Question

Patient is a 29 year old male six feet 2inches admitted with an exacerbation of COPD pt is alert but slightly confused.

Physical findings

HR 120 BP 136/90 BT 38 degrees RR 24, shallow and labored. B/S are decreased in bases with prolonged expiratory phase. Loose non-productive cough. Pt has an IV and is in a regular room.

Lab Data: Ph 7.32 PaCo2 59 Hco3 32 Pao2 50 SaO2 84%, fio2 .21, WBC 11200, HBG 13.3, hematocrit 44

Orders: Vapotherm with 30LPM and 28%

Would you implement this order as written?

If no what would you recommend in its place?

Are there any other interventions pharmacological or otherwise you would recommend at this time?

Answer 1

The patient should be carefully monitored after Vapotherm administration, considering the signs of respiratory acidosis with partial compensation and potential ventilatory failure. Pharmacological interventions may include bronchodilators, corticosteroids, and possibly antibiotics.

Step-by-step explanation:

The patient is a 29-year-old male with an exacerbation of COPD. The Vapotherm order prescribes a high flow of 30 LPM with a fraction of inspired oxygen (FiO2) at 28%. Considering the patient's lab data with a pH of 7.32, PaCO2 at 59mmHg, HCO3 of 32, PaO2 at 50mmHg, and an SaO2 of 84%, the patient is experiencing respiratory acidosis with partial compensation. The patient's elevated PaCO2 indicates CO2 retention, which is common in COPD exacerbations and suggests ventilatory failure. Their elevated HCO3 indicates the kidneys are retaining bicarbonate to compensate for the respiratory acidosis.

Given the patient's condition, initiating Vapotherm is appropriate as it can help improve oxygenation and reduce the work of breathing. However, the patient's confused state and labored breathing necessitate close monitoring to ensure they tolerate the intervention well and do not require escalation of care, such as non-invasive ventilation or intubation, especially given their high respiratory rate and low PaO2.

Pharmacological interventions could include bronchodilators to open airways, corticosteroids to reduce inflammation, and possibly antibiotics if there is suspicion of bacterial infection. Additionally, ensuring adequate hydration and monitoring for potential electrolyte imbalances are important considerations.