Reference no: EM134017821
Assignment:
Lark Chesterfield, a 66-year-old woman, presents to the urgent care office complaining of shortness of breath and coughing up "yellow mucus" for the past 24 hours. She has a history of smoking one pack daily for 48 years and a 12-year history of progressive chronic kidney disease (CKD) based on a decreasing glomerular filtration rate (GFR).
Significant Past Medical History:
Pulmonary: Community-acquired pneumonia 10 years ago; mild chronic obstructive pulmonary disease (COPD) diagnosed two years ago
Renal: Mild kidney disease first diagnosed 10 years ago with progressive decreased GFR; Current GFR is 30 mL/min diagnosed two years ago
Immunizations: Prevnar-23 for pneumonia and Influenza vaccines are up to date.
Allergies: None known
Physical Exam:
Vital signs: temperature 102.2 F (39C), blood pressure 82/48 mmHg, heart rate 128; weight 190 pounds; height 68 inches
The exam reveals a woman who appears older than her stated age. Significant findings include increased work of breathing with decreased breath sounds and rales in the right lower lobe; sinus tachycardia with no murmurs, rubs, or gallops; and 3+ pitting edema.
LABS:
Blood gas indicates a mixed metabolic-respiratory acidosis with pH 7.25; CBC: Hct 30%; MCV 78 fL; WBC 16,800
After the physical exam, blood gas, and chest x-ray, he is diagnosed with right lower lobe pneumonia with sepsis and severe acidosis. She is admitted to the hospital for further evaluation and intensive care where she will receive intravenous antibiotics and further support.
1. Explain the chronological sequence of events (both chronic and acute) that have contributed to her acidosis.
2. Explain why her current sepsis further complicates her acid/base status.
3. How does her body attempt to compensate chronically and acutely for her acidosis? Be specific! In your discussion discuss the relationship and interaction between the pulmonary, renal, and hemopoietic systems and how this affects her ability to compensate for her acidosis. (In other words, how her co-morbidities have affected her ability to compensate for her acidosis.)