Chronic Obstructive Pulmonary Disease - Assignment Example

Paramedic Name Institution Paramedic Question 1 COPD is characterized by the restriction of airflow which is closely associated with the ruination of airflow. This clinical condition is caused by the accumulation of alien irritants in different parts of the respiratory system. These irritants constitute nanoparticles, cigarette smoke and environmental pollutants (Des Jardins & Burton, 2015). With continued exposure to these irritants, the pathology process is initiated by the inflammation. As such, neutrophils, T-lymphocytes and various inflammatory cells concentrate the airways (Bourdin et al., 2009). This decomposition initiates an inflammatory response that differs in normal people and those suffering from COPD. For individuals with normal respiratory systems, the inflammatory response aims at initiating self-healing. Nevertheless, with COPD a patient has continuous deposition of foreign objects in the respiratory system which leads to continuous inflammatory responses that lead to both physiological and structural destruction of the lung tissues. Furthermore, as the inflammation continues, the airway gets constructed due to swelling. As a result, the cilia becomes ineffective, and mucous production increases hence blocking the aware. For this reason, Mr. Wenham displays breath shortness, cough, and chest tightness, wheezes, and jugular veins distention. According to the observations, Mr. Wenham respiratory rate is 45 breaths/ minutes which is high compared to that of a healthy adult who stands between 12-16 breaths per minute. This is associated with the difficulty for inhaling and exhaling which requires one to take more breaths to cover for the air that could have been inhaled or exhaled if the blocked airways did not exist. The observed heart rate is relatively high than that of a normal person who may be attributed to the low oxygen supply in the blood that makes the heart to pump faster. Thirdly, the observed on oxygen saturation is at 82% which is relatively low and thus requires supplementary oxygen. The Glasgow Coma Score depicts that the patient has a mild consciousness issue, with his eyes opening to voice, disoriented conversation, and a normal motor response. This mild conscious state may be attributed to the low level of oxygen in the body that affects cognitive function (Hanania & Sharafkhaneh, 2010). Question 2 The utilization of salbutamol in managing COPD is based on the fact that it is quickly effective and serves several purposes. Salbutamol is an effective drug that is usually administered as an inhaler so that it can act on the targeted region within a short period. By introducing the drug into the system via the inhaler, the drug acquires a large area of absorption which makes small doses effective in relieving pathological signs related to COPD (Bourdin et al., 2009). As per its functionality, this medication is assisted in easing the breathing through widening and relaxation of the lungs airways. Additionally, Salbutamol inhibits chest tightness, coughing, wheezing and breath shortness (Hanania & Sharafkhaneh, 2010). When the medication is administered, it enhances the respiratory system clearance that ensures that accumulated mucus secretion is removed from the system. Salbutamol is generically a beta 2 adrenergic agonist which means that it functions by fostering the activity of beta 2 adrenergic receptors. The medication consists of the Albuterol element which binds itself on the beta 2 adrenergic receptors within the respiratory system thus resulting to the relaxation of bronchi muscles. Question 3 Arterial Blood Gas (ABG) is an essential measurement, as it establishes the acidity of the blood and the capacity of blood’s O2 and CO2. The relevance of ABG in managing COPD is that it determines the functionality status of the lungs in adding O2 and taking away CO2 from the blood. As such, the main aim of ABG is to detect lung disorders and other breathing problems, such as COPD, asthma, and fibrosis. It is also noteworthy that the test is done as a follow-up to evaluate how effective the current intervention is. ABG encompasses several tests including; PaO2, PaO2, Bicarbonate, pH, Oxygen saturation and oxygen content (Bourdin et al., 2009). The standard measurements for this tests include PaO2 (80 – 100 mmHg), PaCO2 (35 – 45mmHg), pH (7.25 – 7.45), and HCO3 (21 -28 mEq/L). According to the case study, Mr. Wenham PaO2 and PaCO2 are high. This is attributed to the supplementary oxygen that was provided to him before reaching the hospital. The pH values are low while the HCO3 is high thus depicting acidosis. Question 4 The normal control of breathing is conducted based on supply and demand basis. In this regards, the respiratory system is the supplier, the cells are the consumer, while the blood acts as the connection between the respiratory system and body cells. So as to control the breathing, there are two levels of control. Level 1 referred to as the local control takes place in the bronchioles, alveoli and alveolar capillaries in the localized regions of the lung. This control ensures that gas and blood enters appropriate lung’s sections for effective gas exchange. This objective is achieved by adjustment to lung perfusion and delivery of oxygen to alveoli. On the other hand, Leve; 2, central control relies on brain activity, specifically the respiratory centers. This control adjusts the rate and depth of ventilation by voluntary and involuntary action stimulated by the respiratory centers (Hanania & Sharafkhaneh, 2010). If an individual has exacerbated COPD, there is need to supplement his or her oxygen supply so that PaO2 can be maintained at 60 mmHg. Nevertheless, there is need to observe these supplemental oxygen supply as it increases the amount of oxygen in the system. Failure to watch the supply, oxygen levels rise thus leading to retention of carbon dioxide. The increased retention is because too much oxygen is in a position to push more carbon dioxide from the hemoglobin. Therefore increasing the amount of carbon dioxide in the blood. These relational dynamics between blood flow and air exchange within lungs leads to retention of carbon dioxide. In this case, to recognize carbon retention, there is need to monitor the levels of PaCO2 and PaO2 (Brashier & Kodgule, 2012). Also since it leads to acidosis monitoring the pH and bicarbonate levels would have been an effective measure. Question 5 Yes, it is clinically right to do away with the supplemental O2. For COPD patients, supplemental oxygen is provided with the aim of sustaining life especially for aggravated cases (Des Jardins & Burton, 2015). Nevertheless, when the level of PaO2 gets to a safe level of 60mmHg, it should be removed. Mr. Wenham has been placed on supplemental oxygen for one hour as he is transported to the hospital. This has led to increased oxygen levels which are evident from the PaO2 measurement that reported a level of 100mmHg. Comparing this to the safe level of 60mmHg, this is too high and can negatively affect cellular oxygenation and lead to tissue hypoxia. Although oxygen is an important component, high volumes lead to the increased amount of carbon dioxide in the blood (Currie, 2010). This can be seen from the high levels of PaCO2 which stands at 110mmHg which contributes to acidosis. These are a dangerous situation as it can further lead to organ failure. Per se, the supplemental oxygen needs to be removed. Question 6 BiPAP refers to the Bilevel Positive Airway Pressure. It is a clinical intervention for COPD and other respiratory related conditions. Essentially, it is non-incursive ventilation mechanical technique that utilizes two pressure levels including; inspiratory positive airway pressure (IPAP) and expiratory positive airway pressure (EPAP) that have high and low pressure respectively (Brashier & Kodgule, 2012). The high pressure associated with the IPAP makes inhalation to be relatively more challenging thus reducing the air capacity inhaled thus decreasing oxygen supply. On the flip side, EPAP’s low pressure makes exhalation to be relatively simpler and thus increases the capacity of air exhaled thus increasing the amount of carbon dioxide being exhaled. Accordingly, Mr. Wenham clinical condition shows that there are high levels of PaO2 and PaCO2, 100mmHg, and 110mmHg respectively. These levels are high compared to the recommended levels of 60mmHg and 30mmHg for PaO2 and PaCO2 respectively. As such, to achieve the standard levels, BiPAP technique will be effective. Question 7 Spirometry refers to a clinical technic of evaluating the functionality of the lungs by considering the amount of air an individual is in a position to release from the lungs following an inspiration that is maximal. It is an effective and reliable technique for distinguishing between restrictive disease and obstructive airway disorders such as COPD. In this regard, this method is the most proper and effective technique of establishing COPD severity. Nevertheless, there are other techniques such as the life quality assessment forms and the MRC dyspnoea scale (Bourdin et al., 2009). All these methods are crucial as the severity of COPD cannot only be based on signs and symptoms. The spirometry test is usually done in a clinical setting with the help of a spirometer, which is a handheld machine that examines the functionality of the lungs, records the results and display it on a graph. Essentially, a patient takes a deep breath and then blows in the spirometer’s mouthpiece. By so doing it measures the total amount exhaled, the forced vital capacity (FVC), and the first second exhale, forced expiratory volume in 1 second (FEV1). Another important measurement in spirometry is the FEV1/FVC ratio (Bourdin et al., 2009). Question 8 The standard values of spirometry are usually established by carrying out a population-based investigation for individuals whose lung function is normal (Brashier & Kodgule, 2012). Additionally, it is worth noting that the interpretation of the spirometry result is dictated by the normal values predicted from persons who are of the same age group, height, mass, ethnicity, and gender. This is crucial as the spirometry values are influenced by the aforementioned aspects. In our case, it is important to establish a standard value for a normal elderly men within Mr. Wenham’s age. Hence, the predictions measures to be used include: FVC [liters] = (5.76) (height in meters) – (0.026) (age) – 4.39 FEV1 [Liters] = (4.30) (height in meters) – (0.029) (age) – 2.49 Source: Currie (2010) Holding the assumption that Mr.Wenham is 2. 1 meters tall, the normal predictive values for an individual of 75years and 2.1 meters height is FVC stands at 5.76 liters, FEV1 at 4.37 liters, and FEV1/FVC at 75.86%. According to the spirometry results, the patients FEV1 is at 0.75 liters, FVC is at 1.5 liters, and the ratio between the two measurements is 50%. This reading is relatively low than the expected standard values for a normal individual. This difference is significant as it shows how much obstruction has occurred in the lungs and is indicated by the low capacity of air exhaled or inhaled per second and low total capacity of air that can be taken in. Nevertheless, there is a moderate variation between the ratios which shows that the severity of the condition has been reduced due to the interventions put in place by the clinicians (Des Jardins & Burton, 2015). A closer look at the FV1 shows that there is a significant different with Mr. Wenham’s results recording 0.75litres while that of a normal person standing at 4.37 liters. The difference illustrates that Mr. Wenham’s health condition is critical. Per se, in his lungs, the airways are constricted because of the obstructive swelling. Additionally, although they can facilitate inhalation and exhalation they are not in their optimum functional state and the capacity of air exhaled is little. On the other hand, the established values of the FVC signified that the air capacity that can be exhaled in one breath is reduced. This can be associated with the decrease of respiratory system’s capacity because of swelling of air sacs in the alveoli. Question 9 The differences between standard values and the spirometry results for Mr. Wenham can be attributed to the pathophysiological characteristic of the respiratory system. Ordinarily, the spirometry readings are established by the chest capacity which is dictated by the height and age of a person (Brashier & Kodgule, 2012). Nonetheless, with a physiological change, these values of spirometry do change. In this clinical case, the values difference originate from the patient’s lungs condition. Mr. Wenham has damaged lungs due to COPD that is caused by prolonged and excessive smoking. This conditions swells and constricts the airway and swells the air sacs in the alveoli (Des Jardins & Burton, 2015). As such, the values are decreased significantly by these two elements. References Bourdin, A., Burgel, P. R., Chanez, P., Garcia, G., Perez, T., & Roche, N. (2009). Recent advances in COPD: pathophysiology, respiratory physiology and clinical aspects, including comorbidities. European Respiratory Review, 18(114), 198-212. Brashier, B. B., & Kodgule, R. (2012). Risk factors and pathophysiology of chronic obstructive pulmonary disease (COPD). J Assoc Physicians India, 60, 17-21. Currie, G. P. (Ed.). (2010). ABC of COPD. John Wiley & Sons. Des Jardins, T., & Burton, G. G. (2015). Clinical Manifestations & Assessment of Respiratory Disease. Elsevier Health Sciences. Hanania, N. A., & Sharafkhaneh, A. (Eds.). (2010). COPD: A Guide to Diagnosis and Clinical Management. 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