Acute on chronic respiratory failure
Hi everyone,
I'm trying to determine if a documented diagnosis of acute on chronic respiratory failure is clinically supported or do I need to query provider if this is really chronic respiratory failure.
Patient with severe COPD, O2 dependent on 2L NC, recently O2 sat was in mid 80's so home O2 was bumped up to 4-5L. Was brought in for tx of CHF. Provider orders an ABG on 4L showed: pH 73.6, pO2 70.5, pO2 59.5, HCO3 39.0, sat 89%. Provider documents acute on chronic respiratory failure. BIPAP is ordered, repeat ABG results the next morning on BIPAP show pH 7.38, pCO2 67.3, pO2 66.9, HCO3 39.0, sat 94%. Provider orders continuous oximeter to determine if patient qualifies for home BIPAP. RT was unable to obtain SpO2 with continuous oximeter as pt's fingers were arthritic & cold, but was able to with ear probe. After 10 minutes on 2L NC, SpO2 was 81-86% for 8 out of the 10 minutes which qualifies them for home BIPAP.
I'm trying to determine if a documented diagnosis of acute on chronic respiratory failure is clinically supported or do I need to query provider if this is really chronic respiratory failure.
Patient with severe COPD, O2 dependent on 2L NC, recently O2 sat was in mid 80's so home O2 was bumped up to 4-5L. Was brought in for tx of CHF. Provider orders an ABG on 4L showed: pH 73.6, pO2 70.5, pO2 59.5, HCO3 39.0, sat 89%. Provider documents acute on chronic respiratory failure. BIPAP is ordered, repeat ABG results the next morning on BIPAP show pH 7.38, pCO2 67.3, pO2 66.9, HCO3 39.0, sat 94%. Provider orders continuous oximeter to determine if patient qualifies for home BIPAP. RT was unable to obtain SpO2 with continuous oximeter as pt's fingers were arthritic & cold, but was able to with ear probe. After 10 minutes on 2L NC, SpO2 was 81-86% for 8 out of the 10 minutes which qualifies them for home BIPAP.
Comments
Jamie
Jamie Dugan RN, CCDS
Clinical Documentation Improvement Specialist
3563 Philips Highway, Suite #106
Jacksonville, Florida 32207
Office: 904-202-4345