Question

You are caring for a patient with a history of emphysema who has a primary complaint of shortness of breath and the following​ findings: pulse oximeter reading of 93​ percent, heart rate​ 110, blood pressure​ 180/86, and respiratory rate​ 26/minute. You find the​ patient's skin to be diaphoretic with ashen fingers and toes. There are bilaterally diminished breath sounds with a slight expiratory​ wheeze, but alveolar sounds are still present. Given these​ findings, how would you characterize this​ patient's current ventilation​ adequacy?

A. He is breathing​ inadequately, and significant findings of inadequacy are present.
B. He displays respiratory​ distress, and he is at risk for deterioration.
C. He is breathing inadequately but shows signs of improving.
D. He is breathing​ adequately, and no indications of respiratory failure are present.

Answer 1

The patient with emphysema is showing signs of respiratory distress with evidence of compromised gas exchange, which puts him at risk for further deterioration. The presence of a pulse oximeter reading of 93%, elevated heart and respiratory rates, and abnormal physical findings support this diagnosis.

Step-by-step explanation:

The patient with a history of emphysema presenting shortness of breath, a pulse oximeter reading of 93 percent, an elevated heart rate of 110 bpm, high blood pressure (180/86 mm Hg), and a respiratory rate of 26/minute is showing signs of respiratory distress. The physical findings of diaphoretic skin, ashen fingers and toes, diminished breath sounds, and an expiratory wheeze with alveolar sounds still present indicate that while oxygen transfer is currently sufficient, the patient is at risk for further deterioration and thus requires careful monitoring and potential intervention.

These clinical signs suggest that the patient's body is working hard to maintain adequate gas exchange in the face of emphysematous lung changes, which affect both lung compliance and airway resistance. Improper gas exchange can lead to a condition known as V/Q mismatch, where the balance between ventilation (the air that reaches the alveoli) and perfusion (the blood that reaches the alveoli) is disrupted. This imbalance is especially problematic in diseases like emphysema, where chronic obstruction leads to inadequate ventilation relative to perfusion, resulting in insufficient oxygenation of the blood and removal of carbon dioxide. The slightly reduced oxygen saturation (93%) and physical symptoms highlight the need for intervening measures to prevent further respiratory failure.