Hyperventilation Syndrome, Essay Example

Patient Medical History

My patient is a 61 year-old male. He has a history of morbid obesity and hospitalization for obesity hyperventilation syndrome, acute and chronic respiratory failure, and pneumonia over the past year. His family history does not have any type of role in his current health status. The patient was a smoker but quit several years ago.

Reason for Admission to Hospital

Over the past week, the patient has had cold-like symptoms and increasing dyspnea. Currently, the patient has experienced acute on chronic hypercapnic respiratory failure that requires him to enter the critical care unit for noninvasive ventilation and close monitoring. In addition, the patient has developed fluid responsive hypotension. These conditions have required his admission to the critical care unit for further monitoring.

Patient Disease/Diagnosis

For this patient, it is likely that his condition is based upon an underlying viral infection which requires further treatment and evaluation. Most likely, the patient is experiencing RSV because there is an absence of myalgia; in addition, influenza is not a likely cause of his current condition. It is also possible that the patient has bacterial bronchitis, which is secondary to staph infection or another type of infection that is community-acquired in nature. Another possible differential diagnosis is pulmonary embolism, based on elevated BNP and elevated troponin.

Medications

For this patient, who has no known allergies, his home-based medications are as follows:

1)Furosemide (Lasix) 80 mg daily to alleviate edema but is not currently taking the medication

2)Albuterol (Ventolin HFA) 90mcg/actuation inhaler (2 inhalations daily) to improve respiratory symptoms but is not taking the medication

3)Aspirin 81 mg daily to prevent heart attack but is not currently taking the medication

In addition, the patient is scheduled to receive the following medications while in the hospital:

• ceFEPime (MAXPIME) 1g intravenously
• Insulin regular (HumuLIN R, NovoLIN R) 0-10 units subcutaneously every six hours to control blood sugar
• Moxifloxacin (AVELOX) 400 mg intravenously every 24 hours
• Sodium chloride 250 mL
• Vancomycin (Vancocin) 2.5 g intravenously
• Continuous infusion of heparin for coronary/AFIB 5 units/kg/hr to manage blood consistency
• Sodium chloride  units/kg/hr
• PRN: Dextrose 50% in water, glucagon

Therapies

For this patient, it is recommended that he continue to receive BiPAP until his condition improves. It is important to continue with Clinical and ABG monitoring in order to determine if the patient will continue to improve in the coming days and what course of action is needed. In addition, a 20-year smoking habit has left the patient with airway disease, but he demonstrates a positive response to the bronchodilator. The patient has had a positive HP panel in the recent past, along with solumedrol over the short term every six hours. Vancomycin has been prescribed for MRSA and moxi for cap while the physician waits for the test results regarding influenza and other possible conditions. Acute chronic hypercarbic failure has occurred, as the patient has been noncompliant with his CPAP; therefore, he must be monitored accordingly in order to prevent future readmission. In addition, he requires close monitoring for early sepsis as a result of cardiac fluid responsive hypotension. There do not appear to be an issues of importance related to renal and electrolytes, and long-term changes are required for endocrine safety.

Lab Results or Test Results

For this patient, current vital signs include the following: Temp of 37 C, BP of 106/59 mm/Hg, HR is 85, and O2 saturation is 91%. For this patient, general observations include morbid obesity, a short and thick neck, pulmonary is bilateral diminished equal with bilateral inspiratory and expiratory crackles. The abdomen is soft, the extremities are warm and with strong peripheral pulses, the skin is flushed, neuro is grossly intact, and no rashes or wounds are evident. Recent laboratory results include the following: NA: 43; K: 4.6; CO2: 38; BUN: 31; Creatinine: 1.6; Calcium: 8.9; WBC: 19.0; HGB 15.4; HCT: 0.51; and PLT: 231. In addition, the chest x-ray that was taken earlier in the day demonstrates increased vascularity, but no other findings that are impacting the patient’s overall health at this time. These tests demonstrate that the patient requires additional support and guidance in order to prevent long-term complications for the patient.

Recommendations

For this patient, it is necessary to make a definitive diagnosis because the team is uncertain regarding his cultures and bacterial testing. Once this diagnosis can be made, the appropriate treatment must be identified in order to provide the patient with the best possible chance for recovery. This is an important reminder of this patient’s current health status and what is required to ensure that the patient will experience the best possible form of recovery, given the circumstances. This patient must be able to experience some degree of relief because his condition must be alleviated improve his quality of life. For this patient, a round of antibiotics is essential in order to eradicate any type of bacteria that are present, including more complex bacteria such as MRSA. This reflects the importance of understanding how the patient’s current condition will be alleviated through these activities and the appropriate level of medication administration at all times. This process will provide further support for the patient’s overall health status and the ability to manage the current condition as best as possible.