Mr Howe Case Study

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Mr Howe Case Study

Mr Howe, a 68 year old man, was admitted this morning to the general medical unit suffering from infective exacerbation of chronic obstructive pulmonary disease (COPD). The nurses caring for Mr Howe have escalated his treatment by calling a Medical Emergency Team (MET) call that was triggered in response to a low oxygen saturation, despite changing his oxygen delivery system from nasal prongs (4 L/min) to Hudson face mask (8 L/min). The nurses also state that his respiratory rate has progressively increased over the past 2 hours. Mr Howe is also reporting some increasing breathlessness and right sided chest pain that increases on inspiration. He is able to speak in short phrases and is alert, orientated but agitated. You, as a critical care nursing student, attend this MET call as the nursing member of the rapid response team. On arrival you are informed by the nurse caring for Mr Howe that his vital signs are: RR 28 bpm, BP 100/60 mmHg, HR 130 bpm, SpO2 88% on oxygen at 8 LPM, Temperature 38 C

Question 1. Mr Howe is hypoxaemic. Explain the pathophysiology of, and relationships between V/Q mismatching, hypoventilation, infective COPD and his presenting clinical condition and how these lead to hypoxaemia. (14 marks)

Chronic obstructive pulmonary disease (COPD) is a blanket term used to describe the progressive deterioration of airflow with irreversible deterioration of respiratory function (Lee-Chiong & Brown, 2009). An exacerbation is a change in the usual course, characterised by dyspnoea and increased work of breathing triggered by a virus, bacteria or air pollutant (Sapey & Stockley, 2006; Tsoumakidou & Siafakas, 2006).

The acute infective state in Mr Howe causes an immune response which consequent...

... middle of paper ...

...he hypoxaemic and even more so the hypercapnic drive (Cretikos, Bellomo, Hillman, Chen, Finfer & Flabouris, 2008). Acid-base is the most protected homeostatic mechanism in a patient’s body and is altered by many different things, such as sepsis, with respiratory rate often compensating a change in the blood pH. Respiratory rate can also show the effect of some mediations such as opiates decreasing respiratory rate and conscious level (Cretikos et al., 2008).

In conclusion, while all vital signs are taught respiratory rate is the least accurately taken even though it’s the first to change in clinical deterioration. Many studies have been completed to show the impact of increased respiratory rate but it is not reflected in clinical practice. This shows that an accurate respiratory rate could minimise many preventable adverse effects from patient deterioration.

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