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Oxygen therapy in the pulmonary artery to lower the hypoxic condition in the pulmonary artery

   

Added on  2021-04-21

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Signs and symptomsDifficulty in breathing, Sputum producing cough, Confusion and distress, Drowsy,but rousable, Speaking in short sentences and Prolonged expiratory rate, chest pain,sweating, wheezing with auscultations, peripheral oedema, crackles in lungs, bluishnails and lips. This suggests tha the patient is the Blue-Bloater variant of COPD. Patho-physiologyThe patients Glasgow coma score was 13/15 which signified thatthe patient was mildly disoriented and his eyes reacted to light. Thepatient was able to be woken up when necessary but was more orless unconscious. The airway passage pf the patient was blockedand caused sputum generation along with inflammation. Theinflammation is the cause of bronchitic condition. The patientshows lowering of ventilation quotient and compensation whichelevates the level of CO2. The poor ventilation in the pulmonaryarteries causes hypoxic conditions. The arterial blood gas reportsshowed that the respiratory cavity contains excess base and partialCO2 pressure is also observed to be high. The x-ray reports showthat the patient is undergoing wheezing breath with crackles in hislower right lungs. The acidosis of the pulmonary cavity leads to thevasoconstriction of the respiratory vessels and the right ventricle ismore pressurized. The patients are called blue-bloaters due to thefact that the imbalance of the V/Q produces inadequateoxygenation in the cavity which makes the nails and lips bluish.The acidosis also causes the pH of the pulmonary cavity to lower. COPD(CHRONICOBSTRUCTIVEPULMONARY DISORDER)Nursing InterventionsOxygen Therapy was commenced to the patient with8L/min using nebulizer masks to lower the hypoxiccondition in the pulmonary artery. Medication wasadministered with salbutanol 5mg and isopratroprium2.5mg. This helped the arterial blood pressure to lowerand the oxygen saturation was elevated to 89%. Thepatient’s Glasgow coma score was found to be 10/15,which did not improve and still showed symptoms ofmoderate disorientation. After this, non-invasiveventilation was commenced by the method of bi-levelairway pressure (BiPAP).RationalModerate amounts of supplemental oxygen can reduce the risk factors of COPD, which helps to overcome the hypoxic conditions. In this case, the oxygen was exceeding the arterialvolume, which leads to the facilitation of the hypercapnia in Arnold. This is the reason why the patient’s coma score was increased and caused neurological effects. Excess oxygenationalso cause the curve of the partial pressure of the CO2 to shift on the right, which means that the oxygenated hemoglobin induce the affinity for CO2. The process is called Haldane effect. The administration of Salbutamol and Ipratropium is commonly administered drugs for COPD treatment. The Salbutamol is a “short acting β agonist” or SABA, which stimulates the βadregenic receptors. It relaxes the bronchial smooth myocytes by elevating the cAMP production which in turn activates adenylyl cyclase enzyme. The denylyl cyclase phosphorylatesprotein kinase and inhibits myosin phosphorylation as well as intracellular calcium ion concentration. This causes relaxation of muscle cells and bronchodilation. Ipratropium, whichblocks the action of cholinergic receptors and results in the cGMP, to decrease the intracellular calcium ions and smooth muscle relaxation. BiPAP is a form of non invasive therapy that delivers pressurized air though the airway which helps patients breathe through an airway. The machine will recognize the patient’s conditionand regulate the diaphragm, which is relaxed or contracts with respect to the breathing. The machine will force the air into the alveoli sacs and help in breathing. This lowers thepulmonary pressure and relaxes the patient’s condition.

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