department with shortness of breath. Her past medical history includes heart failure and COPD. Her pulse oximetry on room air is 82%. You notify the provider, and he orders oxygen at 2 L via nasal cannula NC. Sarah’s chest x-ray reveals bilateral pneumonia. Her arterial blood gas results are below:

Multidimensional Care for Sarah

Scenario

Sarah is a 69-year-old female admitted to the emergency unit due to shortness of breath. She has a history of chronic obstructive pulmonary disorder and heart failure. Her chest X-ray shows bilateral pneumonia, while her pulse oximetry reveals an SPO2 of 82%. Sarah’s arterial blood gas test reveals bicarbonate levels of 26 mmHg, pH of 7.30, PaO2 of 78 mmHg, and PaCO2 of 58 mmHg.

Potential Problems

Sarah is potentially suffering from respiratory acidosis. Normal arterial blood pH in adults is between 7.35 and 7.45; therefore, Sarah’s pH of 7.30 is lower by 0.05. Normal arterial blood partial pressure (PaCO2) in adults ranges between 35 mmHg and 45 mmHg. Sarah has a PaCO2 of 58 mmHg, which is above normal. Normal serum bicarbonate (HCO3) levels are between 21 mEq/L and 28 mEq/L; therefore, Sarah’s HCO3 readings of 26 mEq/L are normal. The normal partial pressure of oxygen (PaO2) is between 75 mmHg to 100 mmHg. Sarah’s PaO2 level of 78 mmHg is within range. Respiratory acidosis is characterized by decreased pH and an increased PaCO2 (Hopkins et al., 2022). Sarah is experiencing respiratory acidosis since she has an increased PaCO2 of 58 mmHg and a decreased pH of 7.30. Potential problems that Sarah might experience due to respiratory acidosis include wheezing, hypoxemia, papilledema, dyspnea, altered sleeping patterns, delirium, hyperinflation, seizures, and chronic hypoxemia or hypoxia.

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Multidimensional Care

Sarah is admitted to the emergency department and,, therefore,, requires oxygen therapy to relieve shortness of breath. The nurse ensures the patient is positioned in a way that eases breathing and comfort. Sarah’s underlying conditions are heart failure and chronic obstructive pulmonary disorder. The nurse must educate the patient on lifestyle adjustments, especially if the patient is a smoker. Sarah’s care may include the administration of bronchodilators such as theophylline and salmeterol. The nurse should also ensure Sarah is adequately hydrated. Monitoring Sarah’s arterial blood gas and vital signs helps the nurse determine whether the patient is responsive to her therapy (Patel & Sharma, 2022).

Roles of Other Departments

Other departments relevant to Sarah’s treatment plan include a neurologist, pulmonologist, and cardiologist. A neurologist and pulmonologist assist in properly treating respiratory acidosis (Patel & Sharma, 2022). On the other hand, a cardiologist assesses and ensures the proper management of heart failure.

References

Hopkins, E., Sanvictores, T., & Sharma, S. (2022). Physiology, Acid-Base Balance. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK507807/.

Patel, S., & Sharma, S. (2022). Respiratory Acidosis. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK482430/.