Mr Howe Case Study Mr Howe, a 68 year old man, was admitted to the general medicine unit this morning suffering from infectious exacerbation of chronic obstructive pulmonary disease ( COPD). Nurses caring for Mr Howe escalated his treatment by calling a medical emergency team (MET) which was activated in response to low oxygen saturation, despite changing his oxygen delivery system to nasal cannulae (4 L/min) to the Hudson face mask (8 L/min). The nurses also say that his respiratory rate has progressively increased over the last 2 hours. Mr. Howe also reports increased shortness of breath and right-sided chest pain that increases on inspiration. He can speak in short sentences and is alert, oriented but agitated. You, as a critical care nursing student, participate in this MET call as a nursing member of the rapid response team. Upon arrival you are informed by the nurse caring for Mr. Howe that his vital signs are: heart rate 28 bpm, blood pressure 100/60 mmHg, heart rate 130 bpm, SpO2 88% on oxygen at 8 LPM, temperature 38 CQuestion 1. Mr. Howe is hypoxemic. Explain the pathophysiology and relationships between V/Q mismatch, hypoventilation, infectious COPD, and initial clinical conditions and how these lead to hypoxemia. (14 points) Chronic obstructive pulmonary disease (COPD) is a general term used to describe the progressive deterioration of airflow with irreversible deterioration of respiratory function (Lee-Chiong & Brown, 2009). An exacerbation is a change in the usual course, characterized by dyspnea and increased work of breathing triggered by a virus, a bacterium or an air pollutant (Sapey & Stockley, 2006; Tsoumakidou & Siafakas, 2006). The acute infectious state in Mr. Howe provokes an immune response resulting in... half of the article ...... hypoxemia and even more hypercapnic drive (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008) . Acid-base is the most protected homeostatic mechanism in a patient's body and is altered by many different factors, such as sepsis, with respiratory rate often compensating for a change in blood pH. Respiratory rate may also show the effect of some mediations such as the decrease in respiratory rate and level of consciousness by opiates (Cretikos et al., 2008). In conclusion, although all vital signs are taught, respiratory rate is the least accurate even though it is the first to be taken. change in clinical deterioration. Many studies have been completed to demonstrate the impact of increasing respiratory rate, but this is not reflected in clinical practice. This demonstrates that an accurate respiratory rate could minimize many preventable adverse effects resulting from patient deterioration.