Diagnostic Choice

Cari’s states, “I feel like I’m panting like a dog, and my chest hurts” Her shortness of breath, fatigue and headache are all results of the lack of oxygen exchange to her tissues. The pH of her blood was rising due to the hyperventilation also.

The Ventilatory threshold was reached at 5 minutes or stage 3 for patient 92 C. The ventilatory threshold is important because it indicates the point at which the blood lactate acid increases non-linearly. It indicates that there is an increase in the lactate acid level in the blood as well as the excess carbon dioxide (Kenny et al., 2015). The increase in carbon dioxide will stimulate chemoreceptors to increase ventilation. The ventilatory threshold is related to the anaerobic threshold which refers to the increase in carbon dioxide and indicates that the body has shifted towards anaerobic metabolism (Kenny et al., 2015).

Because the PCO2 levels are too high the body is not getting the adequate amount of oxygen. This means the oxygen-carrying hemoglobin is not working properly do to the excessive amounts carbon dioxide causing respiratory acidosis.

When your blood pH being alkaline, you experience respiratory alkalosis. The co2 levels drop in your blood which causes complications.

Respiratory acidosis is a condition that occurs when the lungs cannot remove all the carbon dioxide the body produces. This causes body fluids, especially the blood, to become too acidic. Chronic respiratory acidosis occurs over a long period of time, this leads to a stable situation, because the kidneys increase body chemicals, such as bicarbonate, that help restore the body’s acid-base balance. Acute respiratory acidosis is a condition in which carbon dioxide builds up quickly, before the kidneys can return the body to a state of balance. Some of the symptoms may include: confusion, fatigue, lethargy, shortness of breath, and sleepiness. Some causes of

The normal blood pH is between 7.35 and 7.45. Allen’s blood was acidotic due to a decrease in lung expansion and an alteration in the perfusion to his spinal cord. He also has an alteration in spinal innervation to the respiratory muscles including the phrenic nerve that controls the diaphragm. This would further cause Allen to not be able to adequately take in enough oxygen and blow off enough CO2 to adequately have gas exchange, within the alveoli. Respiratory failure.

I think Sally is experiencing metabolic acidosis, and the respiratory response is hyperventilation which increases loss of CO2 hence the reason she is breathing deeply and gasping. Also, if compensation is complete, pH will be within normal range but HCO3- will be low.

2. The medical director makes rounds and writes orders to start an IV of D51/2 NS at 75 m/hr

The patient is a 74-year-old female who was brought to the emergency room by BLS when she awakened from sleep with severe shortness of breath. In transit she received sublingual Nitroglycerin note to supplementation as well as a nebulizer. When seen in the ED she was placed on BiPAP and nebulizer for approximately an hour. It is to be noted the patient has severe COPD and pulmonary hypertension. She does have coronary disease as well. It is to be noted that she is on Citrucel for her pulmonary hypertension. There are no blood gases done, however on BiPAP her O2 sats were 99%. Chest x-ray shows soft tissue mass I believe in the right upper lobe. I believe that this patient in view of her significant history of comorbidities and severe

Other lab results are in normal range. An elevated WBC can indicate the patient suffer from infection. "A decreased percentage of lymphocytes may be due to chemotherapy, HIV infection, leukemia, radiation therapy or exposure, Sepsis, Steroid use " ("Medline Plus", 2015). In this cause, the patient may have sepsis. The Arterial Blood Gases show high pH:7.5 and HCO3: 29 as well as low PaO2: 25 and PaCO2: 25. This patient has respiratory alkalosis. Hyperventilation is typically the underlying cause of respiratory alkalosis and fever and infection are the likely cause the hyperventilation in this cause ("Health Line",

Did the pH level of the blood change at all during normal breathing? If so, how? The pH did not change during the normal breathing.

The possible causes of this acid base imbalance are the vomiting and the overuse of antacids. As the name implies it is bicarbonate which has been added to the body. The vomiting reduces the extracellular fluid and this in turn leads to a release of angiotensin and aldersterone. This release then increases the bicarbonate absorption and increased hydrogen ion and potassium excreted. This patient may also have hypokalemia which is very common in metabolic alkalosis and would need to be replaced if it occurred ( Thomas, 2015). The respiratory rate would also slow to try and compensate for the alkalosis.

For example, the kidneys are not effective in compensating for respiratory alkalosis that occurs in response to hyperventilation triggered by emotions, which usually begins quickly and subsides within minutes or hours. However, if alkalosis results from staying at a high altitude over a 2 or 3 day period, the kidneys play a significant role in helping to compensate.

Respiratory Acidosis occurs when the lungs cannot remove all the carbon dioxide that the body makes. In turn this makes fluid in the body become too acidic. The distinctive feature of respiratory acidosis is an abnormally high PCO2, meaning above 45 mmHg. Improper exhalation of oxygen can cause the blood pH to drop.” Any condition that decreases the movement of CO2 from the blood to the alveoli of the lungs to the atmosphere causes a buildup of CO2, H2CO3, and H+ (Tortora, 2014, p.1036)”. Symptoms of this condition may include: confusion, lethargy, fatigue, sleepiness, and shortness of breath. Probable causes are: obesity, disease of the chest, diseases of the lungs and airways, and drugs that suppress breathing (MedlinePLus, 2012). A health care provider will perform a physical exam to see if this is what is happening. He may do so by: arterial blood gas which measures oxygen and carbon dioxide levels in the blood, basic metabolic panel, a chest x-ray, or possibly a pulmonary function test (MedlinePLus, 2012). Treatment is mainly aimed at the underlying cause not at condition itself. It is treated

Q2. What are the scopes of diagnosis and what is the problem related to narrow diagnosis?