NRNP6566 Week 7 Knowledge Check
QUESTION 1
1. For the following ABGs, identify the level of hypoxemia, the primary acid base
disorder, and the type of compensation. Example - acute respiratory acidosis with
metabolic alkalosis and severe hypoxemia
ABG Result
pH pCO2 pO2 HCO3
7.36 30 80 15
Compensated metabolic acidosis with no hypoxemia (metabolic acidosis with respiratory alkalosis)
Ph – normal (leaning on acidosis )
pCO2 – decreased (respiratory alkalosis)
HCO3 – decreased (rmetabolic acidosis)
Metabolic acidosis (decreased HCO3) with no hypoxemia (pO2 is 80, normal) Fully compensated due to normal pH.
Respiratory (pCO2) is leading to alkalemia to compensate for the metabolic acidosis.
QUESTION 2
1. A 54 year old female has a 30 year pack smoking history. She recently underwent
pulmonary function testing which showed moderate obstructive lung disease. What
would your treatment plan (including medications) include for this patient?
The main risk factor for COPD is smoking. The Global Initiative for Chronic Obstructive Lung
Disease (GOLD) explained that smoking cessation is the key (GOLD, 2020). Pharmacotherapy
and nicotine replacement have increased the abstinence rates long term. Nicotine replacement
products can be suggested to this patient, like gums, inhalers, nasal sprays, patches, sublingual,
or tablets. The use of these methods increases success rates in smoking cessation.
Pharmacotherapy decreases COPD symptoms, reduces exacerbations both in frequency and
severity, and improves the patient’s health status and exercise tolerance. The patient can be
prescribed varenicline, bupropion, and nortriptyline which are medications with proven long-
term quit rates. However, behavioral modification should be a part of the treatment plan through
professional counseling and positive emotional support.
Inhaled bronchodilators are the baseline in symptom management in COPD. The patient can be
prescribed short-acting beta antagonists that can be used regularly or as-needed basis. They
reduce or prevent COPD symptoms. They are commonly used to provide immediate symptom
relief. Meanwhile, the patient can also be given long-acting beta antagonists. They improve lung
function, dyspnea, health status, and also decreases the rate of exacerbation.
Resource
, Global Initiative for Chronic Obstructive Lung Disease - GOLD. (2020). Gold reports for personal
use. https://goldcopd.org/gold-reports/
QUESTION 3
1. Mr. A is a 25 year old male who comes to the ER complaining of increasing
shortness of breath and upper respiratory symptoms – cough, fever, and
progressive dyspnea for three days. On exam he appears cyanotic, has respiratory
distress and inspiratory crackles over the left base. RR = 40 CXR – left lobar
pneumonia. Temp = 102° and WBC = 17,000. ABG and electrolytes:
FIO2 0.2 Hb 1
1 4
PH 7.5 Na 14
5 0
PCO2 25 K 4.
2
PO2 38 Cl 10
6
HCO3 21 CO 20
2
SaO2 78
%
Why is
this
patient
severely
hypoxe
mi c?
The patient is probably having a pulmonary shunt. Pulmonary shunt is a condition when ventilation is zero but
perfusion is normal. The blood from the right side of the heart enters the left side with no gas exchange taking
place. Pneumonia is one of the causes of pulmonary shunt (Sarkar et al., 2017) which leads to hypoxemia. The
patient has a positive left lobar pneumonia, with positive WBC and fever showing an infectious process.
Hypoxemia is defined as an increase in minute ventilation, mainly due to the rise of tidal volume and respiration
rate (Dhont et al.,
2020). The patient was showing tachypnea. Tachypnea and hyperpnea are the most important clinical indicators of
an impending hypoxemic respiratory failure Respiratory alkalosis occur in pneumonia which shows in the patient's
ABG.
Partially compensated Respiratory Alkalosis with severe hypoxemia (respiratory alkalosis with metabolic acidosis)
pH- increased (alkalosis)
pCO2 – decreased (respiratory alkalosis)
HCO3- decreased (metabolic acidosis)
The patient is having respiratory alkalosis. Metabolic (HCO3) is leaning on acidosis to compensate for the
respiratory alkalosis. Hypoxemia is severe since pO2 is 38% (normal is 80-100).
QUESTION 1
1. For the following ABGs, identify the level of hypoxemia, the primary acid base
disorder, and the type of compensation. Example - acute respiratory acidosis with
metabolic alkalosis and severe hypoxemia
ABG Result
pH pCO2 pO2 HCO3
7.36 30 80 15
Compensated metabolic acidosis with no hypoxemia (metabolic acidosis with respiratory alkalosis)
Ph – normal (leaning on acidosis )
pCO2 – decreased (respiratory alkalosis)
HCO3 – decreased (rmetabolic acidosis)
Metabolic acidosis (decreased HCO3) with no hypoxemia (pO2 is 80, normal) Fully compensated due to normal pH.
Respiratory (pCO2) is leading to alkalemia to compensate for the metabolic acidosis.
QUESTION 2
1. A 54 year old female has a 30 year pack smoking history. She recently underwent
pulmonary function testing which showed moderate obstructive lung disease. What
would your treatment plan (including medications) include for this patient?
The main risk factor for COPD is smoking. The Global Initiative for Chronic Obstructive Lung
Disease (GOLD) explained that smoking cessation is the key (GOLD, 2020). Pharmacotherapy
and nicotine replacement have increased the abstinence rates long term. Nicotine replacement
products can be suggested to this patient, like gums, inhalers, nasal sprays, patches, sublingual,
or tablets. The use of these methods increases success rates in smoking cessation.
Pharmacotherapy decreases COPD symptoms, reduces exacerbations both in frequency and
severity, and improves the patient’s health status and exercise tolerance. The patient can be
prescribed varenicline, bupropion, and nortriptyline which are medications with proven long-
term quit rates. However, behavioral modification should be a part of the treatment plan through
professional counseling and positive emotional support.
Inhaled bronchodilators are the baseline in symptom management in COPD. The patient can be
prescribed short-acting beta antagonists that can be used regularly or as-needed basis. They
reduce or prevent COPD symptoms. They are commonly used to provide immediate symptom
relief. Meanwhile, the patient can also be given long-acting beta antagonists. They improve lung
function, dyspnea, health status, and also decreases the rate of exacerbation.
Resource
, Global Initiative for Chronic Obstructive Lung Disease - GOLD. (2020). Gold reports for personal
use. https://goldcopd.org/gold-reports/
QUESTION 3
1. Mr. A is a 25 year old male who comes to the ER complaining of increasing
shortness of breath and upper respiratory symptoms – cough, fever, and
progressive dyspnea for three days. On exam he appears cyanotic, has respiratory
distress and inspiratory crackles over the left base. RR = 40 CXR – left lobar
pneumonia. Temp = 102° and WBC = 17,000. ABG and electrolytes:
FIO2 0.2 Hb 1
1 4
PH 7.5 Na 14
5 0
PCO2 25 K 4.
2
PO2 38 Cl 10
6
HCO3 21 CO 20
2
SaO2 78
%
Why is
this
patient
severely
hypoxe
mi c?
The patient is probably having a pulmonary shunt. Pulmonary shunt is a condition when ventilation is zero but
perfusion is normal. The blood from the right side of the heart enters the left side with no gas exchange taking
place. Pneumonia is one of the causes of pulmonary shunt (Sarkar et al., 2017) which leads to hypoxemia. The
patient has a positive left lobar pneumonia, with positive WBC and fever showing an infectious process.
Hypoxemia is defined as an increase in minute ventilation, mainly due to the rise of tidal volume and respiration
rate (Dhont et al.,
2020). The patient was showing tachypnea. Tachypnea and hyperpnea are the most important clinical indicators of
an impending hypoxemic respiratory failure Respiratory alkalosis occur in pneumonia which shows in the patient's
ABG.
Partially compensated Respiratory Alkalosis with severe hypoxemia (respiratory alkalosis with metabolic acidosis)
pH- increased (alkalosis)
pCO2 – decreased (respiratory alkalosis)
HCO3- decreased (metabolic acidosis)
The patient is having respiratory alkalosis. Metabolic (HCO3) is leaning on acidosis to compensate for the
respiratory alkalosis. Hypoxemia is severe since pO2 is 38% (normal is 80-100).
