Add to your bookmark Subscribe to Philippine Nurses feed Add to StumbleUpon Add to Digg Add to Yahoo Bookmark on Google Add to furl Add to Reddit Add to Blinklist Add to Meneame Add to Fark Add to Ma.golia

Join our Nursing Review Community! Subscribe below. Its Free!

Join NurseReview.Org Community!

Get Connected With Other Nurses All Over The World! Its Free!! Enter your email to receive the Nursing Board Exam NLE Quick Result!


         Nursing Board Exam Result Subscribers PRC December NLE Quick Results Subscription

NurseReview.Org helps nurses all over the world keep in touch with each other. We provide an interactive environment where nurses can share their experience, ask questions regarding issues, provide assistance, etc.

If you want to be informed through email regarding NLE RESULTS, Nursing News, Retrogression Updates, New Nursing Board Exam Question & Answer, Latest Updates Regarding Nclex, please subscribe to us by filling in your email address above.

NOTE: You email address will be kept private and will not be distributed to spammers.

Saturday, September 1, 2007

Case Presentation (Resp Distress C O P Datypical)

If you're new here, you may want to subscribe to our RSS feed. One advantage of subscribing to RSS feeds is that you don't have to constantly re-visit this site to check for updates within specific sections you might be interested in because your browser or Feed reader will do this for you automatically on a regular basis plus you can even get email notification. Thank you so much. Enjoy!

Resp Distress C O P Datypical Slideshow Transcript

Slide 1: Case Presentation Aaron Sibley PGY 3 Emergency Medicine

Slide 2: Objectives: • Learn two “take-home” messages. • Help us all look as smart as Rob2 . • Have fun with an interesting case.

Slide 3: “Take-home” Messages: • “Not all that wheezes is asthma” holds for young to middle aged adults too. • COPD can occur in young to middle aged adults. • Bonus: Recognize potential cognitive errors early and avoid.

Slide 4: Case: • The setting: RAH (newer and better smelling ‘B’ side), Friday night, working with “The Sos”. • From the desk: a forty something, tall, thin Black male, tripod in bed, diaphoretic, rapid laboured breathing-nurse at side. • R1: a) Sick or not sick? b) Initial actions? • Answers: a) Sick. b) ABCs/IV O2 monitor.

Slide 5: Case con’t 2: • As you arrive at the bedside, the nurse says that the patient has a history of asthma, that he drove himself to the ED, and that his sats were 70% at triage. • You ask the patient “Do you have asthma, does this feel like your asthma, what brought it on?”. • The patient states that he has had asthma for 20 years, this is the worst time, and that he got a cold from his 2 daughters 3 days ago and has been getting wheezier and more SOB since.

Slide 6: Case con’t 3: • A: talking in rapid sentences, no stridor. • B: RR 23, sats 98% 10L nonrebreather, breath sounds- increased exp phase (R1 what is normal ratio of insp to exp?) and wheezes throughout, + accessory muscle use, trachea midline, no sub cut emphysema. • C: P 70, BP 138/93, PPP. • D: GCS 15, pupils PERL x2. • E: Temp 36.4 Celsius.

Slide 7: Case con’t 4: • The nurse is at the bedside waiting for direction, R2: Do you take a more compete Hx first then decide on tx/investigations, or do you make decisions now with little info? • Answer: Get things started early with sick patients, don’t worry about over investigating, tx takes time to initiate and you can cancel when more info available.

Slide 8: Treatment/Investigations: • R3: What tx, what tests/investigations? • Answer: Tx: 3 back-to-back masks (Ventolin 5mg/Atrovent 500ug), IV steroids (125mg Methylprednisilone), MgSO4 (2g over 20 mins) Inv/tests: CBC,Lytes, BUN/Cr, CXR (portable), EKG, ABG, peak flow.

Slide 9: History: • Pt describes 20 year hx of asthma, dx’d by family doc. • Last 3 months getting worse, very SOB walking up 1 flight stairs, emptying ventolin puffer q 1wk. • Caught URI from daughters 3 days ago, since getting +++ SOB, 50 puffs ventolin/day- put off coming in until couldn’t breathe.

Slide 10: History: • Questions? • No fever, + dry cough, very wheezy last 3 days. • No CP/HTN/heart troubles, mild HA, no PE risk factors. • Meds: ventolin prn, Allergies: none (no environmental). • PMed Hx: Cocaine use 10 years ago, 35 pk year hx, no ICU/intubations, no ED visits. • Vocation: DJ, singer. • Fam Hx: father died from emphysema in 40s.

Slide 11: Results: labs/investigations: • Please describe this CXR, what potential complication if Asthma are we worried about? • Answer: Large volumes, flat diaphragms, no focal pathology. Pneumothorax. • Please explain this ABG? The patient did not respond well to initial tx, what treatment might this prompt you to start/think about? • Answer: ?Acute on chronic resp acidosis. Bipap (pt tolerated full face well and started to feel better in mins).

Slide 12: CXR: Back

Slide 13: ABG: • 7.22/79/88/30.9 • Acidosis, respiratory (acute roughly 10/1 compensation. Chronic 10/3.5) • Expected comp is increase in bicarb 3.9 if acute 10.5 if chronic Back

Slide 14: Summary of Pt: • 44 year old male, 20 yr hx of asthma,35 pk year smoker, increased SOB in exertion last month, 3 day hx URTI and severe SOB, on exam hypoxic but normal LOC, CXR shows hyperinflation, Blood gas resp acidosis (acute on chronic), minimal response to bronchodilators/Mg/steroids, significant improvement with Bipap. • R4: Is this asthma? Why or why not?

Slide 15: Why not Asthma?: • 1) Hypoxia • 2) CO2 level • 3) Heavy smoker

Slide 16: Asthma Differential Diagnosis: • R2: What is the Dif Dx of Acute Asthma exacerbation? • COPD • Anaphylaxis • Foreign Body Aspiration • IV Drug induced (Talc lung), non IV (ACE) • Cardiac Asthma • Vocal cord paralysis • Pulmonary embolis

Slide 17: What Cognitive Errors? • Anyone: Name 3 cognitive errors that were made in this case? • 1) Diagnosis momentum • 2) Symptom cueing • 3) Anchoring

Slide 18: Course in Hospital: • ICU consulted in case pt progressed to Intubation {art line placed for repeat gases q 2h while on Bipap (full face)} • ICU suggests COPD…..what test did ICU ask to be ordered? • Based on mild improvements in gases (pH and CO2), Pulmonary also consulted. Pt started on Levofloxacin, remained on Bipap 3 days on Pulm ward. • PFTs showed severe obstructive lung disease. CT Chest mod. centrilobular emphysema. • Pt D/C’d home in stable condition (ABG 7.43/55/57/30.9), educated about smoking cessation, started on combivent, po steroids.

Slide 19: Pulmonary Function Tests: FEV1 1.51L (36% pred) FVC 3.4L (65% pred) FEV1/FVC (44%) 1. FEV1>=70% predicted : Mild 2. FEV1=50-69% predicted : Moderate 3. FEV1<50% predicted : Severe Back

Slide 20: Questions?

Slide 21: “Take-home” messages: • “Not all that wheezes is asthma” holds for young to middle aged adults too. • COPD can occur in young to middle aged adults. • Bonus: Recognize potential cognitive errors early and avoid.

Article copyright - #1 source of information to update nurses all over the world. All rights reserved. No part of an article may be reproduced without the prior permission.


Philippine Nurses in Action

Search for Nursing Jobs Abroad!

Quick Nursing Facts:

NLE Results December 2011 Results

December 2011 Nursing Board Exam Successful Examinees for the December NLE 2011

Nursing Board Exam July 2010 NLE PRC

July 2011 Nursing Board Exam Successful Examinee PRC

List of Successful Examinees for Nursing Licensure Examination July 2011 Conducted by the PRC

We are one of the few websites to post results right after the Philippine Regulatory Board have release the list of successful examinees

Results for July 2011 NLE Board Exam

July 2011 NLE Nursing Licensure Examination Results List Of Passers

Recommended Books

Filipino Nurse Tag Rolls

NursingReview.Org Disclaimer

© 2008-2009 NurseReview.Org This site contains links to other Web sites. The owner of this blog has no control over the content or privacy practices of those sites. The information provided here is for general information purpose only. Comments are moderated. If in any case the owner approves a comment, it should not be taken as an endorsement of that comment. The owner doesn't claim full ownership of all photos or articles posted on this site. If the respective copyright owners wish for their photos or articles to be taken down, feel free to e-mail me and it will be taken down immediately.