Instructions
Please Discuss your idea about Obstructive Disorders of the Lungs The use of search Google, YouTube and Yahoo are allowed. 2. Students must submit this accomplished worksheet through Canvas CINICAL SCENARIO NURSING HEALTH HISTORY: PATIENT’S PROFILE Name of Patient Patient Female Date of Birth Malabon Age 60 years old Nationality! Fino Religion Roman Cathole Date Admission August 02, 2020 Time 11.30 Chief complaint Shortnews of breath Admitting Diagnose History of Present liness The patient is a 60 year-old female prosenting to the emergency department without one shortness of breath Symptoms began approximately 2 days before and ad progressively worned with no moted aggraving, or relieving factors noted. She had a symptoms aproximately 1 yow go with an acute, chronic obstructive pulmonary disease (COPD) exacerbation requiring hospitalization. She uses BPAP ventilatory suport al night when sleeping and has requested to use this in the emergency department due to shortness of breath and wanting to sleep She denies fever, chills, cough, wheezing, sputum production, chest pain, palpitations pressure, abdominal pain abdominal detension, nausea, vomiting, and Garrhea She does report difficulty breathing at rest forgetfulness, mild fatigue, fooling chilled requiring blankets, increased urinary frequency. Incontinence, and weling in her bilateral lower extremities that is now onset and worsening Subsequently, she has not ambulated from bed for several days except to use the restroom due to fooling weak, fatigued, and short of breath There are no known il contacts at home. Her family history includes significant heart disease and prostate malignancy in her father Social history is positive for smoking tobacco use at 30 pack years. She quit smoking 2 years ago due to increasing shortness of breath. She denies al alcohol and legal drug use. There are no known foods, drugs or environmental allergies Past Medical History Past medical history significant for coronary artery disme, myocardial infarction, COPO ypertension, hyperipidemia, porodium fabeto matus peripheral values tobacco usage and betty Pastorical story significant for an appendectomy, cardiac Her current medications include Breo Ellipta 400-25 mcg inhaled daily, hydralazine 50 mg by mouth, 3 times per day, hydrochlorothiazide 25 mg by mouh daly, buo Nieb ihaled 24h PRN, levothyroxine 175 meg by mouth daly, metformin 500 mg by mouth twice per day, nebivolol mg by mouth daly, spirin 81 mg by mouth day, vitamin D3 1000 units by mouth daily, clopidogrel 75 mg by mouth daily, isosorbide mononitrate 60 mg by mouth cally and rosuvastatn 40 mg by mouth daily Family History (*) HPN *) Diabetes Asthma Cancer Physical Examination historical stam tovais temperaturo 07.3 F. heart rate 74 bpm. respiratory rate 24. OP 104/14, BMI 40 2 and 2 Sahin on room ar Constitutional Extremelybete, oly appearing female Well-developed and wel nourished with BPAP in place lying on a hospital stretcherunder blankets HEEN Head Nomophoto and from • Mouth Mo mucus memb • Macroglos F Compunctive and EOM are normal. Pupils are equal, mund, and reactive to 1. No sectorus B perioden present Neck Neck suppleNo JVD present. No mases of surgical scarving Throat: Patent and most Cardiovascular Normal rate regular mythm and normal heart sound with no murmur 2 piling edema bilateral lower extremities and strong pulses in all four tramities Pulmonary Chest: No respiratory status distruss at this time, tachypnea present. (*) wheezing noted bilateral rhonch, decreased air movement bilaterally. Patient barely able to finish a ful sentence due to shortness of breath Abdominal: Soft Obese Bowel sounds are normal. No distension and no tenderness Skin Skin is very dry Neurologic: Alert, awake, able to protect her airway, Moving all extremities. No sensation Admission Order Initial evaluation to elucidate the source of dyspnea was performed and included CBC to establish an infectious or anemic source was present, CMP to review electrolyte balance and review renal function, and arterial blood gas to determine the POP for hypoxia and any major acid-base derangement crewinne kinase and troponin to evaluate presence of myocardial infarct or rhabdomyolysis brain natriuretic peptide ECG, and chest x-ray. Considering that it is winter and influenza is endemic in the community, a rapid influenza assay was obtained as well сва Largely unremarkable and non-contributory to establish a diagnosis CMP Showed creatinine elevation above baseline from 1.08 base to 1.81 Indicating possible acute injury. EGFR at 28 is consistent with the chronic renal disease. Calcium was elevated to 10.2. However, when corrected for albumin this corrected to 9.8 mil. Mid transaminitis present as seen in Alkaline Phosphatase, AST and ALT measurements which could be due to ver congestion from volume overload Intial arterial blood gas with pH 7491, PCO2 27.6. PO2 63.6. HCO3 20.6, and oxygen Saturation 90% on room ar indicating respiratory alkalosis with Hypoxio respiratory features Creatinine kinase was elevated along with serial elevated troponin studies. In the seting of her known chronic renal failure, and in the setting of acute injury indicated by the above creatinine value, a differential of rhabdomyolysis a set Influenza A and B Negative ECG Normal sinustythm with non-specific ST changes in inferior leads. Decreased voltage in leads I, III, VRVLIVF Chest X-ray Findirige: basilararepace dose that may represent alveolar edema. Cardiomegaly noted. Prominent inter til markings noted. Small bilateral pleural effusions Radiologia pression: Radiographic changes of congestive failure with bilateral plural offusione greater on the left compared to the right 2Day of Admission The second day of the admission patient’s shortness of breath was not improved, and she was more and examination. To PASSAVA was har mediation. He reports t she does the need to so many Testing was performed to include TSK, froe 74. BNP pederal bloot om, CT an of the chest, and echocardiogram. TSH and Free Talumehypothyroidism NP evaluie fuld ad status and possible coolive heart failure. CT scan of the chest wil look for anatomical thomas Anechocardiogram is used to evaluate for at ventricular ejection fraction right ventricular function, pulmonary artery pressure, valvular function, pericardial offusion and any hypokinetic area. • TSH 112717 (H) Free T4: 0.56 TSH and Free T4 values indicate severe primary hypothyroidism, • BNP107 BNP can be falsely low in obese patients due to the increased surface area. Additionally, adipose tissue has BNP receptors which augment the true BNP value. Also, Adrican American patients more excretion may have falsely low values secondary to greater excretion of BNP. This test is not that helpful in rena falure due to the chronic nature of fluid Overload. This allows for desensitization of the cardiac tissues with a subsequent decrease in BNP release Repeat arterial blood gas on BPAP ventilation shows pH 7.297, PCO2 35.3, PO2 724, HCO3 21.2, and oxygen saturation 90% on 2 L supplemental oxygen. CT chest without contrast was mainly obtained to evaluato let hemithorax especially retrocardiac area Radiologist impression. Tiny bilateral pleural eons. Pericardial effusion Coronary artery calification. Some lettlung base telectasis win minimal arapace disease. Echocardiogram The leverinoular systolic function is normal. The left ventricular cavity is borderline dilated The pericardial ud is collected primarily posteriorly, laterally but not apically. There appeared to be a subtle, early hemodynamic effect of the pericardial Suid on the right sided chambers by way of an early diastolic collapse of the RARV and delayed RV expansion until late diastole. Dedicated tamponade study was not performed Estimated ejection fraction appears to be in the range of 66% to 70%. Theseft ventricular Gavity is borderline dilated The aortic valve is abnormal in structure and exhibit sclerosis The mitral valve is abnormal in structure Mid miral annular calification in present. There blateral thickening present. Trace mitral Valve regurgitation is present CINICAL SCENARIO NURSING HEALTH HISTORY: PATIENT’S PROFILE Name of Patient: Patient L Sex: Female Date of Birth: Malabon Age: 60 years old Nationality: Filipino Religion: Roman Catholic Date Admission: August 02, 2020 Time: 11:30 pm Chief complaint: Shortness of breath Admitting Diagnosis: CHF History of Present Illness The patient is a 60-year-old female presenting to the emergency department with acute onset shortness of breath. Symptoms began approximately 2 days before and had progressively worsened with no associated, aggravating, or relieving factors noted. She had similar symptoms approximately 1 year ago with an acute, chronic obstructive pulmonary disease (COPD) exacerbation requiring hospitalization. She uses BiPAP ventilatory support at night when sleeping and has requested to use this in the emergency department due to shortness of breath and wanting to sleep. She denies fever, chills, cough, wheezing, sputum production, chest pain, palpitations, pressure, abdominal pain, abdominal distension, nausea, vomiting, and diarrhea. She does report difficulty breathing at rest, forgetfulness, mild fatigue, feeling chilled requiring blankets, increased urinary frequency, incontinence, and swelling in her bilateral lower extremities that is new onset and worsening. Subsequently, she has not ambulated from bed for several days except to use the restroom due to feeling weak, fatigued, and short of breath. There are no known ill contacts at home. Her family history includes significant heart disease and prostate malignancy in her father. Social history is positive for smoking tobacco use at 30 pack years. She quit smoking 2 years ago due to increasing shortness of breath. She denies all alcohol and illegal drug use. There are no known foods, drugs, or environmental allergies. Past Medical History Past medical history is significant for coronary artery disease, myocardial infarction, COPD, hypertension, hyperlipidemia, hypothyroidism, diabetes mellitus, peripheral vascular disease, tobacco usage, and obesity. Past surgical history is significant for an appendectomy, cardiac catheterization with stent placement, hysterectomy, and nephrectomy. Her current medications include Breo Ellipta 100-25 mcg inhaled daily, hydralazine 50 mg by mouth, 3 times per day, hydrochlorothiazide 25 mg by mouth daily, Duo-Neb inhaled 94 hr PRN, levothyroxine 175 mcg by mouth daily, metformin 500 mg by mouth twice per day, nebivolol 5 mg by mouth daily, aspirin 81 mg by mouth daily, vitamin D3 1000 units by mouth daily, clopidogrel 75 mg by mouth daily, isosorbide mononitrate 60 mg by mouth daily, and rosuvastatin 40 mg by mouth daily. Family History (+) HPN (+) Diabetes (-) Asthma (-) Cancer Physical Examination Initial physical exam reveals temperature 97.3 F, heart rate 74 bpm, respiratory rate 24, BP 104/54, BMI 40.2, and O2 saturation 90% on room air. Constitutional: Extremely obese, acutely ill-appearing female. Well-developed and well- nourished with BiPAP in place. Lying on a hospital stretcher under 3 blankets. HEENT: • Head: Normocephalic and atraumatic • Mouth: Moist mucous membranes • Macroglossia • Eyes: Conjunctiva and EOM are normal. Pupils are equal, round, and reactive to light. No scleral icterus. Bilateral periorbital edema present. • Neck: Neck supple. No JVD present. No masses or surgical scarring. • Throat: Patent and moist Cardiovascular: Normal rate, regular rhythm, and normal heart sound with no murmur. 2+ pitting edema bilateral lower extremities and strong pulses in all four extremities. Pulmonary/Chest: No respiratory status distress at this time, tachypnea present, (+) wheezing noted, bilateral rhonchi, decreased air movement bilaterally. Patient barely able to finish a full sentence due to shortness of breath. Abdominal: Soft. Obese. Bowel sounds are normal. No distension and no tenderness Skin: Skin is very dry Neurologic: Alert, awake, able to protect her airway. Moving all extremities. No sensation losses Admission Order Initial evaluation to elucidate the source of dyspnea was performed and included CBC to establish if an infectious or anemic source was present, CMP to review electrolyte balance and review renal function, and arterial blood gas to determine the PO2 for hypoxia and any major acid-base derangement, creatinine kinase and troponin I to evaluate presence of myocardial infarct or rhabdomyolysis, brain natriuretic peptide, ECG, and chest x-ray. Considering that it is winter and influenza is endemic in the community, a rapid influenza assay was obtained as well. CBC Largely unremarkable and non-contributory to establish a diagnosis. CMP Showed creatinine elevation above baseline from 1.08 base to 1.81 indicating possible acute injury. EGFR at 28 is consistent with the chronic renal disease. Calcium was elevated to 10.2. However, when corrected for albumin this corrected to 9.8 mg/dL. Mild transaminitis present as seen in Alkaline Phosphatase, AST, and ALT measurements which could be due to liver congestion from volume overload. Initial arterial blood gas with pH 7.491, PCO2 27.6, PO2 53.6, HCO3 20.6, and oxygen saturation 90% on room air indicating respiratory alkalosis with hypoxic respiratory features. Creatinine kinase was elevated along with serial elevated troponin I studies. In the setting of her known chronic renal failure, and in the setting of acute injury indicated by the above creatinine value, a differential of rhabdomyolysis is set. Influenza A and B: Negative ECG Normal sinus rhythm with non-specific ST changes in inferior leads. Decreased voltage in leads I, III, VR, VL, aVF. Chest X-ray Findings: Bibasilar airspace disease that may represent alveolar edema. Cardiomegaly noted. Prominent interstitial markings noted. Small bilateral pleural effusions Radiologist Impression: Radiographic changes of congestive failure with bilateral pleural effusions greater on the left compared to the right 2nd Day of Admission The second day of the admission patient’s shortness of breath was not improved, and she was more confused with difficulty arousing on conversation and examination. To further elucidate the etiology of her shortness of breath and confusion further history was obtained via the patient’s husband. He revealed that she is poorly compliant with taking her medications. He reports that she doesn’t see the need to take so many pills.” Testing was performed to include TSH, free T4, BNP, repeated arterial blood gas, CT scan of the chest, and echocardiogram. TSH and free T4 evaluate hypothyroidism. BNP evaluates fluid load status and possible congestive heart failure. CT scan of the chest will look for anatomical abnormalities. An echocardiogram is used to evaluate for left ventricular ejection fraction, right ventricular function, pulmonary artery pressure, valvular function, pericardial effusion and any hypokinetic area. • TSH: 112.717 (H) • Free T4: 0.56 (L) • TSH and Free T4 values indicate severe primary hypothyroidism. • BNP: 187 BNP can be falsely low in obese patients due to the increased surface area. Additionally. adipose tissue has BNP receptors which augment the true BNP value. Also, African American patients more excretion may have falsely low values secondary to greater excretion of BNP. This test is not that helpful in renal failure due to the chronic nature of fluid overload. This allows for desensitization of the cardiac tissues with a subsequent decrease in BNP release. Repeat arterial blood gas on BiPAP ventilation shows pH 7.397, PCO2 35.3, PO2 72.4, HCO3 21.2, and oxygen saturation 90% on 2 L supplemental oxygen. CT chest without contrast was mainly obtained to evaluate left hemithorax especially retrocardiac area. Radiologist Impression: Tiny bilateral pleural effusions. Pericardial effusion. Coronary artery calcification. Some left lung base atelectasis with minimal airspace disease. Echocardiogram The left ventricular systolic function is normal. The left ventricular cavity is borderline dilated. The pericardial fluid is collected primarily posteriorly, laterally but not apically. There appeared to be a subtle, early hemodynamic effect of the pericardial fluid on the right- sided chambers by way of an early diastolic collapse of the RA/RV and delayed RV expansion until late diastole. Dedicated tamponade study was not performed. Estimated ejection fraction appears to be in the range of 66% to 70%. The left ventricular cavity is borderline dilated. The aortic valve is abnormal in structure and exhibits sclerosis. The mitral valve is abnormal in structure. Mild mitral annular calcification is present. There is bilateral thickening present. Trace mitral valve regurgitation is present.
Order with us today for a quality custom paper on the above topic or any other topic!
What Awaits you:
• High Quality custom-written papers
• Automatic plagiarism check
• On-time delivery guarantee
• Masters and PhD-level writers
• 100% Privacy and Confidentiality