Sample Answer for NUR-631 Topic 11 DQ 2 Included After Question
Select two of the following questions for your discussion response. Indicate which questions you have chosen using the format displayed in the “Discussion Forum Sample.”
Discuss the differences between respiratory acidosis and respiratory alkalosis. Provide a case study or presentation associated with respiratory acidosis or respiratory alkalosis.
Clinicians have developed an appreciation for obstructive sleep apnea. Explain the pathophysiological problems a patient could experience associated with obstructive sleep apnea (OSA).
Multiple conditions lead to pulmonary embolus. Articulate the development and associated conditions during pregnancy which lead to pulmonary embolus.
A Sample Answer For the Assignment: NUR-631 Topic 11 DQ 2
Title: NUR-631 Topic 11 DQ 2
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Clinicians have developed an appreciation for obstructive sleep apnea. Explain the pathophysiological problems a patient could experience associated with obstructive sleep apnea (OSA).
Obstructive sleep apnea-hypopnea syndrome is a sleep disorder characterized by cessation of breathing and/or a considerable decrease in airflow when breathing is exerted. Recurrent oxyhemoglobin desaturations and arousals during sleep relate to apnea episodes (Hollier, 2018). Sleep apnea increases heart stress, which contributes to hypertension, atherosclerosis, insulin resistance, cardiac arrhythmias, myocardial infarction, and stroke (Hollier, 2018). It also raises brain stress, resulting in decreased cognitive and emotional disorders (Hollier, 2018). Symptoms intensify over time due to aging, weight changes, menopause, and other causes (Hollier, 2018). Other than hypertension and CAD, other risk factors include heart failure, atrial flutter, supraventricular tachycardia, V-fib, and, last but not least, pulmonary hypertension (Hollier, 2018).
Multiple conditions lead to pulmonary embolus. Articulate the development and associated conditions during pregnancy which lead to pulmonary embolus.
Pulmonary embolism (PE) is the occlusion of the pulmonary artery or its branches by an embolus (McCance & Huether, 2019). This blockage is usually life-threatening as it can prevent the blood from reaching the lungs. A small portion of cases is due to embolization of air, fat, or talc in drugs of intravenous drug abusers and a small piece of tumor that has broken off from a more massive tumor of the body . In almost all cases, the cause of PE is a blood clot that originated from deep vein thrombosis (DVT). This type of clot travels through circulation and eventually gets lodged in one of the blood vessels in the lung. The thrombus that has broken away is called an embolus, causing an embolism. Most DVTs come from the lower extremities or pelvis. Occasionally, a PEay come from in the upper extremity vein, or a blood clot formed in the heart . Risk factors for PE include conditions and disorders that promote blood clotting because of venous stasis, hypercoagulation that could stem from inherited coagulation disorders, malignant, or hormone therapy, and endothelial injury (McCance & Huether, 2019).
References
Hollier, A. (2018). Clinical guidelines in primary care (3rd ed.). Obstructive sleep apnea- hypopnea syndrome. Layfayette, LA: APEA
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8thed.). St. Louis, MO: Mosby
REPLY
DS
Hi Elizabeth,
Thank you for explaining the risks of developing a pulmonary embolism (PE) during pregnancy. I would like to add on to your discussion the way that a PE is treated in pregnant patients. As we know, a PE is caused by a dislodged blood clot, suggesting there was some venous stasis, immobility, and a hypercoagulable state based on genetics and other risk factors. To diagnose a PE, it is safe for pregnant women to get a chest x-ray and/or a pulmonary ventilation/perfusion study (VQ scan), a chest x-ray is the first line of diagnosis (Dado et.al, 2018). It is important to note that a fetus will be exposed to a small amount of radiation but not as much as a cat scan. The treatment of PE for pregnant women must be considered safe for both the patient and the fetus. Medications such as enoxaparin (low molecular weight heparin) and unfractionated heparin (UFH) do not cross the placenta are considered the blood thinners of choice for pregnancy (Dado et.al, 2018). UFH is considered for patients who present with renal dysfunction. Warfarin should never be considered as it crosses the placenta and contains teratogenic properties, placing the mother at risk for fetal hemorrhage (Dado et.al, 2018). Ultimately, UFH is used if a LMWH is not readily available, plus it has a short half-life and can help those patients requiring thrombolytic treatment.
Reference:
Dado, C. D., Levinson, A. T., & Bourjeily, G. (2018). Pregnancy and Pulmonary Embolism. Clinics in chest medicine, 39(3), 525–537. https://doi.org/10.1016/j.ccm.2018.04.007
REPLY
JS
**Respiratory Acidosis:**
Respiratory acidosis occurs when the lungs cannot remove enough CO2 from the body, leading to an accumulation of carbonic acid in the blood and a decrease in blood pH below the normal range (7.35-7.45).
Causes: It is commonly caused by conditions that impair normal lung function, such as COPD, pneumonia, asthma exacerbation, respiratory muscle weakness, and respiratory depression due to drug overdose.
Symptoms: Patients with respiratory acidosis may present with symptoms like shortness of breath, confusion, headache, drowsiness, and increased heart rate.
**Respiratory Alkalosis:**
Definition: Respiratory alkalosis occurs when there is excessive elimination of CO2 from the body, resulting in decreased carbonic acid levels and an increase in blood pH above the normal range (7.35-7.45).
Causes: It can be triggered by hyperventilation due to various reasons, including anxiety, fever, pain, sepsis, high altitudes, or excessive mechanical ventilation.
Symptoms: Patients with respiratory alkalosis may experience symptoms such as lightheadedness, tingling sensations, chest discomfort, and muscle spasms.
**Case Study: Respiratory Acidosis**
Patient Profile:
Name: Mr. Smith
Age: 65
Medical History: Known case of severe chronic obstructive pulmonary disease (COPD), currently on home oxygen therapy.
Presenting Complaint:
Mr. Smith is brought to the emergency department with complaints of increasing shortness of breath, confusion, and fatigue over the past 24 hours. His family also noticed that he has been less responsive than usual.
Physical Examination Findings:
– Respiratory Rate: 30 breaths per minute
– Oxygen Saturation (SpO2): 88% on supplemental oxygen (previously 92%)
– Heart Rate: 110 beats per minute
– Blood Pressure: 150/90 mmHg
– Neurological Examination: Mild confusion and drowsiness
Laboratory Results:
– Arterial Blood Gas (ABG) Analysis:
- pH: 7.28 (below the normal range)
- PaCO2: 60 mmHg (elevated, normal range: 35-45 mmHg)
- HCO3-: 24 mEq/L (normal range: 22-26 mEq/L)
- PaO2: 60 mmHg (reduced, normal range: 75-100 mmHg)
Diagnosis and Management:
Based on the ABG analysis and the patient’s clinical presentation, Mr. Smith is diagnosed with acute respiratory acidosis due to exacerbation of his underlying COPD. The high levels of CO2 in his blood have caused the pH to drop, leading to acidosis. Treatment includes providing immediate respiratory support with supplemental oxygen and, if necessary, non-invasive positive pressure ventilation (NIPPV) to help improve his breathing and oxygenation. The medical team will also administer bronchodilators, corticosteroids, and antibiotics to manage the underlying COPD exacerbation.
It is crucial to closely monitor Mr. Smith’s response to treatment, ABG levels, and his clinical status to ensure his condition improves. Additionally, efforts to identify and address the factors contributing to the COPD exacerbation will be taken to prevent future occurrences.
Obstructive Sleep Apnea is a sleep disorder characterized by recurrent episodes of partial or complete upper airway obstruction during sleep. This obstruction leads to interruptions in breathing, resulting in decreased airflow and, in some cases, complete cessation of breathing for brief periods. These repeated episodes can have significant pathophysiological consequences for patients, affecting various organ systems. Here are some of the key problems a patient could experience associated with OSA:
1. **Cardiovascular Issues:** OSA is strongly associated with cardiovascular problems due to the intermittent hypoxia and sleep fragmentation. These factors can lead to increased sympathetic nervous system activity, elevated blood pressure, and reduced oxygen supply to the heart. Over time, this can contribute to the development or worsening of hypertension, heart rhythm abnormalities, and an increased risk of heart attacks and strokes.
2. **Daytime Sleepiness and Fatigue:** The recurrent awakenings and sleep disruptions caused by OSA can prevent patients from achieving restorative sleep. As a result, they often experience excessive daytime sleepiness, which can impair cognitive function, reduce concentration, and increase the risk of accidents, both on the road and in occupational settings.
3. **Neurocognitive Impairment:** Chronic sleep fragmentation and intermittent hypoxia can negatively impact brain function. Patients with OSA may experience memory problems, difficulties with attention and focus, reduced executive functioning, and a higher risk of developing cognitive disorders, such as dementia, in the long term.
4. **Metabolic and Endocrine Abnormalities:** OSA has been linked to metabolic disturbances, including insulin resistance and glucose intolerance, which can increase the risk of developing type 2 diabetes. Additionally, OSA can disrupt hormonal regulation, leading to imbalances in hormones like cortisol, ghrelin, and leptin, which are involved in appetite regulation and metabolism.
5. **Obesity:** OSA and obesity often coexist and can have a bidirectional relationship. Obesity can contribute to the development of OSA due to increased soft tissue around the upper airway, while OSA may lead to weight gain through mechanisms such as disrupted sleep-wake regulation and hormonal imbalances.
6. **Mood Disorders:** Sleep disturbances caused by OSA have been associated with an increased risk of mood disorders such as depression and anxiety. The disrupted sleep patterns and reduced oxygen levels may contribute to changes in brain chemistry and emotional regulation.
7. **Increased Risk of Accidents:** OSA-related daytime sleepiness and cognitive impairments can significantly increase the risk of accidents, both at home and at work. This is particularly concerning in situations that require sustained attention and quick reaction times, such as driving or operating heavy machinery.
8. **Impaired Quality of Life:** OSA can have a substantial negative impact on a person’s quality of life. Sleep disturbances, chronic fatigue, and associated health problems can lead to decreased productivity, reduced social engagement, and overall diminished well-being.
Early recognition and proper management of OSA are crucial to mitigating these pathophysiological issues and improving patients’ overall health and quality of life. Treatment options may include lifestyle modifications, positive airway pressure therapy (CPAP), dental devices, and in some cases, surgical interventions to address airway obstructions.
Pulmonary embolism:
1. **Hypercoagulability:** During pregnancy, there is a natural increase in blood coagulability to prevent excessive bleeding during childbirth. This heightened state of coagulation increases the risk of DVT.
2. **Venous stasis:** As the uterus grows during pregnancy, it can compress the inferior vena cava. This compression can slow down blood flow in the lower extremities, leading to venous stasis. Slower blood flow increases the risk of clot formation.
3. **Endothelial injury:** Pregnancy can cause injury or damage to the endothelial lining of blood vessels. This damage can activate the clotting cascade, leading to the formation of blood clots.
4. **Pregnancy-related medical conditions:** Certain conditions that are more common during pregnancy can also increase the risk of pulmonary embolism. These conditions include:
- **Preeclampsia:** A condition characterized by high blood pressure and signs of organ damage, usually in the second half of pregnancy. Preeclampsia can lead to endothelial dysfunction, increasing the risk of clot formation.
- **Placental problems:** Issues with the placenta, such as placental abruption or placenta previa, can result in bleeding and increased coagulation, leading to potential clot formation.
- **Cesarean section:** Women who undergo a cesarean section have a higher risk of developing blood clots due to the surgical trauma and prolonged immobilization during the recovery period.
- **Multiple gestations:** Women carrying multiple fetuses (twins, triplets, etc.) have an increased risk of developing DVT and subsequently pulmonary embolism.
- **Inherited or acquired thrombophilia:** Some women may have genetic or acquired conditions that predispose them to clot formation.
McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Elsevier.
Dado, C. D., Levinson, A. T., & Bourjeily, G. (2018). Pregnancy and pulmonary embolism. Clinics in Chest Medicine, 39(3), 525–537. https://doi.org/10.1016/j.ccm.2018.04.007
