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B.T., a 2222-year-old man who lives in a small mountain town in Colorado, is highly allergic to dust and pollen. B.T's wife drove him to the clinic when his wheezing was unresponsive to fluticasone/salmeterol (Advair) and ipratropium bromide (Atrovent) inhalers, he was unable to lie down, and he began to use accessory muscles to breathe. B.T. is started on 4 L4 \mathrm{~L} oxygen by nasal cannula and an IV of D5W at 15 mL/hr15 \mathrm{~mL} / \mathrm{hr}. He appears anxious and says that he is short of breath.

 Arterial Blood Gases pH7.31Paco248 mmHgHCO326mmol/IPaO255 mmHgSaO288%\begin{aligned} &\text { Arterial Blood Gases }\\ &\begin{array}{ll} \mathrm{pH} & 7.31 \\ \mathrm{Paco}_2 & 48 \mathrm{~mm} \mathrm{Hg} \\ \mathrm{HCO}_3 & 26 \mathrm{mmol} / \mathrm{I} \\ \mathrm{PaO}_2 & 55 \mathrm{~mm} \mathrm{Hg} \\ \mathrm{SaO}_2 & 88 \% \end{array} \end{aligned}

You will need to monitor B.T. closely for the next few hours. Identify four signs and symptoms of impending respiratory failure that you will be assessing for.

Solution

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Answered 1 year ago
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Symptoms that indicate respiratory failure are:

  • a) inability to recline
  • b) respiratory rate greater than 30 breaths/min
  • c) relative bradycardia
  • d) absent pulsus paradoxus

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