Mild hypoxemia with a fully compensated respiratory acidosis

Mild hypoxemia with a fully compensated respiratory acidosis92% 100%The following 5 ABG analyses were formulated using Pierces (2007) systematic analyses (p.55 60). Normal set according to Pierce are listed as followsThe systematic analysis is done by first looking at each number individually and labeling it. game describing the adequacy of oxygenation by assessing PaO2 and SaO2. Pierce (2007) lists hypoxemia as tame (ABG 1FiO20.21pH7.40NormalPaCO250AcidemiaPaO271HypoxemiaHCO330.9AlkalemiaBE5.0AlkalemiaSaO295.1NormalHb12.9Mr. Puffins PaO2 of 71 shows mild hypoxemia, with a SaO2 within normal limits. His pH of 7.40 is neutral and shows that his acid fore status is within normal limits however his PaCO2 of 50 demonstrates that he is acidotic and his idealistic HCO3 indicates compensation is occurring. These results suggest Mr. Puffin has a mild hypoxemia with a fully compensated respiratory acidosis. His normal pH indicates full compensation is occurring,ABG2FiO20.50pH7.14Acidem iaPaCO2127AcidemiaPaO244.2HypoxemiaHCO341.6AlkalemiaBE7.1AlkalemiaSaO269.2HypoxemiaHb14.1Mr. Puffins PaO2 and SaO2 show he has a severe hypoxemia. His pH of 7.14 is indicative that he is acidotic. His PaCO2 is wondrous which shows the acidemia is respiratory in origin. The elevated HCO3 of 41.6 shows that metabolic compensation is occurring, wherefore these results indicate Mr. Puffin has severe hypoxemia with a partially compensated respiratory acidosis.ABG 3FiO20.40pH7.22AcidemiaPaCO299.6AcidemiaPaO245.3HypoxemiaHCO339.9AlkalemiaBE8.3AlkalemiaSaO2HbABG 3 shows Mr. Puffins respiratory acidosis has improved repayable to BiPAP therapy. on that point is a slight increase in his PaO2 although it still shows severe hypoxemia. His pH has improved but still shows acidemia. PaCO2 has decreased due to BiPAP therapy but frame elevated and indicates respiratory remains his primary cause of acidosis. Mr. Puffins HCO3 is also still elevated indicative of partial compensation occurring. ABG 3 shows Mr. Puffin still remains severely hypoxic, with a partially compensated respiratory acidosis.ABG 4FiO20.40pH7.32AcidemiaPaCO271.9AcidemiaPaO255.6HypoxemiaHCO336.1AlkalemiaBE8.0AlkalemiaSaO2HbABG 4 shows encourage improvement in Mr. Puffins severe hypoxemia and respiratory acidosis. His PaO2 has increased further but still shows a severe hypoxemia. His pH although increased still suggests mild acidosis, as well as his PaCO2 of 71.9, although it has decreased, still indicates a respiratory origin. HCO3 remains elevated showing compensation is occurring therefore Mr. Puffin still has severe hypoxemia with a partially compensated respiratory acidosis.ABG 5FiO20.28pH7.00AcidemiaPaCO259.1AcidemiaPaO262.4HypoxemiaHCO318AcidemiaBE-7.8AcidemiaSaO292%Hb14.2Mr. Puffins 5th ABG PaO2, indicates moderate hypoxemia. His pH is low and shows he is acidotic. An elevated PaCO2 suggests acidemia respiratory in nature. HCO3 is also low which also shows acidemia metabolic in nature. Mr. Puffin in ABG 5 has a moderate hypoxemia with a mixed respiratory and metabolic acidosis confirmed by the decreased BE.Question TwoWhat case of respiratory chastening does Mr. Puffin have?Provide a rationale for your answer based on the clinical information supplied.Differentiate between Type 1 and Type 2 Respiratory failure.Respiratory failure as described by Pierce (2007) is the absence of the normal homeostatic state of external respiration as it relates to acid base status of the blood and the exchange of oxygen and coulomb dioxide (p.181).Type 1 respiratory failure, Pierce (2007), describes as a failure to oxygenate or hypoxemic respiratory failure, categorized by a PaO2 of less than 60mm Hg on an FiO2 of more than 0.5, and Type 2 respiratory failure as failure to ventilate, also called ventilatory failure, hypercapnic respiratory failure, or respiratory pump failure, as a PaCO2 of greater than 50mm Hg, with a pH of 7.25 or less (p.181-182).In contrast to Pierces definition Hennes sey Japp (2007) touch on respiratory failure as respiratory impairment. Hennessy Japp define type 1 respiratory impairment as low PaO2 with normal or low PaCO2 which implies defective oxygenation despite adequate ventilation and the PaCO2 is low due to compensatory hyperventilation (p.20). Hennessey Japp (2007), define type 2 respiratory impairment as a high PaCO2 (hypercapnia), and is due to understaffed alveolar ventilation, and since oxygenation also depends on ventilation, the PaO2 is usually low, but may be normal if the patient role is on secondary oxygen (p.22).Type 1 respiratory failure is most commonly caused by VQ mismatch, pneumonia, pulmonary embolism, pneumothorax, pulmonary edema, shunt and acute respiratory distress syndrome and initial treatment is aimed at achieving an adequate PaO2 and SaO2 with supplemental O2 while attempting to correct the underlying cause, Hennessey Japp (2007) p. 20.Type 2 respiratory failure is commonly caused by chronic obstructive p ulmonary disease, exhaustion, flail chest injury, opiate/benzodiazepine toxicity, neuromuscular disorders and obstructive sleep apnea, with clinical signs that include confusion, drowsiness.Based on the case study information it is evident Mr. Puffin has Type 2 respiratory failure. The diagnosis of type 2 respiratory failure could be made through the interpretation of ABG 2 as he has a decreased pH and elevated PaCO2 with hypoxemia. His display of his difficulty breathing, productive green cough, drowsiness and confusion are consistent with the presentation of an acute exacerbation of chronic obstructive pulmonary disease due to his previous diagnosis made by his doctor of emphysema.Question ThreeWhat is BiPAP?BiPAP (Bi Level Positive Airway bosom) is a form of non invasive mechanical ventilation commonly administered to patients with exacerbations of type 2 respiratory failure, that delivers two airway pressures through inspiration, (IPAP), and expiration, (EPAP) measured in cm H20. IPAP is the abbreviation for Inspiratory Positive Airway mechanical press and EPAP is the abbreviation for Expiratory Positive Airway Pressure.BiPAP is delivered to the patient through an appropriate bilevel ventilator eg Vision BiPAP, or Respironics BiPAP, through a nasal mask, full pose mask, or total face mask.Describe the effects of BiPAP.In your answer consider its effects on airway pressures, the alveoli, the lung,and the cardiovascular and neurological systems.When BiPAP is administered to a patient with type 2 respiratory failure, during inspiration (IPAP) a higher level of positive airway pressure is delivered, increasing breath size, which helps to clear out carbon dioxide and assumes a fatigued patients work of breathing, and during expiration (EPAP) prevents atelectasis, recruits collapsed alveoli and enables gas exchange between breaths (Woodrow 2003). The difference between IPAP and EPAP is termed pressure support so for example if Mr. Puffin was commenced on 1 2 cm H20 IPAP and 6 cm H20 EPAP he would have 6 cm H20 being the being the difference between 12 and 6 of pressure support. Pressure support decreases the work of breathing by initiating breathing and increasing tidal volume.Question FourOutline the clinical indications for the use of BiPAP in Mr Puffins case.Discuss the supervise that would be required for the safe application ofBiPAP.List the possible complications of BiPAP that may occur in Mr Puffins case.