Top 2 nursing priority diagnosis Case Study Assignment:A 21-year-old man with a past medical history ofasthma presented with acute worsening shortness ofbreath overnight with no identifiable trigger. The patienthad experienced this symptom for three weeks althoughless severe initially.He also stated that the symptom was accompanied bycough, chest tightness, and pain across the anterior chestbut could not clearly describe the characteristics of thepain. The difficult breathing was worsened with lying flat.He denied any history of smoking.On initial presentation, his vital signs included atemperature of 36.7°C, a blood pressure of 119/83 mmHg,a heart rate of 105 beats/min, respiratory rate of 18breaths/min, and an oxygen saturation of 97% on room air.The patient was 170.2 cm tall and weighed 57.2 kg andBMI of 19.79 kg/m³.Physical examination revealed a distressed and ill-appearing male. Cardiopulmonary examination wasnotable for tachycardia, tachypnea, and decreased breathsounds in both upper lung fields. Laboratory resultsshowed mild leukocytosis with a white blood cell count of12.9 x 10° cells/L, 72% neutrophils, and 16% lymphocytes.His hemoglobin level was 16.2 g/dl with a hematocrit of48.6% and platelet count of 243 x 10° cells/L. The bloodbiochemical profiles were unremarkable. Chest X-ray(CXR) (Figure 1) showed bilateral large pneumothorax(2cm) with minimal bilateral pleural effusions andsignificantly compressed mediastinum.A diagnosis of Simultaneous Bilateral PrimarySpontaneous Pneumothorax (SBPSP) was made. Chesttubes were placed bilaterally with immediate improvementin breathing and tachycardia. The right- and left-sidedchest tubes drained serosanguinous fluids, 5 ml and 10 ml,respectively.Patient's clinical condition continued to improve and afollow-up CXR immediately following the procedures(Figure 2) showed a decrease of pneumothorax in bothsides. However, during the hospital course, the chesttubes continued to have an air leak and the follow-up CXRcontinued to demonstrate residual pneumothorax withoutfull lungs expansion. Computed tomography (CT) scanwithout contrast of the chest revealed subpleural blebs inboth upper lobes. Due to continuous air leak without fulllung expansion with conservative management, thepatient was referred to thoracic surgery evaluation.

Question

Top 2 nursing priority diagnosis Case Study Assignment:A 21-year-old man with a past medical history ofasthma presented with acute worsening shortness ofbreath overnight with no identifiable trigger. The patienthad experienced this symptom for three weeks althoughless severe initially.He also stated that the symptom was accompanied bycough, chest tightness, and pain across the anterior chestbut could not clearly describe the characteristics of thepain. The difficult breathing was worsened with lying flat.He denied any history of smoking.On initial presentation, his vital signs included atemperature of 36.7°C, a blood pressure of 119/83 mmHg,a heart rate of 105 beats/min, respiratory rate of 18breaths/min, and an oxygen saturation of 97% on room air.The patient was 170.2 cm tall and weighed 57.2 kg andBMI of 19.79 kg/m³.Physical examination revealed a distressed and ill-appearing male. Cardiopulmonary examination wasnotable for tachycardia, tachypnea, and decreased breathsounds in both upper lung fields. Laboratory resultsshowed mild leukocytosis with a white blood cell count of12.9 x 10° cells/L, 72% neutrophils, and 16% lymphocytes.His hemoglobin level was 16.2 g/dl with a hematocrit of48.6% and platelet count of 243 x 10° cells/L. The bloodbiochemical profiles were unremarkable. Chest X-ray(CXR) (Figure 1) showed bilateral large pneumothorax(>2cm) with minimal bilateral pleural effusions andsignificantly compressed mediastinum.A diagnosis of Simultaneous Bilateral PrimarySpontaneous Pneumothorax (SBPSP) was made. Chesttubes were placed bilaterally with immediate improvementin breathing and tachycardia. The right- and left-sidedchest tubes drained serosanguinous fluids, 5 ml and 10 ml,respectively.Patient's clinical condition continued to improve and afollow-up CXR immediately following the procedures(Figure 2) showed a decrease of pneumothorax in bothsides. However, during the hospital course, the chesttubes continued to have an air leak and the follow-up CXRcontinued to demonstrate residual pneumothorax withoutfull lungs expansion. Computed tomography (CT) scanwithout contrast of the chest revealed subpleural blebs inboth upper lobes. Due to continuous air leak without fulllung expansion with conservative management, thepatient was referred to thoracic surgery evaluation.

Accepted Answer

A pneumothorax is a medical disorder characterised by the presence of air or gas in the pleural…