Question

1. Case Study #1a: Respiratory System

Mrs. Breathless is a 43-year-old female, just getting off the late shift. She reports to the ER in the early morning with shortness of breath. She has cyanosis of the lips. She has had a productive cough for 2 weeks. Her temperature is 102.2, blood pressure 110/76, heart rate 108, respiration 32, rapid and shallow. Breath sounds are diminished in both bases, with coarse rhonchi in the upper lobes. Chest X-ray indicates bilateral pneumonia.

ABG (Arterial Blood Gases) Lab results are:   

pH= 7.44

PaCO2= 28

HCO3= 24

PaO2= 54

Note: rhonchi are continuous low pitched rattling lung sounds that often resemble snoring or wheezes.

Problems:

PaCO2 is low.

pH is on the high side of normal, therefore compensated respiratory alkalosis.

Also, PaO2 is low, probably due to mucous displacing air in the alveoli affected by the pneumonia.

Discussion Questions Case Study #1a:

Explain what ARDS is.

Explain what is significant with her lab results using the ABG normal values

Explain why the solution or treatment is appropriate.

2. Asthma Case Study# 1b:

Aaron is a 10-year-old boy (32 kg) presenting to the emergency department with an exacerbation of his asthma. His mother reports he has had an upper respiratory tract infection (URI) for the last two days, and has been using his albuterol inhaler more frequently. Today, he has received treatments every 3 hours, but still complains of shortness of breath and has frequent coughing. His controller medication is Flovent® 110 mcg 1 puff BID. A call to the pharmacy verifies the drug has been refilled at appropriate intervals.

Research the Disorder of Asthma and Discuss the following regarding Asthma:

Causes or triggers

Symptoms

Management

Answer 1

1.a) ARDS is a group of disorders that has diverse causes but similary pathophysiology, symptoms and treatment. It is progressive , refractory severe form of respiratory failure in which a person is in respiratory acidosis .

b. Significant with ABG report :-

PaCO2 is low.

pH is on the high side of normal, therefore compensated respiratory alkalosis.

Also, PaO2 is low, probably due to mucous displacing air in the alveoli affected by the pneumonia.

2. a) Etiology of asthma :-

Asthma is classified into different types based on how the attacks are triggered; however, the effect on oxygenation is similar for all types of asthma. Inflammation of the mucous membranes lining the airways is a key event in triggering an asthma attack. Inflammation occurs in response to the presence of specific allergens; general irritants such as cold air, dry air, or fine airborne particles; microorganisms; and aspirin and other NSAIDs. Hyperresponsiveness can occur with exercise, with an upper respiratory illness, and for unknown reasons. (Ignatavicius 601)

#. Triggers of asthma can be :-

Household dust

Tobacco smoke

Pollen & other allergins

Exercise

Cold/dry air

Animal dander

URIs

#. Early S&S of asthma :-

Chest tightness*

Feeling of inability to exhale*

Dyspnea*

Tachypnea/Tachycardia

Retractions/Accessory muscle used

Other symptoms of asthma

Increased mucus production>productive cough

Bronchiole hypersensitivity > bronchospasm

Airway Inflammation

Expiratory wheezing

Stridor (late)

Problems sleeping

Low tolerance for exercise

Inspiratory wheezing (late)

Hypoxia (late)

Edema usually occurs

6-24h after exposure to trigge

#. Treatment :-

- Mild Asthma :

S&S no more than twice/week

Lasting hours-days

Normal peak expiratory flow between attacks

No daily medication.

- Mild Persistent :

S&S More than twice/week, but less than once/day

Low dose inhaled corticosteroids (long-term)

#. Moderate persistent :

Daily S&S

Daily Bronchodilator use (short-term) + inhaled corticosteroids + beta agonist