Case Studies on Respiratory Disorders Case 1: R.S. Clinical Findings as a Consequence of COPD and Differences with Those of Emphysematous COPD
Clinical findings on the patient that are a consequence of COPD include PaCO2 of 60mmHg and PaO2. Increased PaCO2 seen in COPD is due to the inability of the lungs to fully exhale, causing retention of CO2 and consequent elevation of PaCO2. PaO2 is likely to fall in COPD due to lowered capacity of the lungs to transfer oxygen to the capillary space. Emphysema is a form of COPD that causes damage to the walls of the alveoli. Emphysematous COPD is characterized by profound elevation of PaCO2 due to airflow limitation and consequent CO2 trapping (Fazleen & Wilkinson, 2020).
Laboratory Results Interpretation
The acid-base disorder seen in the patient can be classified as respiratory acidosis. The patient’s ABG findings reveal a pH of 7.32 (Normal 7.35-7.45), indicating acidosis. The patient’s acid-base disorder can further be classified as respiratory acidosis due to the presence of PaCO2 elevation. The patient has a PaCO2 of 60mmHg (normal 38-42mmHg). The most likely cause of polycythemia is increased secretion of erythropoietin in response to chronic hypoxia.
The Rationale for Treating R.S. with Theophylline and a β2 Agonist
Theophylline and β2 agonists are effective in managing COPD. Theophylline use is merited in this case as it causes relaxation of the smooth muscles of the bronchioles with consequent bronchodilation. β-agonist also causes smooth muscle relaxation resulting in bronchodilation (Fazleen & Wilkinson, 2020). These two agents are used adjunctively for their synergistic effects on the bronchial smooth muscles.
Effects of the Respiratory Disease on the Patient’s Cardiovascular Functionalities
COPD has a negative impact on cardiovascular functionalities. COPD lowers the oxygen levels in the blood. The resulting hypoxemia may exacerbate left-side heart failure by placing additional stress on the heart. It can also result in pulmonary vasoconstriction with consequential right ventricular diastolic dysfunction (Fazleen & Wilkinson, 2020).
The Position in Which R.S. Will Have the Worst Ventilation-Perfusion Matching
Ventilation-perfusion matching will be worst when the patient is in the left lateral decubitus position. In this position, blood flows predominantly to the lower lung. There is also an increase in ventilation to the lower lung. This results in a significant reduction in ventilation-perfusion match in the non-dependent lung. In this case, the non-dependent lung is affected by pneumonia and COPD. This further worsens the ventilation-perfusion match on the non-dependent lung.
Case 2: T.V.
The Most Likely Cause of Distress in the Patient
The most likely cause of distress in the patient above is pulmonary embolism. Pulmonary embolism mostly occurs when a blood clot dislodges from the extremities, travels upwards, and embolizes in the pulmonary circulation. This causes disruptions in pulmonary circulation, with consequent manifestations of shortness of breath, sweating, and irregular heartbeat (Freund et al., 2022).
Diagnostic Findings That Would Help Confirm the Diagnosis
Several diagnostic workups are valuable in confirming pulmonary embolism (PE). Arterial blood gas analysis can reveal unexplained hypoxemia suggestive of PE. Elevations in brain natriuretic peptide and serum troponin levels are also suggestive of PE. Electrocardiographic abnormalities can also indicate the presence of PE. Chest radiography, computed tomography, pulmonary angiography, and pulmonary angiography can be used to visualize the respiratory system and detect the presence of an embolus (Freund et al., 2022). Other diagnostic techniques valuable in this case include magnetic resonance angiography, echocardiography, and compression ultrasonography.
Pathogenesis of the Hypoxemia in the Disorder
Hypoxemia in pulmonary embolism arises from disruption in the pulmonary circulation. Pulmonary embolism occurs when a clot breaks off from a primary site, mostly the lower extremities. This clot moves upward and is embolized in the pulmonary circulation. Larger emboli may obstruct the pulmonary arteries leading to pulmonary infarction. The resultant vascular obstruction impairs gas exchange leading to ventilation-perfusion mismatch and, consequently, hypoxemia.
Treating T.V.’s Respiratory Disorder
Management options for pulmonary embolism include anticoagulation therapy, supportive management, and reperfusion. Anticoagulation therapy using anticoagulants is the mainstay treatment option for pulmonary