Transcript
Chapter 10: Determinants and Assessment of Pulmonary Gas Exchange
Critical Thinking Checkpoint Case Studies
Case Scenario: Robert McDonald, a 45-year-old construction worker, is brought to the Emergency Department with complaints of severe shortness of breath and a productive cough that is keeping him up during the night. His medical history is positive for chronic bronchitis and hypertension. He has smoked a pack of cigarettes a day for the past 30 years. He is married and has three adult children. He was diagnosed with emphysema several years ago. During auscultation, you hear rhonchi, particularly evident in his right lung fields. His temperature is currently is 100.4°F (38C). He is tentatively diagnosed with bacterial pneumonia.
This activity contains 5 questions.
1. Mr. McDonald's emphysema disease state alters the surface area of his lungs in which way?
2. Mr. McDonald has developed consolidations in his alveoli from pneumonia. (a) Describe the type of pulmonary shunt this creates and (b) explain how this will affect his receiving oxygen therapy.
3. Clinical Update: Mr. McDonald has an arterial blood gas drawn on room air. The results are: pH 7.28, PaCO2 53, PaO2 56 mmHg, HCO3 36 mEq/L, and SaO292. He also has a chest x-ray ordered.
Interpret his blood gas, including degree of compensation.
4. What is his P/F ratio at this time, and what is its significance?
5. Mr. McDonald's chest x-ray shows cor pulmonale. He asks you to explain what it is. What will you tell him?
