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the red blood cell. Due to this space there is retention of CO2 in the blood stream and a
lack of O2 uptake from the lungs. These conditions along with the barrel chest, which
prohibits an adequate amount of airflow further, decrease the gas exchange.
Now that we realize that there is an increase in CO2 in the emphysema client how
does this affect the chemoreceptors? The normal ABG will have a PaO2 of 80-100 and a
PaCO2 of 35-45, along with a Ph of 7.35 to 7.45. The chemoreceptors located in the
carotid bodies and the aortic arch will sense changes in the level of CO2 in the blood and
increase their impulses to the respiratory center of the brain which in turn increase the
impulse and contraction the skeletal muscle of the chest notability the diaphragm,
external intercostals, scalenes and the sternocleidomastoid muscles (fig 23.14, 23.18, and
23.27).
However with an emphysema client it is not uncommon to have a CO2 level of
50-70mmHg and an O2 less an 88mmHg, which causes a drop in the Ph to below 7.35
during in exacerbation of their emphysema. Because of the increase CO2 level in the
blood it will bind to the H2O form carbonic acid H2CO3 that will rapidly convert to
Hydrogen and H2CO3 (hydrogen and bicarbonate). There needs to be a 20:1 ratio
between bicarbonate and hydrogen to cancel them selves out, it is only a matter of time
until all buffer systems fails and the client become acidotic. The over accumulation of
CO2 in the blood for a chronic period of time eight to ten years causes the chemoreceptor
to become desensitized and they no longer see changes in the CO2 level. The desensitized
receptors how change their focus from CO2 to O2 levels. Remember that the COPD
client O2 levels are normally below 92mmHg and if the level drops the receptors will
increase the impulses to the brain stem, which in turn will increase the respiratory rate.
However the Inspiratory center of the brain is more strongly stimulated by an increase of
CO2 then it is by a drop in O2 levels in the arteriole blood. As an example if a diver were
to hyperventilate cause a drop in the CO2 level and a rise in the O2 level, while
swimming under water he would consume the O2 at a faster rate then he would produce
carbon dioxide, thus causing him to pass out under water due to the lack of O2 by for the
CO2 would have a chance to rise to alert him to breath. (Tortora PG 839)
If the emphysema client is in acute distress we will administer high flow O2 along
with bronchial dilators while closely watching for changes in the respiratory effort, rate
and depth. With this is in mind it is important to remember that an emphysema client
can’t handle high flow O2 for prolong periods of time because the increase in the blood
PaO2 levels above 95-100mmHg will in fact suppress the respiratory function an stop
any and all desire to breath. The client will cease to breath and develop a life threatening
respiratory arrest. This in turn will cause the client to be placed on a ventilator, and they
will have to be weaned off of it, which in some cases is nearly impossible because of the
hypoxic drive. Any attempt to decrease the O2 level to encourage them to breath will
cause an increase in the CO2 levels, however do to the fact that an increased CO2 level
will not stimulate them to breath and before the O2 level can drop low enough to
stimulate respiration the client will develop respiratory acidosis; it causes a self-perpetual
problem.
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Treatments:
Albuteral inhaler Q 4-6hrs prn
Xopenex inhaler Q 4-6 hrs
Atrovent inhaler Q6 hrs prn
Digoxin QD
Lasix QD
K-Dur 20 MEq QD
Cipro prn
Biaxin prn
Advair disk
Prednisone 10 mg alternating cycle
Flovent inhaler
Diflucan prn
References:
Principles of anatomy and physiology tenth edition Tortora and Grabowski
Medical surgical nursing third edition Lemone and Burke
Anatomy and physiology by professor Bryan h Derrickson PH.D.
Physical examination fourth edition Saunders by Carolyn Jarvis
http://www-medlib.med.utah.edu/WebPath/ORGAN.html
http://www-medlib.med.utah.edu/WebPath/LUNGHTML/LUNGIDX.html