Question

Sandra and Bob were excited to board the plane for their first intercontinental flight since Bob’s retirement last summer. This was their first trip to Europe, and they were looking forward to the trip of a lifetime beginning with London and then visiting a variety of European cities. They relaxed in their coach seats with Bob on the aisle and Sandra in the middle seat. Bob lifted the middle armrest to give Sandra some extra room since she had gained more than a few pounds during their long and happy marriage. The 8-hour flight seemed to pass quickly for the couple. Bob slept through most of it while Sandra read her book. She only left her seat once to go to the restroom and didn’t want to disturb Bob. The sudden jolt from the landing woke Bob from his sleep. A few minutes later, the couple was deboarding the plane and heading toward baggage. "Just hold on a minute," said Sandra to Bob. "I need to catch my breath. I must really be out of shape." Bob heard Sandra’s wheezing. He was all too familiar with her asthma attacks and reached into her bag for her inhaler. "Let’s just sit for a while and you take a few puffs of this," said Bob while he handed over the inhaler. The Hotel "Bob, wake up! Something is wrong," said Sandra in a panicked tone. "What’s wrong?" said a concerned Bob. "I can’t catch my breath and I have pain on the left side of my chest. It is radiating into my left arm!" "We’ll have to get you to the hospital!" said Bob reaching for the phone. The Hospital Sandra was wheeled into a room on a gurney. A nurse took her pulse and blood pressure, administered oxygen, and hooked her up to a heart monitor. Sandra’s Vitals: Pulse 102 bpm BP 90/56 "Sandra, have you had leg swelling like this before?" asked the nurse. "Sometimes, but usually not this bad," said Sandra. "I see the swelling is worse in the right leg," said the nurse. Just then the ER doctor entered the room. He greeted the couple, viewed the records, and briefly examined Sandra. "We’ll need to run some tests," said the doctor. "You may be here for a while." Tests Sandra was given a blood draw which was sent to the hospital lab for some tests. The test results included:

Test: Sandra: Normal
Blood pH: 7.25: 7.35-7.45
Arterial PO2: 78 :80-100
Arterial PCO2 :48: 35-45
Creatine Phosphokinase: 2.7 ng/mL: 3 ng/mL
Breathing Rate: 28: 12-20
Breathing Sounds rapid: shallow breathing.
Back in the ER room, the doctor read the test results. I think we need to do some imaging," said the doctor. "I’m ordering a CT and ultrasound of each leg along with a V/Q scan which I think will confirm my diagnosis."
Read the case study. Answer each question/complete the tasks and create a report for the case study.
1. Which signs and symptoms would indicate a respiratory problem, and which would indicate a cardiovascular system problem?
2. How are Sandra's breathing rate, blood pH, and PCO2 related?
3. Why would Sandra's blood pressure be lower than normal and why would a CT and V/Q scan of the legs be indicated in Sandra's case?
4. How would asthma cause changes in blood CO2 and pH?

Answer 1

Sandra's symptoms suggest both respiratory and cardiovascular issues, with tests indicating she may have a pulmonary embolism. Her elevated breathing rate is an attempt to correct respiratory acidosis, as indicated by her low blood pH and high PCO2. Asthma contributes to respiratory acidosis due to impaired exhalation of CO2.

Step-by-step explanation:

Respiratory and Cardiovascular Indications in Sandra's Case

The case study of Sandra on her trip to Europe highlights symptoms indicative of respiratory and cardiovascular issues. Wheezing, elevated breathing rate, chest pain, and radiating pain into the left arm suggest a cardiovascular problem, while the elevated breathing rate, low arterial PO2, and high arterial PCO2 indicate a respiratory problem. Sandra's lower-than-normal blood pressure could be a sign of cardiac distress, possibly due to a pulmonary embolism, which is supported by the leg swelling and differentiates from her asthma condition.

Relationship Between Breathing Rate, Blood pH, and PCO2

Sandra's breathing rate is elevated as a compensatory mechanism to expel more CO2 in response to respiratory acidosis, which is indicated by her low blood pH and high PCO2. The body is attempting to correct the acidic environment by increasing breathing to lower CO2 levels.

Reasons for Lower Blood Pressure and Imaging Indications

Sandra's lower blood pressure may result from her cardiovascular system struggling to compensate for a possible pulmonary embolism, causing reduced cardiac output. A CT and V/Q scan are indicated to check for blood clots in the legs and lungs, respectively.

Asthma's Effect on Blood CO2 and pH

During an asthma attack, the airways become narrowed, leading to difficulty in exhaling CO2. This leads to respiratory acidosis, where the blood pH decreases due to the accumulation of CO2 in the blood.

Answer 2

1. Signs and Symptoms:

• Respiratory Issues: Signs include rapid breathing, wheezing, and shallow breathing.
• Cardiovascular Issues: Symptoms encompass chest pain, leg swelling, and low blood pressure.

2. Relationship between Breathing Rate, Blood pH, and PCO2:

• The correlation between rapid, shallow breathing and low blood pH (acidosis) is influenced by elevated PCO2.

3. Low Blood Pressure and Imaging Indications:

• Low blood pressure is indicative of potential cardiovascular compromise.
• To assess chest, lung, and leg issues, medical professionals may order CT scans, V/Q scans, and leg ultrasounds.

4. Asthma's Impact on Blood CO2 and pH:

• During an asthma exacerbation, inadequate CO2 removal leads to respiratory acidosis.
• Compensatory mechanisms may prove insufficient in such cases.

Conclusion:

• Sandra's case presents intricate respiratory and cardiovascular challenges.
• Continuous monitoring and diagnostic tests are imperative for an accurate diagnosis and appropriate intervention.

Step-by-step explanation:

Report on Sandra's Medical Case:

1. Signs and Symptoms of Respiratory and Cardiovascular Issues:

Respiratory Problems:

• Rapid breathing rate (28 breaths per minute).
• Wheezing and difficulty catching breath.
• History of asthma attacks.
• Shallow breathing sounds.

Cardiovascular Problems:

• Pain on the left side of the chest radiating into the left arm.
• Leg swelling, worse in the right leg.
• Low blood pressure (90/56).
• Abnormal blood pH (7.25).

2. Relationship Between Sandra's Breathing Rate, Blood pH, and PCO2:

• Sandra's rapid and shallow breathing (28 breaths per minute) indicates respiratory distress.
• The lower blood pH (7.25) suggests respiratory acidosis, possibly due to inadequate removal of CO2 (elevated PCO2).

3. Reasons for Lower Blood Pressure and Indications for CT and V/Q Scan:

Lower Blood Pressure:

• Possible cardiogenic shock due to cardiovascular distress.
• Insufficient oxygen delivery to tissues.

Indications for Imaging:

• CT Scan: To assess chest and cardiac abnormalities.
• V/Q (Ventilation/Perfusion) Scan: To evaluate lung ventilation and blood perfusion, especially in the presence of chest pain and respiratory symptoms.
• Ultrasound of Legs: To investigate the cause of leg swelling, checking for deep vein thrombosis (DVT) or other vascular issues.

4. Asthma's Impact on Blood CO2 and pH:

Respiratory Acidosis:

• Inadequate removal of CO2 during asthma exacerbation.
• Elevated PCO2 (48 mmHg) contributes to decreased blood pH (7.25).
• Shallow breathing exacerbates the condition.

Compensatory Mechanism:

• Kidneys attempt to compensate by retaining bicarbonate, but the compensatory effect might be insufficient.

Conclusion:

Sandra presents with a complex medical condition involving both respiratory and cardiovascular distress. Further imaging and diagnostic tests are necessary to determine the exact nature and extent of her condition, allowing for appropriate and timely intervention. The medical team should closely monitor respiratory parameters, blood gases, and cardiovascular indicators to guide treatment decisions.