Ventilatory Threshold Analysis

American Sci-Fi writer, Ted Chiang shows how a fictional species comes to grips with accepting the jarring reality of death being inevitable to their kind. In the short story"Exhalation", through his protagonist, Chiang develops his intertwining themes on life and acceptance by exhibiting them through the narrators perspectives as his curoitsty leads him to discovering the harsh truth.

The nurse found Mrs Smith to be tachypnoeic, her respirations were recorded as 24 breaths per minute it was observed as being fast and it appeared that her accessory muscles were being used. Mrs Smith’s pallor also appeared flushed and her saturations were documented as 93%. The nurse used the stethoscope to check for wheeze the patient’s lungs were clear and chest rise was symmetrical. Mrs Smith was commenced on 100% oxygen through a non-rebreathe mask, oxygen as an intervention is necessary as Creed & Spiers (2010) highlight ‘metabolic demand for oxygen throughout the body is hugely increased by sepsis and is essential to ensure the supply of oxygen is maximized’ .The nurse monitored the patient closely because in her confused state the patient may try to remove the oxygen mask.

Both rapid, shallow breathing patterns and hypoventilation effect gas exchange. Arterial blood gases will be monitored and changes discussed with provider. Alteration in PaCO2 and PaO2 levels are signs of respiratory failure. Patient’s body position will be properly aligned for optimum respiratory excursion, this promotes lung expansion and improved air exchange. Patient will be suctioned as needed to clear secretions and maintain patent airways. The expected outcome is that the patient’s airway and gas exchange will be maintained as evidence by normal arterial blood gases (Herdman,

hypotensive with a blood pressure of 82/44 mm Hg. His respiratory rate is 28 breaths/min

The altitude that this stage could happen in is between 5000 to 11400 ft.(3) "The body generally has the ability to stave off further effects of hypoxia by increasing the rate and depth of ventilation and cardiac output ".(1) The respiration rate, blood pressure, and the heart rate can rise up in this stage.(2) the arterial oxygen saturations in this stage is between 80 and 90 percent.(1)

Another follow up ABG at 0100 shows a small improvement on the Ph to 7.18, the Pco2 became more acidotic moved to 53, the Po2 improved to 77 which shows he is oxygenating better but still hypoxic, his Hco3 acidosis is improving at a change to 19.8, and sating 91% now. The Pt is now breathing at a rate has come down to 10 BPM on his own above and beyond the vent. After consulting with the physician we changed the Vt to 600 and the pressure support to 20 and Cpap to 15. The Pt continued on these settings till 0415. The physician then made the change to Bi-level with the settings of a rate of 14 pressure support of 25, and an H/L pressure of 35/15. The Pt at this time is pulling a Vt of 745 and a spontaneous rate of 17 and still at 100% Fio2 and sating 92%. This is the point when the Pt makes the turn. The Bi-level or APRV was the proper setting for this Pt. He continued to improve over the next several days with his peek pressure climbing to 40. The Pt continues these settings and slowly improves and eventually weaned from the ventilator till the Pt no longer needs support.

His Pulse ox of 94% reading is on the lower side, but still in normal range which indicated that there is less oxygen perfusion.

Assessment: the patient 's vital signs are 108/68, 125 beats per minute, respirations, even and non-labored at 14 breaths per minute, 92% on 2 liters of oxygen via nasal cannula, afebrile 98.5 F.

B. heart rate greater than 100 beats/minute C. hyperventilation. D. respiratory rate greater than 20 breaths/minute 13. A client who has cervical cancer is scheduled to undergo

The data have supported the hypothesis because it showed the results in the data. When the PCO2 is 40, the blood pH is 7.38 which it is normal that lead to have normal H+ in urine and HCO3- in urine. The PCO2 get lower to 30, the blood pH is 7.58 which it is high that lead to decreased in H+ in urine and elevated in HCO3- in urine. The PCO2 get higher to 60, the blood pH is 7.28 which it is low that lead to elevated in H+ in urine and decreased in HCO3- in urine. Respiratory alkalosis is when the PCO2 is lowered that cause a person to have hyperventilation that it is over breathing. It can happen if someone have panic attack, anxiety, or stress. The treatments are breathing exercise, practice relaxation, and exercise regularly to raise the carbon dioxide levels. Respiratory acidosis is when the PCO2 is raised that cause a person to have hypoventilation that is slow breathing. It can happen if someone have daytime drowsiness, fatigue, morning headaces,and bluish color on the skin. The treatments are losing weight, supplemental oxygen, and continuous positive airway pressure to decrease the carbon dioxide

The primary nursing diagnosis for this patient is impaired gas exchange, related to abnormal ventilation and perfusion ratio, as evidenced by restlessness, irritability, anxiety, decreased level of consciousness, abnormal arterial blood gases, and abnormal skin color (Gulanick & Myers, 2014, p. 82). A.C. has an endotracheal tube (ETT), and there is a note for the next day to have surgery to put in a tracheostomy. She is currently a smoker, her C02 is 74.6mEq/L which is high, her pH is low at 7.19, and the bicarbonate is 28.6mEq/L which is high. Her oxygen saturation is maintaining at 90%. Her PA02 is 56mm Hg and FI02 is 0.60. The patient is very anxious and restless in the bed, despite sedation and pain medication, and her skin is pale in color and she is diaphoretic.

38. American Journal of Respiratory care and critical care Medicine, Volume 175, issue 7, pages 698 – 704

Peak expiratory flow rate (PEFR) is a measure of how much a person can breathe out in a single large breath. PEFR is used as a clinical tool to test the functionality of a patient’s lung, the severity of asthma or other respiratory illness symptoms and the best course of treatment for the patient. The PEFR reading will be lower when a person’s airways are constricted and should be at its highest when the patient is at full health. The PEFR is measured using a small handheld device known as a peak flow meter.

➢ The patient may have no respiratory problems, but may still have inhaled carbon monoxide.

Choice “C” is the best answer. This patient has an anion gap (sodium (149)- (chloride (114) + bicarbonate (15))=20) lactic acidosis (serum lactate 5.6 mmol/L) most likely secondary to an infectious etiology. He also has an elevated white blood cell count, a CT scan and X-ray suspicious for multiple nodular pulmonary infiltrates. The patient also meets criteria for severe sepsis: pulse >90 beats/minute, temperature greater than 38.0 °C, respiratory rate greater than 20/min, WBC greater than 12,000 cells/mm3 with signs of sepsis-induced tissue hypoperfusion (elevated lactate).