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1) Winter is a 4-year-old girl with a history of asthma. Her mother has brought her in an “asthma attack”. Winter is sitting in her mother’s lap and breathing rapidly through an open mouth. She has a cough that sounds congested and wheezy. The physician has already ordered a nebulized treatment containing albuterol (Proventil) and ipratropium bromide (Atrovent).
2) Mr. Chung is a 68-year-old man complaining of cough, sore throat, fatigue, and weakness. His BP is 166/82, pulse is 90, respirations are 26, and temperature is 100.4 degrees.
3) Jackson is a 19-year-old man who has had a sudden onset of right-sided chest pain and shortness of breath. His chest x-ray film revealed a right pneumothorax, and he is currently receiving 35% oxygen by face mask while waiting for an ambulance to transport him to the hospital for further evaluation.
4) Ms. Summers is a 45-year-old homemaker. She says she has been extremely tired, easily becomes short of breath, and is unable to complete her chores without frequent rest breaks. She is pale and seems tired. Her vital signs are as follows: BP 136/78, pulse 86, respirations 24 and unlabored; temp 98.4 and pulse oximetry 98% on room air. She is now waiting for her lab results, which include a complete blood count (CBC).
Answer the following questions that pertain to the above patients.
a. Which patients are experiencing problems with ventilation? Explain your answer.
b. Which patient appears to be experiencing problems with hypoxia? Does the problem appear to be related to oxygenation or perfusion? Explain your answers.
c. Mr. Chung has smoked two packs of cigarettes per day for 50 years. ABGs reveal a low PO2 and a high PCO2 consistent with chronic lung disease. He is diagnosed with an acute exacerbation of chronic bronchitis. He is placed on oral antibiotics and long acting bronchodilators by metered-dose inhaler (MDI). What teaching could you offer to help Mr. Chung mobilize and expectorate secretions?
d. Winter receives her nebulizer treatment and markedly improves. The physician has ordered a variety of take-home medications that you must teach her mother about. The treatment plan includes a protocol based on peak expiratory flow monitoring. Discuss how you might involve Mary in her own care.
e. Jackson’s chest x-ray film reveals a spontaneous pneumothorax. There is no apparent fluid in the pleural space. What chest tube systems can be used to treat his pneumothorax? Explain your thinking.
f. Ms. Summers is diagnosed with severe anemia. She is hospitalized because her hemoglobin is 5.9 g/dL. How will this affect her oxygenation? What interventions would improve her fatigue?