Pathophysiological Processes Demonstrating Bob’s Clinical Status

Case Study 1 Name of Student Institution Affiliation Case Study 1 1. “Pathophysiological Processes Demonstrating Bob’s Clinical Status” The principle pathophysiological processes involved in the clinical status of Bob include COPD exacerbations, violations of gas exchange, and pulmonary hypertension. The violations of gas exchange are presented by oxygenation and ventilation status. The SpO2 level indicates the estimated oxygen amount present in the blood, i.e. “peripheral capillary oxygen saturation” (Harvey, Salehizadeh, Mendelson, & Chon, 2019). The normal value for SpO2 lies between 95 to 100 per cent. However, the SpO2 level of Bob is 89 percent. Therefore, a nebulizer mask has been placed at the rate of 8L/min. Support is important to emphasize that the main problem with COPD is pulmonary hyperinflation, i.e., an increase in lung volumes. Consequently, it leads to flattening of the primary respiratory muscle or diaphragm, i.e., moving it to a less efficient the null position on the curve length tension (Cushen et al., 2016). The COPD pulmonary hyperinflation leads to the creation of an internal positive pressure at the end of expiration that in turn increases the load on the breathing apparatus leads to increase respiratory rate. 1.1. ABG findings of Bob The ABG values are found to be slightly abnormal. For instance, Bob has a pH value of 7.23, while the normal range is 7.38 - 7.42. His PaCO2 (78 mmHg) is excessively increased from the normal range of 38 - 42 mmHg. The bicarbonate level is 29 mmol/L which is slightly increased than the normal values, i.e. 22 - 28 mmol/L (Tilanus et al., 2017). Furthermore, the partial pressure of oxygen is found to be 55 mmHg, which is also decreased as compared to the normal range of 75 - 100 mmHg 1.2. Hemodynamic Parameters Furthermore, considering the hemodynamic parameters, it has been noticed that Bob’s blood pressure is 183/97 mmHg which violates the normal range of 120/80 mmHg (Son et al., 2018). In addition, the pulse rate is 124 beats per min that is also excessively increased, while the normal range is 60 to 100 beats per minute. The observation of peripheral edema in the patient is a strong indicator of cardiac hemodynamics (Sterns, Emmett, Forman, 2016). Furthermore, the patient’s Jugular Venous Pressure was also elevated and was presenting the signs of sinus tachycardia. 1.3. Neurological Observations The neurological observation reveals that the patient is mentally disturbed. He is not orientated to the person, place, and time. Also, he is showing drowsiness. He was looking unwell, no well-orientation with time and place; lethargic; speaking short sentences; breathing with obvious accessory muscle use; and having prolonged expiratory phase 2. “Physiological Effects of BiPAP and Significance of Non-Invasive Ventilation in Bobs Condition” 2.1. Physiological Effects of BiPAP According to the Stanford Healthcare (2019), the patients with complicated COPD require the health care professionals to use specialized techniques to manage their respiratory rates. The “BiLevel Positive Airway Pressure” (BiPAP) mode is set by the expiratory pressure level which corresponds to the positive pressure at the end of exhalation (Expiratory positive airway pressure; EPAP), and “Inspiratory positive airway pressure” (IPAP). The levels can be synchronized with the patient’s respiratory effort and the time parameters of the pressure inhale and exhale (Chiumello, Gotti, & Chiurazzi, 2016). It has been recommended that the Non-Invasive Ventilation (NIV) and BiPAP mode resulted in more rapid decrease of dyspnea and improvement of gas exchange parameters in the patients of COPD. Therefore, the BiPAP will have a significant physiological effect on Bob’s breathing condition. BiPAP is a two-level positive airway pressure; a ventilation mode in which the device creates a higher pressure of the supplied air during inhalation and less high during expiration. It works as a compressor that pumps air into the airways under pressure, the level of which depends on the inhalation and exhalation phases (Chweich, Hill, & Dziura, 2017). The device will support Bob’s inhalation with higher pressure, and exhalation in a lower pressure. In addition, this respirator has a special trigger device, i.e. a sensor that records Bob’s respiratory effort in real time. Since Bob was showing widespread inspiratory and expiratory wheezes, with crackles at the right base, therefore, this needs to be assessed through the BiPAP. The BiPAP is one of the important types of “non-invasive respiratory support devices”, the other one is “Continuous Positive Airway Pressure” (CPAP). The physiological effects of BiPAP involve the improvement of breathing, quality of life, and hemodynamics’ parameters due to normalized blood gaseous exchange (ElKhatib, Baraka, & Khatib, 2016). Almost all COPD patients provided with the non-invasive ventilation significantly present improved quality of life. The BiPAP is supposed to be more effective for elimination of CO2 as compared to CPAP, due to the significant generation of pressure support in the gap between EPAP and IPAP (Lian, 2013). The BiPAP combines the advantage of ventilation with pressure support and CPAP and keeps the lungs open during the entire breathing cycle. Furthermore, the BiPAP is used during pre-oxygenation to reduce intrapulmonary shunting and increase safety margins in the COPD patients (Kirti, & Sonia, 2016). This technique is also used to reduce postoperative pulmonary insufficiency and to treat patients with respiratory disorders of various etiologies. This is fundamentally important for Bob’s condition since his breath is weak. When the patient begins to exhale, the device understands that it is time to stop breathing and relieve pressure (Sklar, et al., 2018). The difference between inhalation pressure and exhalation pressure can be 10 to 15 or more centimeters of water column. Thus, to improve Bob’s condition, assisted ventilation of the lungs is ensured, in which the respiratory volume increases, gas exchange in the lungs is improved and the respiratory muscles are facilitated. 2.2. Non-Invasive Ventilation The NIV has been a significant improvement for managing the condition of COPD patients, both in patients with exacerbation and in stable patients. Currently, NIV is the first line treatment for patients with exacerbation of COPD and acute hypercapnic respiratory failure. In this case study, non-invasive ventilation is implemented as a method of respiratory support to avoid COPD exacerbation (Moga, Marchie, Saey, & Spahija, 2015). For people with COPD, respiratory support through NIV is one of the factors that affect the prognosis and quality of life. Therefore, as the vital capacity of the lungs (VC) decreases, non-invasive ventilation of the lungs will be required, particularly in the absence of contraindications (Lu, Liu, & Li, 2019). Before prescribing BIPAP therapy in COPD case, the physician experienced in non-invasive ventilation must establish a diagnosis of the underlying disease on the basis of history, examination and d...