Becky B. Breathless is a new patient on your floor. She has been admitted to the

Question

Becky B. Breathless is a new patient on your floor. She has been admitted to the hospital with long term chronic bronchitis. A) since this a respiratory system illness you are concerned about Becky’s acid base homeostasis. Why would bronchitis be a cause of concern for acid-base homeostasis? B) If Becky is in an uncompensated state what would her abnormal blood values look like and what would cause them. Fortunately, when you review Becky’s chart you find Becky in a compensated state. C) What would her compensated blood values look like and what caused them. D) One of the physicians suggests putting Becky on oxygen; while another argues oxygen is contraindicated for compensated patients. They turn to you ask what for your opinion. What would you suggest and why? For the (d) portion of this question you will need look on the internet and read about oxygen and compensated patients. You must list two sources and cite them to support your treatment recommendation.

Explanation / Answer

Bronchitis, as it names explain, is the inflammation of the lung bronchial tube (the airways that carry air to your lungs), which results in breathing in difficulty, chest tightness, coughing etc because of production of excessive mucus. It is basically a COPD ie chronic obstructive pulmonary disease.

A) A major complication in COPD patients is the development of stable hypercapnia. As there is an alteration in respiratory exchanges, in the advanced phase of COPD, it results in retention of CO2. Carbon dioxide is then hydrated with the formation of carbonic acid that subsequently dissociates with the release of hydrogen ions (H+) in the body fluid leading to the development of respiratory acidosis, also called hypercapnic acidosis.

B) Compensatory mechanism works to normalize the system leading to uncompensated patient

1. When hypercapnia occurs acutely, the buffering of H+ takes place by proteins, mainly hemoglobin, and other intracellular nonbicarbonate buffers.

2. Subsequently, renal adaptive changes occur mainly in the proximal tubular cells than in distal tubules leading to increased bicarbonate reabsorption and increased excretion of titratable acid and ammonium.

C) When renal failure occurs in COPD patients, the compensatory role of kidney in respiratory acidosis may be less effective, resulting in a reduced ammoniagenesis and titratable acidity production with consequent smaller increase of serum bicarbonate and more severe acidosis. (Compensated)

Arterial blood gas may show hypoxemia with or without hypercapnia depending on the disease severity. pH may be normal due to renal compensation. A pH less than 7.3 usually indicates the severe respiratory compromise. A blood sample taken from an artery, i.e. Arterial Blood Gas (ABG), can be tested for blood gas levels which may show low oxygen (hypoxemia) and/or high carbon dioxide (respiratory acidosis if pH is also decreased). A blood sample taken from a vein may show a high blood count (reactive polycythemia), a reaction to long-term hypoxemia.

D) oxygen therapy should be given to the patients.It is used as a treatment for respiratory failure, itself defined as an inability of the lungs and respiratory apparatus to ensure adequate systemic oxygenation and/or carbon dioxide excretion. This is further classified by whether there is a failure of oxygenation (a low partial pressure of oxygen [PaO2]) with a normal partial pressure of carbon dioxide (PaCO2, “type 1” respiratory failure), or whether the PaCO2 is high (“type 2,” or hypercapnic, respiratory failure).

links:

1. Brill SE, Wedzicha JA. Oxygen therapy in acute exacerbations of chronic obstructive pulmonary disease. International Journal of Chronic Obstructive Pulmonary Disease. 2014;9:1241-1252. doi:10.2147/COPD.S41476.

2. http://medind.nic.in/iae/t08/i1/iaet08i1p97.pdf

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