SOLVED1473

A 75-year-old male is noted to have an irregular pulse on examination. He has severe COPD from smoking for many years and uses an albuterol (Proventil, Ventolin) inhaler and tiotropium (Spiriva). On examination his blood pressure is 130/70 mm Hg, and his pulse rate is 110 beats/min and irregularly irregular. Auscultation of the lungs reveals a few scattered wheezes and rhonchi. Chest Xray notes some pulmonary congestion. An EKG shows irregular R-R intervals with narrow QRS complexes and no P waves. A metabolic panel find CO2 to be elevated at 30, TSH level was normal, hemoglobin level are normal, and hematocrit is slightly elevated, an echocardiogram shows an ejection fraction of 60-65%. 1.What is causing the elevation of the patient’s CO2, is this a metabolic acidosis or alkalosis? 2.Is the metabolic state compensating for any respiratory acidosis or alkalosis? 3.What would be the best medication to control the patients heart rate? 4.Why would this patient have an elevated hematocrit?
SCIENCE
HEALTH SCIENCE
NURSING

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