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Tony is a 56-year-old, Hispanic male that presented to the Emergency Room with complaints of shortness of breath, which he has been experiencing for the past two days. He states “I haven’t felt good for about a week, but couldn’t afford to miss work.” He complains of a cough, fever, and feeling exhausted. Past medical history includes asthma, chronic obstructive pulmonary disease and diabetes. Upon physical examination, you notice that Tony is struggling to breathe, his respiratory rate is 36 breaths per minute and labored, heart rate 115 beats per minute, blood pressure 90/40 mm Hg, and his pulse oximetry is 84% on room air. You notify the MD. He orders oxygen at 2 L via NC and an arterial blood gas.
Tony’s ABG results:
pH 7.28
PaCO2 – 55 mm Hg
PaO2 – 70 mm Hg
HCO3 – 30 mEq/L
1)Determine Tony’s acid-base imbalance and Describe possible causes of the imbalance
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- A 23-year-old woman with a history of asthma was brought to the emergency department by ambulance. She was extremely short of breath. Her level of consciousness was diminished greatly, and she was only able to respond to questions with nods or one-word responses. She had a weak cough, with nearly inaudible breath sounds. After drawing blood gases, she was placed on supplemental oxygen. Vital signs: heart rate, 160 bpm; blood pressure, 120/84 mm Hg; temperature, 37°C; and respiratory rate, 36/min. Her initial blood gas and total hemoglobin results were as follows: pH = 7.330 pCO2 = 25 mm Hg pO2 = 58 mm Hg HCO3 = 13 mmol/L tHb = 12.4 g/L QUESTIONS: 1. What is the patient’s acid-base and oxygenation status? 2. What is the cause of the acid-base disturbance? 3. Does asthma typically present in this matter? 4. What clinical findings are most indicative of this patient’s impending failure?Joe Ritter, a 74-year-old retired bricklayer, has a 40-pack-year tobacco history and a history of chronic obstructive pulmonary disease (COPD). Today, he presents to the emergency department with reports of shortness of breath and difficulty breathing. He in respiratory distress with retracting respirations of 26 breaths/min, BP is 154/76 mm Hg, pulse is 120 beats/min, and temperature is 37°C. His skin color is pale gray, his chest is barrel-shaped, and he uses accessory muscles to breathe; he appears anxious and is sitting in a tripod position. His nail beds are bluish in color; his oxygen saturation by pulse oximetry is 72%. Chest auscultation reveals wheezes and decreased-to-absent breath sounds in bilateral bases. Hyperresonance is noted upon chest wall percussion. Chest x-ray showed atelectasis bilaterally in the bases. Mr. Ritter coughs with minimal amounts of clear sputum. (Learning Objectives 5 and 8) Nursing Diagnosis 1: Goals: (Expected Outcome, long and short term)…Joe Ritter, a 74-year-old retired bricklayer, has a 40-pack-year tobacco history and a history of chronic obstructive pulmonary disease (COPD). Today, he presents to the emergency department with reports of shortness of breath and difficulty breathing. He in respiratory distress with retracting respirations of 26 breaths/min, BP is 154/76 mm Hg, pulse is 120 beats/min, and temperature is 37°C. His skin color is pale gray, his chest is barrel-shaped, and he uses accessory muscles to breathe; he appears anxious and is sitting in a tripod position. His nail beds are bluish in color; his oxygen saturation by pulse oximetry is 72%. Chest auscultation reveals wheezes and decreased-to-absent breath sounds in bilateral bases. Hyperresonance is noted upon chest wall percussion. Chest x-ray showed atelectasis bilaterally in the bases. Mr. Ritter coughs with minimal amounts of clear sputum. (Learning Objectives 5 and 8) What is the pathophysiology related to this disease process in the aging…
- Kenneth Bronson is a 27-year-old male who was just admitted to the Medical Unit from the Emergency Department. He presented to the Emergency Department two hours ago with chest tightness, difficulty breathing, a productive cough for a week, and fever. Chest x-ray revealed right lower lobe pneumonia. IV was started of normal saline at 75 mL per hour. He is receiving oxygen at 2 L/min per nasal cannula. SpO2on room air was 90%, which increased to 95% with supplemental oxygen. He had a temp of 102.6°F and was given acetaminophen 1,000 mg in the Emergency Department. The pharmacy just delivered the antibiotics to be given. Would you do anything different for a patient experiencing respiratory distress? Would you do anything differently if Kenneth had told you he had been using e-cigarettes? How would the RN collaborate with the hospital pharmacist to prevent anaphylaxis? What evidence-based interventions would you perform on Kenneth?Exaplain the histologic changes that occur inside the airways during an Asthma attack.Dorcas, a student of KAAF University college had an asthmatic attack during lectures and was rushed to KAAF University hospital and was admitted to the hospital by the doctors. Upon arrival at your ward, she was in a wheel chair accompanied by a nurse and her friend Sandra. What category of patient is she?
- Alan has been smoking for the past 20 years and has been experiencing some shortness of breath and a cough. His physician, Dr. Anthony, sees him. The physician orders a lung capacity test and a chest X-ray. Is there any surgical procedure for emphysema?LF, a 34 year old white male, presented to the emergency room complaining of acute and severe shortnessof breath and intense chest tightness. LF’s speech was choppy and breathing was very rapid and erratic,punctuated by noticeable wheezing. LF’s medical records included the results of pulmonary functiontesting he had undergone six months beforeHis medical records also indicated prior admission for respiratory symptoms and a history of poorly-controlled asthma.LF received high-dose bronchodilator medication through use of a valved holding chamber. This wasfollowed by intravenous glucocorticoids and nebulized bronchodilators every two hours for a twelve-hourperiod, followed by nebulized bronchodilators every four hours for a forty-eight hour period.After discharge from the hospital, LF was provided a take-home flow meter to monitor his lung function.Table 4 shows LF’s PEFR results during a 30-day period.Table 4. Peak flow monitoring from day 1-30 post-discharge. All PEFR values are given…JR is a 56 yo man with h/o asthma, HTN and hyperlipidemia. He presents to the ER today with h/o shortness of breath for 45 minutes at rest. He reports that he was feeling well and in his usual state of health until about an hour ago, when he smelled something burning. 20 minutes later, he began to feel short of breath and was wheezing. He tried using his albuterol inhaler without success, so he proceeded to the ER. Upon arrival, he was tachycardic, tachypneic, wheezing, using accessory muscles and hypertensive. His last admission for an asthma attack was 2 months ago. He denies a recent cold or URI and says the albuterol usually helps him when he feels an attack coming on and tends to use it on a daily basis. He generally has wheezing and shortness of breath on a daily basis. JR reports poor sleep due to waking about 2 times a week for shortness of breath. He has 2 cats, which sleep next to him on his pillow and he lives in an apartment complex. JR does not smoke, but his neighbor…
- . A client complains of severe pain during inspiration. His x-ray shows inflammation of the left lung pleura. What is the cause of the inflammation in the lung?pediatric, please fill the report For any case that has been studied of any child with bronchitis, you can write a case of just as an example. The important thing is to fill the report with what makes sense.A patient has been diagnosed with haemoglobinopathy, discuss the two most common haemoglobinopathies this patient could have?
