Pulmonary Problem Solving II

Scenario Two

Patient Chart
BV is a 19-year-old male who presents to the emergency department complaining of shortness of breath and fever. He has a respiratory rate of 34, temperature of 101.4oF. His SpO2 on room air is 88%. He has a frequent cough productive of small amounts of very thick, dark yellow mucus. He appears to be undersized for his age. Upon questioning, he reveals that he has a history of cystic fibrosis.

Use the Auscultation and Blood Pressure tabs to capture heart rate, blood pressure and lung sounds.

Portable chest radiograph reveals infiltrates throughout both lung fields. Arterial blood gases drawn while the patient is receiving oxygen via nasal cannula running at 3 Lpm reveals:

pH 7.36
PaCO2 56 mmHg
HCO3 31 mEq
PaO2 64 mmHg
SaO2 92%
Hgb 15.4 gms

Heart Rate:
Blood Pressure: /


Which of the following is this patient’s most likely diagnosis at this time?