...The goal of supplemental oxygen should be a SpO2 of 88 to 92 percent or PaO2 of 60 to 70 mmHg, using titrated oxygen. (Ntoumenopoulos, 2011). Venturi masks are recommended for more precise oxygen delivery and control of FiO2. Nasal cannula may be used later in the treatment to improve patient comfort and convenience (Stoller, 2015). Arterial blood gases should be checked 30 to 60 minutes after starting oxygen therapy to ensure appropriate oxygenation without increased hypercapnia or acidosis (GOLD, 2014). Ventilatory support may be necessary during an exacerbation and can be provided by non-invasive or invasive ventilation. Bauman and Hyzy (2014) explain that non-invasive positive pressure ventilation (NPPV) is the preferred method of support for COPD exacerbation patient and has shown success in improving respiratory acidosis and decreasing respiratory rate and work of breathing. Additionally, NPPV reduces the risk of ventilator-associated pneumonia, hospital length of stay, mortality, and intubation rates. According to Allen (2014), invasive ventilation is normally avoided in the COPD population, but in situations such as respiratory distress and failure of oxygenation and ventilation it may be necessary. The decision of using invasive ventilation depends on clinical signs and symptoms, the patient’s preference for life support, and the availability of intensive care facilities (GOLD,...
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...induced asthma, albuterol, teenage, school setting, and physical education Assignment Questions Guidelines What two guidelines were used? (AHRQ, n.d.) “Pathogenesis, prevalence, diagnosis, and management of exercise-induced bronchoconstriction: a practice parameter.” (John M. Weiler, September 26, 2010) “Evidence-based care guideline for management of acute exacerbation of asthma in children aged 0 to 18 years.” (Acute Asthma Guideline, Cincinnati Children's Hospital...
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...Health Assessment Case Study Introduction The focus of this case study is to examine further focused assessments that should be undertaken after Mr S's initial presentation of acute exacerbation of asthma. Reasoning for recommended focused assessments will be discussed with consideration of Mr S's presentation of symptoms, history, pathophysiology and risk factors for asthma exacerbation. Research on current asthma assessment protocols will guide recommendations, and assessment parameters will be described. Follow up care and self-management options for Mr S will also be explored. Asthma Asthma is a chronic inflammatory disease of the lungs. It is characterised by airflow obstruction and lung inflammation (Johnson, 2010). Asthma symptoms include wheezing, chest tightness, shortness of breath and cough (Johnson, 2010). Potential triggers for asthma include allergens, viral respiratory infections, irritants, stimuli such as cold air or exercise and gastro-oesophageal reflux (Estes et al, 2013). Airway obstruction in asthmatics is variable and reversible. However poorly managed asthma can leave lasting structural changes in the cells and tissues of the lower respiratory tract, resulting in airway remodelling and permanent fibrotic damage (Kaufman, 2011). There is currently no cure for asthma, therefore the disease needs to be managed (NACA, 2014). Pathophysiology and assessment parameters It is important to understand the underlying pathophysiology of Mr Saunders’ presentation...
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... Abstract D.Z.is a 65-year-old man admitted to medical ward with an exacerbation of chronic obstructive pulmonary disease (COPD; emphysema). Past medical history (PMH) indicates hypertension (HTN), well managed with enalapril (Vasotec) past six years, diagnosis (Dx) of pneumonia yearly for the past three years. D.Z. appears cachectic with difficulty breathing at rest. Patient reports productive cough with thick yellow-green sputum. He seems anxious and irritable during subjective data collection. He states, he has been a 2-pack-a-day smoker for 38 years. He complains of (c/o) insomnia and tiredness. His vital signs (VS) are 162/84, 124, 36, 102° F, SaO2 88%. Admitting diagnosis is chronic emphysema with acute exacerbation. Admitting orders includes: diet as tolerated; out of bed with assistance; oxygen (O2) to maintain SaO2 of 90%; maintenance IV of D5W at 50 ml/hr.; intake and output (I&O); arterial blood gases (ABGs) in AM; CBC with differential, basic metabolic panel (BMP), and theophylline (Theo-Dur) level on admission; chest x-ray (CXR) q24h; prednisone 60 mg/day PO; doxycycline 100 mg PO q12h x10 days, azithromycin 500 mg IV piggyback (IVPB) q24h x2 days then 500 mg PO x 7 days; theophylline 300 mg PO bid; heparin 5000 units SC q12h; albuterol 2.5 mg (0.5 ml) in 3 ml normal saline (NS) and ipratropium 500 mg by nebulizer q4-6h; enalapril 10 mg PO q AM. In this case, I will discuss the definition of COPD/emphysema, causes, S/S, risk factors, contributing...
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...Six-Year Old Asthma Case Study Week 2 Jacqueline Norton South University October 4, 2014 Advanced Pathophysiology NSG5003 Faculty: Rhonda Johnston CASE STUDY: A 6-year-old boy is being readied for discharge from the hospital. He was hospitalized with asthma for four days and will be using a nebulizer and metered dose inhaler at home. Develop a discharge plan that focuses on patient education, the use of the metered dose inhaler, and when the patient should use the nebulizer. You must include substantive rational for your answers using the readings and interjecting the pathological process resulting from the asthma and how the interventions stop the pathological process. (Grossman, 2013) defines asthma is a chronic disorder of the airways that causes...
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...Ellen Diane Windham 11/8/15 Case Study: CHF Helen Montgomery * An 83-year-old female presents to ambulance crew after an episode of sudden weakness. A GP is on scene and has assessed the patient, deciding on hospital admission by ambulance as a matter of urgency. History Patient became very weak and was put to bed by NOK. Her breathing became very laboured and the NOK called for the local GP out-of-hours service to attend. The doctor was on scene within 15 minutes, and upon assessing the patient requested an ambulance transfer to the ED. Initial Clinical Findings * Airway – clear & patent * C Spine – not indicated (MOI/NOI: episode of weakness) * Breathing – tachypnoeic * Circulation – Pulse present, irregular, tachycardic; skin colour normal, cap refill normal * Disability – No LOC before ambulance arrival, patient responding to verbal stimuli Clinical Impression * ? Exacerbation of CHF * ? CVA * ? Post-seizure AMPLE History * A – Allergic to penicillin * M – Currently taking Warfarin, Furosemide * P – History of CVA x 1 year, CHF * L – Last oral intake 7pm the evening previous * E – Son stated patient became very weak before going to bed Observations * Pulse rate 110bpm * Pulse rhythm Irregular * ECG rate 116 * ECG rhythm A Fib * Resp rate 24 per...
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...CASE STUDY 29-Emphysema Scenario D.Z., a 65 year old man, is admitted to a medical floor for exacerbation of his chronic obstructive pulmonary disease (COPD; emphysema). He has a past medical history (PHM) of hypertension (HTN), which has been well controlled by enalapril (Vasotec) for the past 6 years, and a diagnosis (Dx) of pneumonia yearly for the past 3 years. He appears as a cachectic man who is experiencing difficulty breathing at rest. He reports cough productive of thick yellow-green sputum. D.Z. seems irritable and anxious when he tells you that he has been a 2-pack-per-day smoker for 38 years. He complains of (C/O) sleeping poorly and lately feels tired most of the time. His vital signs (VS) are 162/84, 124, 36, 102 F, SaO2 88%. His admitting diagnosis is chronic emphysema with an acute exacerbation, etiology to be determined. His admitting orders are as follows: diet as tolerated; out of bed with assistance; oxygen to maintain SaO2 of 90%; maintenance IV of D5W at 50mL/hr; intake and output (I & O); arterial blood gasses (ABGs) in am; CBC with differential, basic metabolic panel (BMP), and theophylline (Theo-Dur) level on admission; chest x-ray (CXR) q 24h; prednisone 60mg/day PO; doxycycline 100 mg PO q 12h x 10 days, PO bid; heparin 5000 units SC q12h; albuterol 2.5 mg (0.5 mL) in 3 mL normal saline (NS) and ipratropium 500 mg by nebulizer q4-6h; enalapril 10 mg PO q am. 1. Explain the pathophysiology of emphysema. 2. Are D.Z.’s VS and SaO2 appropriate...
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...Adults Many individuals suffer from a respiratory condition known as asthma and experience the acute and sometimes chronic effects of this disorder. This disorder often presents itself in an individual exhibiting the hallmark signs and symptoms of breathlessness, wheezing and coughing, due to the airway wall being inflamed and smooth muscle bronchospams. At this time it is imperative to assess the situation and take the appropriate action. Research shows that there is various causes to why inflammation and bronchospasm obstruct the airway, making it difficult to pin point any one cause. This article states that atopy has been identified as a risk factor, as well as exposure to allergens can increase or induce an asthma attack (GINA: the Global Initiative for Asthma, Global strategy for asthma management and prevention). There are many factors that can affect any one person with this condition, such as heredity, obesity, smoke, exercise, upper respiratory tract infections, perfumes and certain occupations can trigger respiratory distress with an asthmatic episode. There are other treatment considerations that evaluate and treating other conditions may help resolve asthma management. The conditions such as gastroesophgeal reflux disease, rhinosinusitis, and nasal polyposis may improve some symptoms for asthmatic individuals if such conditions exist. Most cases of asthma are managed with drug therapy with an inhaler or oral medication. There are various drugs...
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...diagnosis in these patients. However, studies have indicated that many physicians treat bronchitis with antibiotics. These drugs have generally shown to become ineffective in patients with complicated bronchitis. A patient satisfaction with their treatment of bronchitis is related to the quality of the physician-patient interaction rather than to the prescription of an antibiotic. Bronchitis Bronchitis is an inflammation of the membrane that lines the air passages, or, bronchial tubes, of the lungs and results in the narrowing of these air passages. This disorder may be of either an acute or chronic type. Irritation of mucus-producing glands within the membrane results in the production of excess bronchial secretions. The main symptoms of bronchitis are cough and increased expectoration of sputum, with or without associated wheezing and shortness of breath. Men are more of a target to bronchitis then most women, men out numbering them 10 to 1 for reasons that are unclear. Acute bronchitis is a self-limited infection of the lower respiratory tract causing inflammation of the bronchi. Acute bronchitis is an acute illness lasting less than three weeks with coughing as the main symptom, and at least one other lower respiratory tract symptom such as wheezing, sputum production, or chest pain. Most coughing, which is a common symptom of acute bronchitis develops in any attempt to expel the excess mucus from the lungs. Other common symptoms of acute bronchitis can include a:...
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...However, previous studies have shown some association between outdoor air pollution and increasing symptoms, acute exacerbations, hospital admissions, and mortality in patients with pre-existing COPD (Ko & Hui, 2012). A study of hospital admissions related to heart and lung disease observed that there was a 2.5% increase in COPD admissions for a 10 µg/m3 increase in PM10 (Zanobetti, Schwartz, & Dockery, 2000). Another study regarding COPD and hospital admissions found that 10 µg/m3 increase in PM2.5 occurring at lag 0 and 1 day was associated with a risk of approximately 0.9% for COPD hospitalizations (Dominici, et al., 2006). Regarding mortality, a six-city study conducted by Harvard found that adjusted mortality due to cardiopulmonary diseases appeared to increase in areas that had the highest past levels of fine particles and sulphates (Sunyer, 2001). The cities included in the study were Boston, MA, Knoxville, TN, Portage, WI, St. Louis, MO, Steubenville, OH, and Topeka, KS (Sunyer, 2001). Even though there is limited evidence to suggest a causal relationship between urban air pollution and COPD, harmful health effects due to air pollution continues to be an issue (Ko & Hui,...
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...believe that it replaced Chronic Pain Syndrome and/or Chronic Fatigue Syndrome. Did it, we will examine that here. Depending on who you talk to Fibromyalgia exists, Endocrinology says no and Neurology says yes. Who’s right, which is what we will find out? What we do know; “Fibromyalgia is a chronic musculoskeletal syndrome characterized by widespread joint and muscle pain, fatigue, and tender points” (McCance RN & Huether RN, 2010, p. 1606). If that is Fibromyalgia does that not describe Chronic Pain Syndrome? Well yes and no, Chronic Pain Syndrome usually stays, is always with you all the time, whereas Fibromyalgia has exacerbations that come and go. Chronic pain Syndrome can also incorporate two different syndromes such as Fibromyalgia and Chronic Fatigue Syndrome together ("Pain," n.d.). While the exacerbations of Fibromyalgia seem to come and go, long term studies indicate that signs and symptoms stabilize within the...
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...that it replaced Chronic Pain Syndrome and/or Chronic Fatigue Syndrome. Did it, we will examine that here. Depending on who you talk to Fibromyalgia exists, Endocrinology says no and Neurology says yes. Who’s right, which is what we will find out? What we do know; “Fibromyalgia is a chronic musculoskeletal syndrome characterized by widespread joint and muscle pain, fatigue, and tender points” (McCance RN & Huether RN, 2010, p. 1606). If that is Fibromyalgia does that not describe Chronic Pain Syndrome? Well yes and no, Chronic Pain Syndrome usually stays, is always with you all the time, whereas Fibromyalgia has exacerbations that come and go. Chronic pain Syndrome can also incorporate two different syndromes such as Fibromyalgia and Chronic Fatigue Syndrome together ("Pain," n.d.). While the exacerbations of Fibromyalgia seem to come and go, long term studies indicate that signs and symptoms stabilize within the first year and rarely change over time (Wierwille, 2010). Fibromyalgia (FM)...
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...Airway/Breathing (Oxygenation) Pneumonia/Chronic Obstructive Pulmonary Disease Clinical Reasoning Case Study STUDENT Worksheet JoAnn Walker, 84 years old Overview This case study incorporates a common presentation seen by the nurse in clinical practice: community acquired pneumonia with a history of COPD causing an acute exacerbation. Principles of spiritual care are also naturally situated in this scenario to provide rich discussion of “how to” practically incorporate this into the nurse’s practice. Concepts (in order of emphasis) I. Gas Exchange II. Infection III. Acid-Base Balance IV. Thermoregulation V. Clinical Judgment VI. Pain VII. Patient Education VIII. Communication IX. Collaboration I. Data Collection History of Present Problem: Pneumonia-COPD JoAnn Walker is an 84-year-old female who has had a productive cough of green phlegm 4 days ago that continues to persist. She was started 3 days ago on prednisone 60 mg po daily and azithromycin (Zithromax) 250 mg po x5 days by her clinic physician. Though she has had intermittent chills, she first noticed a fever last night of 102.0. She has had more difficulty breathing during the night and has been using her albuterol inhaler every 1-2 hours with no improvement. Therefore she called 9-1-1 and arrives at the emergency department (ED) by emergency medical services (EMS) where you are the nurse who will be responsible for her care. Personal/Social History: JoAnn was widowed...
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...Name: Meredith Hillegass Date: 04/10/16 Instructions: All questions apply to this case study. Your responses should be brief and to the point. When asked to provide several answers, list them in order of priority or significance. Do not assume information that is not provided. Please print or write clearly. If your response is not legible, it will be marked as ? and you will need to rewrite it. Scenario D.Z., a 65 year-old man, is admitted to a medical floor for exacerbation of his chronic obstructive pulmonary disease (COPD, emphysema). He has a past medical history of hypertension, which has been well controlled by Enalapril (Vasotec) for the past 6 years, has had pneumonia yearly for the past 3 years, and has been a 2 pack-a-day smoker for 38 years. He appears as a cachectic man who is experiencing difficulty breathing at rest. He reports cough productive of thick yellow-green sputum. D.Z. seems irritable and anxious; he complains of sleeping poorly and states that lately feels tired most of the time. His vital signs (VS) are 162/84, 124 HR, 36 RR, 102 degrees F, Sao2 88%. His admitting diagnosis is an acute exacerbation of chronic emphysema. Chart View Physician’s OrdersDiet as toleratedOut of bed with assistanceOxygen (O2) to maintain Sao2 of 90%IV of D5W at 50 ml/hrECG monitoringArterial blood gases (ABGs) in AMCBC with differential nowBasic metabolic panel (BMP) nowChest x-ray (CXR) q 24 hrs. Sputum cultureAlbuterol 2.5 mg plus ipratropium 250 mcg nebulizer treatment...
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...to person, but almost always involve joint swelling and pain. Other symptoms include fever, rash, and fatigue as well as issues with any of the following systems; *Musculoskeletal (joint swelling and pain, muscular pain and stiffness) *Integumentary (rash, sensitivity to sunlight) *Neuropsychiatric (psychosis, seizure, headaches) *Pulmonary (pleurisy, pneumonitis, pulmonary hypertension) *Renal (acute or chronic kidney failure, acute nephritic disease) *Cardiac (myocarditis, arrhythmias, pericarditis) *Hematologic (anemia, leukocytopenia, thrombocytopenia) Etiology: The underlying cause of SLE is not fully known. Genetic predisposition is often triggered by environmental factors such as viral or streptococcal infections, extreme physical or emotional stress, and overexposure to ultraviolet light or x-rays. Some drugs are also known to trigger an exacerbation; such as hydralazine, sulfur, penicillin, and other antibiotics. Hyperactivity of the immune system is also attributed to abnormal estrogen metabolism in both men and women. Incidence: The annual incidence of SLE averages 5 cases per 10,000 population. It occurs approximately 4 times more in women than in men. Ethnically, it occurs more frequently in African-Americans, Asians, and Hispanics. Diagnosis: There are believed to be 11 common signs of SLE. In order to be diagnosed with SLE, you must present with at least 4 out of the 11, including 1 clinical and 1 immunologic criterion. These signs are: *Serositis (inflammation...
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