Question

Peter Brown is a 67 year old man with a past medical history of hypertension and COPD. Peter states that he started feeling short of breath yesterday and was short of breath all night last night. He was unable to sleep because of the difficulty breathing, so he sat in his chair all night. About an hour ago, he states having much more difficulty breathing, and feels like he is gasping for air. His chest feels tight like his previous COPD exacerbation, but no chest pain. He said he felt warm but did not take his temperature andhad an increased cough since this event started without production. Shortness of breath became so severe he finally called an ambulance. On the way to the hospital, EMS was able to give one albuterol treatment. In ER vitals were T 37.9 107 30 165/98 02 Sats 88%. CXR was completed, ABG's and IV insitu. In ER patient received Ventolin ji nebs. Atroventi nebs. Prednisone 50mg Po at 0800. Pt sent to the medical floor at 0930 Orders His ABG results are as follows: pH 7.36 PaCo2 51 PaO2 55 HCO3 30 CXR results are moderate hyperinflation, depressed diaphragms and an enlarged right side of the heart. Consolidation to RIL indicating pneumonia CBC - RBC-5.2x10°/1 WBC-12.5x10°/1 Hgb170 g/l Hct- 0.48 Platelets- 340x10°/1 Sputum culture - Gram stain shows neutrophils with gram-positive diplococci (Streptococcus pneumonia) 02 to keep 02 Sats > 88% Vitals q4h and PRN Ventolin i neb QID Atroventi neb QID Ventolin i-ii nebs q2h PRN Prednisone 50mg PO Daily ABG's with SOB and 02 Sats <88% IV NS @ TKVO

1.The medications that peter is taking , are there any contraindications or interactions that might be occuring between some of them? Determine why peter is on each of these meds and identify any concerns you might have with her taking these?

2.In looking peter's lab results please determine whra might be occuring to cause these results.What assessments or interventions are needed when dealing with peter's lab results? Does he have any orders that could be used to assist in improving or monitoring these results? i.e. What does peter have ordered to help with the pneumonia?

3.Looking at peter' s whole picture ,what assessment results would tell you that peter's conditions is improving (be very specific,look at what he came with, his labs).What assessment results would tell you that Peter's condition is getting worse?

Answer 1

1, Prednisone medication is a corticosteroid that improves lung inflammatory condition. that medicine stimulates alpha-2 receptors and beta-adrenergic receptors that are contraindicated for a patient with acute asthma and COPD. The patient is using bronchodilators with prednisone that increases the risk of hypokalemia due to drug interaction. prednisone drug interaction with many drugs like bronchodilators and increase the risk of hypertension effect. Taking prednisone in the morning at a particular time avoids this risk. beta 2 agonists like albuterol reduce airway constriction that can be taken through nebulizer r inhaler to avoid the drug interaction.
2, Patient ABG results shows there is respiratory acidosis (ph- is normal, paco2 is high indicate acidosis)
Patient sputum culture indicates there is streptococcal pneumonia and the patient's hypoxic state indicates that the patient is more prone to the shock.
Bronchodilators help patients to prevent airway constriction and o2 supplements reduce hypoxia.
Assess patient acidosis symptoms and check patient vitals, ABG and physical assessment regularly. check patient breathing pattern, lung sound and skin color for the hypoxic state. and check patient neurologic conditions.
Serum electrolytes find serum potassium level, chloride and calcium level, check patient urine PH. maintain adequate hydration level, clear the airway with suctioning and monitor the ABG regularly. CRP blood test helps GPs determination and pulse oximetry measure o2 in the blood.
3, Patient respiratory acidosis condition makes the blood more acidic that reduces heart muscle function and lung function. patient chest Xray reveals enlarged right side of the heart and right lower lung pneumonia. O2 sat reduced and he is having arrhythmias and tachycardia and hypertension and high cardiac output. the patient is in a chronic hypoxic state and the patient is more prone to septic shock due to streptococcus pneumonia.