coronary artery disease

49 years severe COPD, who is on 4 liters nasal cannula home oxygen with pulse oximetry and who has OSA on BiPAP at night. Patient’s medical history is CAD (coronary artery disease), DM2, HTN, HLD, history of tobacco use. Last night, her oxygen saturation dropped to the mid 60’s and has used her nebulizer with albuterol and albuterol MDI about 30 times in the past 24 hours. She has a productive cough, shortness of breath, use of accessory muscles and is wheezing, the sputum is thick white. The patient then decided to come to the emergency room. Once the patient was in the ED, she became obtunded and the following laboratory results were obtained:

Ht: 6 feet 1 inch

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WBC: 10.2                                            7.26/>80/102/37.9/7.9/95% on 70% High flow aerosol mask

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RBC 4.51

Hgb 13.8

Hct 42.5%

Platelets: 135

Na: 134

K: 3.9

Total CO2: 38

BUN: 27

Creatinine: 1.0

Glucose: 130

1-Calculate the A-a gradient? Based on the result of the A-a gradient, what does it tell you about your patient?

2-Make specific recommendations for treatment of this patient

 

In: Nursing

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