Acute Respiratory Failure Caused By Aspiration Pneumonia

A 68 year old male presented to the emergency department at 0800 hours via ambulance after experiencing chest discomfort and intermittent palpitations since 0500 hours. Prior to presentation, the patient stated he

Susan is a 78 year old widowed lady who was admitted to a medical ward following an episode of coffee brown vomiting and breathlessness. Susan has a past medical history of chronic

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

PHYSICAL EXAM: Temperature 98.6, Blood pressure 140/90. Pulse 110. Respirations 26. Her lungs are clear, showing mild signs of distress. Heart sounds are normal, irregular rhythm and bradycardia noted. No edema noted in extremities. Patient skin is cool to touch, slightly clammy. EEG shows prolonged QRS wave, with ischemic ST changes and PVCs. Chest radiograph clear.

States that it started 3 days back and uses oxygen at home. States that he is a former smoker and laying on his back feels better. Also says he has a list of medication, more than 20. Pt has a history of COPD, CHF, DM,morbid obesity, HTN, HLM, hypothyroid, and sleep apnea. Has no accessory muscle use. CC is shortness of breath. Assessment is that there is no deformities or trauma of the head or neck area. Chest shows no signs of deformities or trauma. The abdominal area is tender and warm to the touch. Pelvis and back was not assessed. The upper and lower extremities show signs of low circulation and swelling. PMS=4. I helped with placing the BP cuff on the left arm and attaching it to the monitor. First vitals were recorded. O2 was given by the Nurse and then Albuterol by nebulizer. After 30 minutes, I assisted the Nurse and other hospital workers in moving the PT to a bigger bed. Second set of vitals were recorded. After becoming stable the Pt was moved up to the floor.

Lungs: Diminished breath sounds in all lung fields. Resonant to percussion. No wheezes, rales, or rhonchi. Symmetric chest expansion. Breathing nonlabored.

Throughout my clinical rotation, the only concern for this patient was pain management and discomfort from the chest tube site. The patient was given Ketorolac for a pain of 4/10 using the numeric pain sale. The patient was also at risk for pneumonia and pressure ulcers from immobility and not coughing/deep breathing. Nursing interventions were getting the patient up to the chair and using the incentive spirometer ten-times per hour. Another concern was SOB and fatigue with activities.

On the early morning of August 17, 2002, James C., a patient in one of the wards under the supervision of Ellen Hughes Finnerty, RN, went into respiratory depression. Between 3:00 and 4:00 a.m., Ann Mugi, the patient’s primary nurse, sought the assistance of a respiratory therapist, Hiran Obeyesekere, to help her care for the patient. As Obeyesekere suctioned the patient airway, Mugi called the service of the patient’s primary care physician, Dr. Jackson, to report the changes in the patient’s respiratory status, e.g., respiratory rate of 40 breaths per minute and low urine output.

History: Martha Wilmington, a 74-year-old woman with a history of rheumatic fever while in her twenties, presented to her physician with complaints of increasing shortness of breath ("dyspnea") upon exertion. She also noted that the typical swelling she's had in her ankles for years has started to get worse over the past two months, making it especially difficult to get her shoes on toward the end of the day. In the past week, she's had a decreased appetite, some nausea and vomiting, and tenderness in the right upper quadrant of the abdomen.

Client is limited in her mobility with exertion she suffers from shortness of breath, dizziness and tiredness. At times her breathing becomes a great effort and soon she will be using oxygen continuously. Client is seen by Bellevue Hospital Center located at Frist Avenue & 27th Street, New York, New York tel# 212-562-4141.

38. American Journal of Respiratory care and critical care Medicine, Volume 175, issue 7, pages 698 – 704

The incident happened on Nov 21st, 2017. The patient has sleep apnea and a health history of chronic bronchitis (no episode in recent 2 years). Her respiration rate was 16 and all lung fields were clear upon auscultation. After I took the patient’s vital signs, I noticed that her oxygen saturation was low (83%). Then, I notified the nurse and asked the patient to do take some deep breath. After that, we put her on 2L of oxygen and her oxygen saturation went up to above 90s. However, the patient had a bladder control problem (was incontinent), so I took the oxygen off because she went to the toilet for around 4-5 times in an hour. However, I forgot to monitor her O2 saturation right away. Instead, I checked her oxygen saturation after she finished her dinner, and it dropped to 86%. The instructor showed me how deep breathing exercise can help the patient increase her oxygen level quickly. I notified the nurse and we put the patient on 2L of oxygen, but again I forgot to check her oxygen saturation right away. Instead, I checked her oxygen around 7pm later.

Aspiration pneumonia results from an abnormal entry of fluid or particulate secretions into the lower airways. Factors that may cause aspiration pneumonia are those that compromise our body’s defense mechanism to protect the lower airways. These mechanisms include: epiglottis, cough reflex, and the ability to clear our airways. When our swallowing mechanism become weak with age and or inactivity, especially something like stroke, it puts the body at risk for aspirating bacteria that is typically found in the oral and nasaopharynx. The organisms responsible for pneumonia include: “Streptococcus pneumonia, Haemophilus influenza, Staphylococcus aureus, and gram-negative bacteria” (Swaminathan, 2017). In addition, the occurrence of aspiration pneumonia

Ms. G. was admitted to the hospital for scheduled gastric bypass surgery on 9/14/2010. On 9/15/2010 she aspirated dye during a post-operative test. This began the process of aspiration caused pneumonia for Ms. G. Signs and symptoms of respiratory problems began immediately. However she was released on 9/17/2010. She was admitted for pneumonia on 9/18/2010. Ms. G. stated that “the two radiologists began arguing because the first radiologist was forcing me to drink faster than I could tolerate due to my gastric bypass surgery.” She began choking on the dye and aspirated it into her lungs.

Recently I took care of a patient N.S, 77-year-old male diagnosed with pneumonia by an ER doctor. He transferred to hospital acute care medical unit after a few hours of stay in the ER. SBAR from ER gave information on N.S: No known allergies, full code, NIBP 158/83, Heart Rate (HR) 92 beats per minute, Temperature 36.8, respiration rate 18 breaths per minute, regular with decreased breath sounds to the bilateral bases lower lungs, SPO2 98% 0n 2LNP. N.S has an occasional productive cough and shortness of breath on exertion (SOBOE). N.S has a history of MI x 1 (dates not mentioned) and coronary artery bypass graft (2009), HTN, and hyperlipidemia, asthma (for unknown years).