NURS 6550 Respiratory System Week 5 Discussion

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For this discussion you will select one of the following case studies. You will then discuss pertinent differential diagnoses and identify a leading diagnosis. Consider treatment strategies and develop a management plan for the patient. Please state appropriate dosages for any recommended pharmacologic interventions and/or provide specific orders for nonpharmacologic treatments. Discuss age specific strategies for educating patients and families on the respiratory disorder and the management plan.

Case #1

A 44 year old man seeks treatment due to sudden onset of shaking chills, fever, and productive cough. He states he has had some nasal congestion and achiness for about 1 week but was fine before that. The fever and chills started last night. He has had a couple of coughing fits and produced some yellow colored sputum. He has smoked 1 pack per day for 15 years. He normally does not take any medications. The patient is allergic to PCN and Keflex.

Physical Exam: BP 132/77 HR 88 RR 20 T 102 oxygen saturation 100%

S1S2 regular rate and rhythm. No murmur, gallops, or thrills

Lungs are clear except for bronchial breath sounds and end inspiratory crackles in the R lower lobe.

Case #2

A 26 year old with history of asthma is brought to the ED by ambulance with complaints of severe shortness of breath that began about 30 minutes ago. The patient is unable to talk due to her SOB. EMS states they were called to her home by her mother. An albuterol inhaler was present and she has tried to use it twice.

PE BP 140/78 HR 92 RR 34 T 98.2

Extremely short of breath and anxious

S1S2 with normal rate and rhythm

Expiratory wheezes are heard throughout the lung fields.

Case #3

A 38 year old woman is admitted for repair of a fracture left wrist. Patient states that she has a 3 month history of non-productive cough that has continued to get worse. The cough is nonproductive and worse at night or after exercise. She has gotten progressively more short of breath during her exercise routine and has had to stop exercising after 20 minutes due to coughing fits. She has never smoked and denies any nasal congestion, headache, fever, or weight loss.

PE BP 134/87 HR 82 RR 22 T 98.2

S1S2 with normal rate and rhythm

Lungs are clear with expiratory wheezes heard in the bases

Chest x-ray is normal.

Case #4

A 58 year old man arrives in urgent care center with complaints of shortness of breath. He states that he has been short of breath in the past but only on exertion. He has become more short of breath over the past few months with in occurring at rest now. Over the past several nights, he has slept in the recliner. He reports a productive cough and usually the sputum is white in color. He has smoked 2 packs per day for 15 years. He does not have a primary physician or health insurance. He came in today because he couldn’t catch his breath this morning and got scared.

PE – BP 135/85 HR 96 RR 28 T 97.6

He appears uncomfortable with labored respirations and cyanotic lips.

No lymphadenopathy, carotid bruits, or JVD. He is using accessory muscles to breath.

Wheezes and rhonci notes throughout all lung lobes.

S1S2 regular rate and rhythm.

No cyanosis, edema, or clubbing of the extremities.

Case #5

A 21 year old male who comes to the ER complaining of left sided rib pain with increasing shortness of breath over the last 24 hours. He has a non productive cough and T is 100.8 orally. He was recently released from the hospital after a motorcycle accident in which he sustained a clavicle fracture, and 2 left sided rib fractures, and a cerebral contusion.

On exam he appears cyanotic, has respiratory distress and inspiratory crackles over the left base. Current weight is 205 lbs. Height is 6’0”

VS – BP 106/88 P 98 RR 38 T 102

Labs results:

  • FIO2 0.21      Hb 14
  • pH 7.56      Na 140
  • pCO2 25      K 4.2
  • PO2 40      Cl 106
  • HCO3 20      CO2 20
  • SaO2 78%
  • Hg 12.6
  • WBC 15,000

Case #6

A 65-year-old female suddenly becomes hypotensive one day following surgery for a fractured femur. Her ABG before surgery on room air showed a PaO2 of 84 and PaCo2 of 39. Current ABG is

  • FIO2 0.21      Hb 11.5
  • pH 7.47
  • pCO2 32
  • pO2 57
  • HCO3 23
  • SaO2 83%

Case #7

Mr. B is a 65-year-old male brought to the ER with moderate respiratory distress. He smokes 2 packs of cigarettes daily X 45 years. He has severe COPD. Stated he was doing pretty good until two days ago when he developed a cough and dyspnea. ABGs results:

  • FIO2 0.21      Hb 17
  • pH 7.36      Na 140
  • pCO2 60      K 4.2
  • pO2 35      Cl 91
  • HCO3 33      CO2 35
  • SaO2 51%

Case #8 (Continuation of #7)

Mr. B does well on your regimen, but six hours later he is much less alert, falls asleep easily and responds only when vigorously stimulated. You repeat his ABGs:

  • pH 7.10
  • pCO2 80
  • pO2 40
  • HCO3 24
  • SaO2 64%

To prepare:

  • Select and review 1 of the 8 case studies provided. Analyze the patient information.
  • Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
  • Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.
  • Consider strategies for educating patients and families on the treatment and management of the respiratory disorder.

Post on or before Day 3 the case you selected along with a discussion of the pertinent differential diagnoses and a leading diagnosis. Present treatment strategies and a management plan for the patient. Please state appropriate dosages for any recommended pharmacologic interventions and/or provide specific orders for nonpharmacologic treatments. Finally, discuss age specific strategies for educating patients and families on the respiratory disorder and the management plan.

Read a selection of your colleagues’ responses.

Respond on or before Day 6 to at least two of your colleagues on two different days who selected a different case study than you. Share additional insights or alternative perspectives.

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