Question

1. Paul Elder, a 65 year old man, presents to the emergency room with increased shortness of breath which is worse on exertion. You note his respiratory rate is 34. You notice he is in the tripod position. Also, upon inspection you note that he has a barrel chest and is using accessory muscles to breath. Based on this information: a. What do you suspect this patient is suffering from? b. Based on this suspected finding, what other information would you need to gather from the patient? Include history questions (subjective) and any further assessment data (objective) you would need 2. Ginger Malloy, a 45 year old woman, was involved in a motor vehicle accident. When she enters the emergency room on a stretcher you notice that her chest is not expanding equally. You also notice that the respiratory rate is 30. She is very apprehensive. a. What do you suspect this patient is suffering from? b. Based on this suspected finding, what other assessment data would you expect to find? c. You notice tracheal deviation to the right. What does this mean?

Answer 1

1) The patient admitted in emergency room with increased shortness of breath that worsen on exertion, respiratory rate id 34 breaths per minute, patient maintains tripod position. Inspection reveals barrel chest and using accessory muscles to breathe. From above assessment the patient is suffering from COPD (Chronic obstructive pulmonary disease) a group of progressive lung disease that involves destruction of air sacs. Cigarette smoking,occupational lung disease,underlying lung diseases results in COPD.

Nursing assessment :

History collection includes the following questions: history of tobacco smoking,duration of smoking,number of cigarettes per day,any previous respiratory diseases,occupational exposure to allergens or irritants, medications taken,family history of lung diseases, aggravating and relieving factor for shortness of breath.

Physical assessment : Inspect for symmetrical chest movement,barrel chest,presence of wheeze a high pitched musical sound during breathing, usage of accessory muscles,pursed lip breathing,cyanosis and any generalized body edema,

2) Patient came to ER with alleged history of RTA and there is asymmetrical movement of chest and RR is 30. The patient is suffering from traumatic pneumothorax secondary to lung injury as a result of motor vehicle accident.

Air entry in the pleural space is trapped during inspiratory phase results in increased intra pleural pressure. Tracheal deviation occurs when trachea is pushed to either side as a result of excess pressure over the thoracic cavity. The common symptoms are breathing difficulty,chest pain,intense cough.