Question

Concept: Assessment

Concept Based Case Based Experience

Must be your own work in your own words

	Assessment #2 CB: Respiratory Scenario
Purpose	To provide students with the opportunity to assess a patient who is experiencing postoperative respiratory distress.
Overview	Marc Kozlov is a 21-year-old white male. He lives a very active life and is involved in many sports. Marc is status postoperative after undergoing surgical repair of an ankle fracture, which he sustained yesterday afternoon while rock climbing. Overnight, he developed early signs of atelectasis with crackles in his lungs.
Skill Review: Please review the following skills.	Chest/Thoracic Assessment Peripheral Vascular Assessment Heart Assessment
Pharmacology Review: Please review the following medications.	D5 ½NS Morphine Acetaminophen
Questions 1: Define atelectasis, and identify potential causes.
Question 2: Identify the various types of adventitious sounds that might be assessed while conducting a lung assessment. Describe the characteristics of each sound.
Question 3: What are the contributing factors that predispose Marc Kozlov to the development of atelectasis?
	Growth & Development
What stages of development is Marc and how will that influence your management of the scenario.

Answer 1

Ans 1. Define atelectasis & identify potential causes. It is the collapse or closure of the lung resulting in reduced or absent gas exchange. It may affect past or all of one lung. Atelactasis is the collapse of alveoli or lung tissue. → potential causes :o 1) Obstruction of an airway: - Airway foreign body - Extrinsic compression on an airway. Enlarged lymph nodes that compress the airway or alveoli Tumor in the chest Cardiomegaly Orendarged pulmonary vessel that compress adjacent airways Altered breathing pattern Retained secrctions, abnormal airway secretions in cystic fibrosis. 2) Diminished distention of alveoli - Anesthesia Isedation 1 abdominal pressure Vlung volume due to misculoskeletal disorders. - Surgery , bronchospasm , pleural effusion préunio thorax

Sounds & characteristia Sounds are abnormal breath is a patients dne 2. Types of adventitious sounds & ch eddventious sounds are a sound that are heard over a pat lung Kairways. o crackle Bound. It is produced by passing over retained airway's secretion or o the the sudden opening of collapsed airways. These are of two types coarse coackles: louders low pitched Tung sounds. Coaxse inspiratory & expiratory Crackles indicate excessive airway secretion fine crackles : Soft, very short , high pitched lung sound , heard in pulmonary fibrosis & acute pulmonary edema. 18 Diminished breath soundi ed solt, decreased or distant vesicular lung sounds heard in patient with pooy” respiratory effort emphysema. iii) Pleural friction rub: Creaking egraling sounds made when inflamed pleural surfaces move during respiration : ya wheezes are continuous , high pitched , hissing sounds heard in airway Obstruction , foreign boelies.

musical D Rhonchi : low pitched , continrw us ,musical sounds similar to wheezes, usually heard in obstruction of a larger airway by secretion - vi) stridor : it is inspiratory musical wheeze beard loudest over the trachea during inspiration. Jus 3) contributing factors - Anesthesia in Surgery Trauma (fracturejo - immobilisation, decreased use of the diaphragm Collapse of Pung often a postoperative complication Ans4 Marc is 24 year old male. He is in his early adulthood. In this stage the developmental task are like choosing career & establishment of career choosing a life partner, taking care of a home. By motivatina , establishing clear boundaries, use of assertive & effective communication, showing empathy & helping in solving problems can influence disease management