You are a new graduate nurse on your second rotation in a 30-bed medical ward. It is 0800hrs during a morning shift, and you have been allocated the care of a 70-year-old female, who has been on your ward for the last week, recovering from an acute infective exacerbation of chronic obstructive pulmonary disease (copd).
Past medical history: ischaemic heart disease (ihd) and severe copd (with type ii respiratory failure).
When assisting the patient with breakfast you notice she has become increasingly breathless, only speaking in single words, and not interested in eating. A set of observations are taken:
SAO2 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.
lab results:
abg
uec's
fbc
ph 7.33
na 144mmol/l
hb 155 g/l
pa02 55 mmhg
k 4.5 mmol/l
wcc 11 x 109/l
pac02 70 mmhg
cl 109 mmol/l
plt 400 x 109/l
hc03 36 mmol/l
urea 8 mmol/l
creat 90 µmol/l
Questions
1. Using the information given in the (above) case study start by prioritizing 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?
