Overview the Normal Physiological Control of Breathing - Medical Science Assignment Help

Assignment Task:

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Assignment Requirements
A 1500 word, structured response answering the specific questions presented in the following case study.
Information provided in your answers must be referenced following academic conventions. A bibliography should be included at the end of your document conforming to Harvard (author/date) OR APA format. References and in text citations are not included in the word count.
Diagrams can be included to help support your answers – they are not included in the word count.
Use the answer template provided by pasting it into a new document
Patient Background
You have been tasked Priority 2 to a 75 year old man with chest tightness and shortness of breath. On your arrival you find a very thin, elderly man sitting on a chair with his arms braced on his knees. He looks very dyspnoeic. His initial observations are:
Table 1
Respiratory rate 45 breaths/minute
Heart rate 120 beats/minute
Blood Pressure 95/50 mmHg
Oxygen saturation 82%
Glasgow Coma Score 13 (E=3, V=4, M=6)
The man’s name is Mr Wenham, and he is only able to speak single words. His wife tells you that his breathing is never very good, because he smoked far too much. She says he sometimes struggles to walk around the house.
Table 2
Symptoms Shortness of breath, chest tightness, cough
Onset “His breathing has been particularly bad for the last two days and much worse for the last hour or so”
Chest examination Barrel chested, little chest wall movement
Breathing sounds Very quiet breath sounds, occasional wheeze
Jugular veins Elevated 5cm

You form the view that Mr Wenham is suffering from an exacerbation of Chronic Obstructive Pulmonary Disease (COPD). You administer supplemental oxygen, atrovent and salbutamol (following local guidelines), and prepare for the 60 minute journey to hospital.
Describe specifically the pathophysiological changes occurring in COPD that result in each of the signs or symptoms listed in Table 2, and the observations listed in table 1 (ie detail what pathophysiological change is responsible for each sign or symptom and observation). (20 marks)
Discuss why you would administer salbutamol and describe how it works at the cellular level. (10 marks)
Mr Wenham’s oxygen saturation improves with supplemental oxygen but he remains tachypnoeic, tachycardic and hypotensive. On arrival at the Emergency Department you go straight to the resuscitation room and an arterial blood gas sample is taken and analysed immediately with the following results:
Table 3
pH 7.12
PaO2 100 mmHg.
PaCO2 110 mmHg
HCO3 38

• Discuss why they would take an arterial blood gas and explain what the results mean and how they are influenced by the underlying pathophysiology of Mr Wenham’s condition. (10 marks)
• The emergency department staff suggest you may have given Mr Wenham too much oxygen. They say they are going to remove the oxygen.
• Overview the normal physiological control of breathing (not the mechanics of ventilation). Then, explain how carbon dioxide retention might occur when COPD patients are receiving supplemental oxygen. How would you recognise this if it was happening to Mr Wenham? (20 marks)
• When considering his blood gas analysis, do you think it is a good idea to remove Mr Wenham’s oxygen and have him just breathing air? Provide an argument supporting why it is OR why it is not. (10 marks)
• The emergency department consultant returns from his lunch break to interrupt the oxygen debate. He suggests that Mr Wenham needs BiPAP.
• What is BiPAP? How might BiPAP help to improve Mr Wenham’s clinical condition? (10 marks)

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