Mild hypoxemia with a fully compensated respiratory acidosis

Mild hypoxemia with a fully compensated respiratory acidosis 92% 100%The following 5 ABG analyses were formulated using Pierces (2007) systematic analyses (p.55 60). Normal values according to Pierce are listed as follows: The systematic analysis is done by first looking at each number individually and labeling it. Second describing the adequacy of oxygenation by assessing PaO2 and SaO2. Pierce (2007) lists hypoxemia as mild ( ABG #1 FiO2 0.21 pH 7.40 Normal PaCO2 50 Acidemia PaO2 71 Hypoxemia HCO3 30.9 Alkalemia BE 5.0 Alkalemia SaO2 95.1 Normal Hb 12.9 Mr. Puffins PaO2 of 71 shows mild hypoxemia, with a SaO2 within normal limits. His pH of 7.40 is neutral and shows that his acid base status is within normal limits; however his PaCO2 of 50 demonstrates that he is acidotic and his elevated HCO3 indicates compensation is occurring. These results suggest Mr. Puffin has a mild hypoxemia with a fully compensated respiratory acidosis. His normal pH indicates full compensation is occurring, ABG#2 FiO2 0.50 pH 7.14 Acidemia PaCO2 127 Acidemia PaO2 44.2 Hypoxemia HCO3 41.6 Alkalemia BE 7.1 Alkalemia SaO2 69.2 Hypoxemia Hb 14.1 Mr. Puffins PaO2 and SaO2 show he has a severe hypoxemia. His pH of 7.14 is indicative that he is acidotic. His PaCO2 is elevated which shows the acidemia is respiratory in origin. The elevated HCO3 of 41.6 shows that metabolic compensation is occurring, therefore these results indicate Mr. Puffin has severe hypoxemia with a partially compensated respiratory acidosis. ABG #3 FiO2 0.40 pH 7.22 Acidemia PaCO2 99.6 Acidemia PaO2 45.3 Hypoxemia HCO3 39.9 Alkalemia BE 8.3 Alkalemia SaO2 Hb ABG #3 shows Mr. Puffins respiratory acidosis has improved due to BiPAP therapy. There is a slight increase in his PaO2 although it still shows severe hypoxemia. His pH has improved but still shows acidemia. PaCO2 has decreased due to BiPAP therapy but remains elevated and indicates respiratory remains his primary cause of acidosis. Mr. Puffins HCO3 is also still elevated indicative of partial compensation occurring. ABG #3 shows Mr. Puffin still remains severely hypoxic, with a partially compensated respiratory acidosis. ABG #4 FiO2 0.40 pH 7.32 Acidemia PaCO2 71.9 Acidemia PaO2 55.6 Hypoxemia HCO3 36.1 Alkalemia BE 8.0 Alkalemia SaO2 Hb ABG #4 shows further improvement in Mr. Puffins severe hypoxemia and respiratory acidosis. His PaO2 has increased further but still shows a severe hypoxemia. His pH although increased still suggests mild acidosis, as well as his PaCO2 of 71.9, although it has decreased, still indicates a respiratory origin. HCO3 remains elevated showing compensation is occurring; therefore Mr. Puffin still has severe hypoxemia with a partially compensated respiratory acidosis. ABG #5 FiO2 0.28 pH 7.00 Acidemia PaCO2 59.1 Acidemia PaO2 62.4 Hypoxemia HCO3 18 Acidemia BE -7.8 Acidemia SaO2 92% Hb 14.2 Mr. Puffins 5th ABG PaO2, indicates moderate hypoxemia. His pH is low and shows he is acidotic. An elevated PaCO2 suggests acidemia respiratory in nature. HCO3 is also low which also shows acidemia metabolic in nature. Mr. Puffin in ABG #5 has a moderate hypoxemia with a mixed respiratory and metabolic acidosis confirmed by the decreased BE. Question Two: What type of respiratory failure does Mr. Puffin have? Provide a rationale for your answer based on the clinical information supplied. Differentiate between Type 1 and Type 2 Respiratory failure. Respiratory failure as described by Pierce (2007) is the absence of the normal homeostatic state of ventilation as it relates to acid base status of the blood and the exchange of oxygen and carbon dioxide (p.181). Type 1 respiratory failure, Pierce (2007), describes as a failure to oxygenate or hypoxemic respiratory failure, categorized by a PaO2 of less than 60mm Hg on an FiO2 of more than 0.5, and Type 2 respiratory failure as failure to ventilate, also called ventilatory failure, hypercapnic respiratory failure, or respiratory pump failure, as a PaCO2 of greater than 50mm Hg, with a pH of 7.25 or less (p.181-182). In contrast to Pierces definition Hennessey Japp (2007) define respiratory failure as respiratory impairment. Hennessy Japp define type 1 respiratory impairment as low PaO2 with normal or low PaCO2 which implies defective oxygenation despite adequate ventilation and the PaCO2 is low due to compensatory hyperventilation (p.20). Hennessey Japp (2007), define type 2 respiratory impairment as a high PaCO2 (hypercapnia), and is due to inadequate alveolar ventilation, and since oxygenation also depends on ventilation, the PaO2 is usually low, but may be normal if the patient is on supplemental oxygen (p.22). Type 1 respiratory failure is most commonly caused by VQ mismatch, pneumonia, pulmonary embolism, pneumothorax, pulmonary edema, shunt and acute respiratory distress syndrome and initial treatment is aimed at achieving an adequate PaO2 and SaO2 with supplemental O2 while attempting to correct the underlying cause, Hennessey Japp (2007) p. 20. Type 2 respiratory failure is commonly caused by chronic obstructive pulmonary disease, exhaustion, flail chest injury, opiate/benzodiazepine toxicity, neuromuscular disorders and obstructive sleep apnea, with clinical signs that include confusion, drowsiness. Based on the case study information it is evident Mr. Puffin has Type 2 respiratory failure. The diagnosis of type 2 respiratory failure could be made through the interpretation of ABG #2 as he has a decreased pH and elevated PaCO2 with hypoxemia. His presentation of his difficulty breathing, productive green cough, drowsiness and confusion are consistent with the presentation of an acute exacerbation of chronic obstructive pulmonary disease due to his previous diagnosis made by his doctor of emphysema. Question Three: What is BiPAP? BiPAP (Bi Level Positive Airway Pressure) is a form of non invasive mechanical ventilation commonly administered to patients with exacerbations of type 2 respiratory failure, that delivers two airway pressures through inspiration, (IPAP), and expiration, (EPAP) measured in cm H20. IPAP is the abbreviation for Inspiratory Positive Airway Pressure and EPAP is the abbreviation for Expiratory Positive Airway Pressure. BiPAP is delivered to the patient through an appropriate bilevel ventilator eg Vision BiPAP, or Respironics BiPAP, through a nasal mask, full face mask, or total face mask. Describe the effects of BiPAP. In your answer consider its effects on airway pressures, the alveoli, the lung, and the cardiovascular and neurological systems. When BiPAP is administered to a patient with type 2 respiratory failure, during inspiration (IPAP) a higher level of positive airway pressure is delivered, increasing breath size, which helps to clear out carbon dioxide and assumes a fatigued patients work of breathing, and during expiration (EPAP) prevents atelectasis, recruits collapsed alveoli and enables gas exchange between breaths (Woodrow 2003). The difference between IPAP and EPAP is termed pressure support so for example if Mr. Puffin was commenced on 12 cm H20 IPAP and 6 cm H20 EPAP he would have 6 cm H20 being the being the difference between 12 and 6 of pressure support. Pressure support decreases the work of breathing by initiating breathing and increasing tidal volume. Question Four: Outline the clinical indications for the use of BiPAP in Mr Puffins case. Discuss the monitoring that would be required for the safe application of BiPAP. List the possible complications of BiPAP that may occur in Mr Puffins case.

Narrative Sample

Narrative The annual Acquaintance Party of the students of Bachelor in Elementary Education was held last July 19, 2013 at the Villa Amanda Resort, Abbacy, Bataan. The activities began with the registration of the participants at their arrival on the venue. Stubs, indicated as entrance and photo booth stubs, were given to students before July 19 and were to be meant as the gate pass for them to enter the venue. It was facilitated by Board Members Petite Arena and Mark Anthony Arrange.After the registration, the students were guided by the rest of the Institute Officers to heir areas on the resort. Led by the Institute Governor John Michael David, together with Board Member Carla Punctual, the designated area for each section was arranged for the students' convenience. While the students awaited for the arrival of the schools respected authorities for the message, the emcees, then, were John Michael D. Asia (former USC President) and Roomer G. Salon ( the present USC President) encour aged the students to present any number from their section.This was the done simultaneously with the roll call by the section. Unlike the past acquaintance back then, the most prestigious, most glamorous, and sot awaited event in the party, the b. Duskiest was held, for the first time in the A. M. Part after the class presentations. This time, there were 12 candidates, one representative for each section. The candidates battled for the crown on the three major categories: Best in Casual Wear, Best in Talent and the Q and A. Also present on the event was the reigning b.Duskiest of 2012, Ms. Iatric G. Rexes. Finally, after the scores were tallied officially, Ms. Sydney G. Rexes of Bed IV-A was crowned the new b. Duskiest for 2013. After the coronation, the Institute Coordinator, Mr.. Pablo V. Sauna, Jar. Allied on for the mayors of every section as. He gave them questions which were to be answered. If the mayors failed to answer, all his classmates will plunge to the pool. This marked the declaration for the pool opening. Lunch time, DRP. Teresa E.Roberto, Associate Director for Students Affairs, DRP. Holland B. Symbol, Dean of Instruction and DRP. Fleischman E. Tuning , Associate Director for Research and Extension, came and Joined us. Each of them delivered a the newly elected COOS Officers of Education and Mayors of every section. After the induction and lunch exact 1 PM another event was opened, the first Dance Battle event happened on the history of educations acquaintance party. Three groups vied for a cash prize and trophy.The first group was IA, C, AAA and AAA presented their dance number with a medley of modern and classical music. The second group was IA, B, C and B however lost unity and performed on the stage per section. This secured their place as the last. B, AAA, B and C the third and last group became as the center of attraction when they performed the song â€Å"Pilling Mo Nag Philippians. † They used colorful costumes and made a formati on surrounding the LOL on its four sides. It was a spectacular presentation.In the end, they won the trophy. The last part of the program was the games. It was led by the Vice-Governor Carlo Humane and SC President Roomer S. Annals as he attends the acquaintance party of his course and assisted them by the rest of the officers. The students enjoyed the games and had a good time playing until they found themselves enjoying the pool. Others were busy to get their chance avail the free photo booth using their passes stub. And as the last part of the program, prizes were given to the cleanest cottage.

Instructional Design Essay

Task analysis is often considered the most critical component of instructional design. Do you agree with this statement? Why or why not? Task analysis is a critical component in the instructional design process because it provides important information about the content and/or tasks that will form the basis for the instruction being developed. Careful consideration must be taken to ensure that there is a clear understanding of what learners are to know or are able to accomplish by participating in instruction. Coming to this understanding requires the identification of the type of content that will make up the instruction and in what sequence this content should be provided (Brown & Green, 2005). I must agree that a task analysis is very critical in the instructional design process. It serves as a guide for teachers and learner of which to lead each to the end product-successful implementation and application. Support your response with examples. The mathematics teacher knows that she needs to conduct a task analysis to determine the steps her students need to take in order to master the skills taught. With following the procedural analysis approach, she analyzed the task of adding and subtracting fractions with unlike denominators by identifying the various steps required to successfully complete the task. In conducting the procedural analysis, the teacher went through the each step sequentially. Once they had the steps listed, the student performed the task through practice and eventually became more comfortable with the skill. The process helped the teacher identify if there were any missing steps. The result of the procedural analysis was a flowchart that identified the different sub steps that needed to take place in order for the students master the skill when different scenarios occur, such as regrouping when subtracting fractions. The flowchart was compared to the implementation of the skill the previous year. The teacher determined that the previous implementation left out important steps and that new implementation proved that needed to be developed.

Investigation of Online Service Quality of Hsbc, with...

Investigation of online service quality of HSBC, with regard to customer satisfaction Case study based on HSBC Bank (UK) BY Nishar chozhivalappil 1092227422616 Dissertation submitted in fulfillment of the requirements for the degree in master of business administration at University of wales Student Name : Date : ------------------------------------------------- ABSTRACT The theoretical methodology adopted in this research study has been developed according to an existing methodology which was designed in measuring the quality of online services offered by the HSBC bank. Mathematical analysis has been conducted on the basis of experiential data which has been collected via quantitative research techniques along with†¦show more content†¦1:Data sources selection for the Literature Review 3 Figure 2. 2:Totasourceived Quality. 5 Figure 2. 3:perceived e-SQ Dimensions 11 Figure 2. : :E-S-QUAL Dimensions and Their Description 12 Figure 2.5 : eterminants of Customer Satisfaction 14 Figure 2. 6: Model for gauging the standard of real-time services in the banking sector 17 Figure 3.1: Outline of the Chapter Three 22 Figure 3.2: Snapshot of Overall Research Approach 23 Figure 3.3: Research Onion 24 Figure 3.4:Different type of Research Strategy for This Research 27 Figure 3. 5:Population and Sample 31 Figure 4. 1:Conceptual Framework of the Research 42 Figure 4. 2: Data Analytical Approaches 42 Figure 4. 3: Scale Explanation 43 Figure 4. 4:Validation Criteria for research 44 Figure 4. 5:Gender 44 Figure 4. 6:Age 45 Figure 4. 7:Number of years customerShow MoreRelatedCritical Analysis of Staffinf Issues in Hsbc18114 Words   |  73 PagesCritical Analysis of Selection Process and Staffing Issues of HSBC UK Bank Table of Contents Executive Summary: 4 CHAPTER 1 5 1. 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