Respiratory Case Studies Tuesday by Mélanie Filion

Respiratory Case Studies Tuesday by Mélanie Filion https://padlet.com/melanie_filion/RespiratoryTuesdayClass en-us 2020-03-03 14:42:36 UTC 2020-03-03 15:59:30 UTC hello@padlet.com Consider T.V.'s history, what is most likely the cause of her respiratory distress? slittle_home https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453658492 Pulmonary embolism because DVT is a risk for PE if the clot travels to the lungs. The symptoms include: dyspnea (sudden onset).]]> 2020-03-03 14:45:01 UTC https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453658492 R.S is a long-time smoker who developed bronchitic chronic obstructive pulmonary disease (COPD). He also has a history of Coronary artery disease and peripheral vascular disease. His arterial blood gas (ABG) values are pH= 7.32, PaCO2= 60 mm Hg, PaO2= 50 mm Hg, HCO3-= 30 mEq/L. His hematocrit is 52% with normal red cell indices. He is taking an inhaled B agonist and theophylline to manage his respiratory condition. At his clinic visit, it is noted that R.S has an area of consolidation in his right lower lobe thought to be consistent with pneumonia. https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453658739 2020-03-03 14:45:18 UTC https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453658739 What risk factors, clinical and diagnostic findings would help confirm this diagnosis? slittle_home https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453659200 90% of pulmonary embolisms are caused by DVT. Other causes of this include; hypercoagulation and, injuries to endothelial cells that line the vessels.
Diagnostic findings:
- low pulse oximetry
- arterial blood gas
- chest x-ray
- VQ scan
- pulmonary angiogram
- echogram

]]> 2020-03-03 14:45:51 UTC https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453659200 1. Discuss the pathophysiology underlying COPD https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453659551 This process initially affects only the largest bronchi, but eventually all airways are involved. The thick mucus and hypertrophied bronchial smooth muscle constrict the airways and lead to obstruction, particularly during expiration when the airways are narrowed. Obstruction eventually leads to ventilation-perfusion mismatch with hypoxemia. The airways collapse early in expiration trapping gas in the distal portions of the lung. Air trapping expands the thorax and positions the respiratory muscles at a mechanical disadvantage. This air trapping leads to decreased tidal volume, hypoventilation and hypercapnia. ]]> 2020-03-03 14:46:16 UTC https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453659551 What do her ABGs reveal? What is the pathogenesis of the hypoxemia in this disorder? slittle_home https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453659688 Respiratory alkalosis because of high pH, low CO2 and, low PO2.
Initial hypoxemia at acute PE is caused by an altered distribution of ventilation to perfusion.]]> 2020-03-03 14:46:25 UTC https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453659688 1. What is the underlying mechanism of R.J's asthma? What are three airway responses that occur during an asthma episode? https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453667730 A)
1) Bronchoconstriction
2) Mucosal edema
3) Hypersecretion of mucous

B) What mechanisms cause obstruction in asthma?
- Bronchoconstriction
- Obstruction of airflow by intraluminal mucous
- Inflammation and remodelling of airway wall]]> 2020-03-03 14:56:10 UTC https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453667730 what is the most likely cause of JC's manifestations https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453668122 tension pneumothorax from the motor vehicle accident]]> 2020-03-03 14:56:40 UTC https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453668122 explain the pathophysiology and manifestations underlying this cause. Discuss the different types https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453668459 Tension pneumothorax is a pneumothorax causing a progressive rise in intrapleural pressure to levels that become positive throughout the respiratory cycle and collapses the lung, shifts the mediastinum, and impairs venous return to the heart. Air continues to get into the pleural space but cannot exit. Without appropriate treatment, the impaired venous return can cause systemic hypotension and respiratory and cardiac arrest (pulseless electrical activity) within minutes. Tension pneumothorax most commonly occurs in patients receiving positive-pressure ventilation (with mechanical ventilation or particularly during resuscitation). Rarely, it is a complication of traumatic pneumothorax, when a chest wound acts as a one-way valve that traps increasing volumes of air in the pleural space during inspiration]]> 2020-03-03 14:57:06 UTC https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453668459 1. State the cause of pneumonia and describe how it affects the lungs. https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453668560 the cause of pneumonia is commonly caused by aspiration of colonized oropharyngeal secretions, factors include; capsules that make phagocytosis by alveolar macrophages difficult and release toxins, and inflammatory response.
Neutrophils and inflammatory exudates cause alveolar edema.
Most common is bacterial. ]]> 2020-03-03 14:57:14 UTC https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453668560 the patient is at risk for severe hypoxemia. What is hypoxemia? Explain why this is a possible complication for this patient? https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453669945 Hypoxemia is an abnormally low concentration of oxygen in the blood. The patient t risk for this complication because of the diminished or altered oxygen exchange]]> 2020-03-03 14:58:29 UTC https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453669945 2. D.P. reports rust colour sputum. what does this information reveal? Explain D.P.s other manifestations. https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453670762 Rust colour sputum reveals blood and pus which means Streptococcus pneumonia.
other manifestations: fever, cough, chest pain, SOB, drowsiness, cyanotic nail beds ]]> 2020-03-03 14:59:17 UTC https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453670762 How does pneumothorax differ from pleural effusion? https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453671197 Pleural effusion is a result of excess fluid that accumulates in the pleural cavity, the fluid- filled space that surrounds the lungs. Pneumothorax is the accumulation of air in the plural space- "collapsed lung".]]> 2020-03-03 14:59:45 UTC https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453671197 3. Describe the normal mechanisms that defend against infection in the respiratory tract. https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453672208 Cilla - hair like projections that line the respiratory tract
Mucous layer - trap pathogens
Alveolar macrophages - type pf WBC on the surface of alveoli ]]> 2020-03-03 15:00:48 UTC https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453672208 4. What precautions could you take as nurses to reduce the risk of respiratory infection for yourself, your colleagues, and your patients? https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453674357 -stay current on vaccinations
-proper hand hygiene
-appropriate PPE
-proper ventilation ]]> 2020-03-03 15:03:15 UTC https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453674357 1. Explain what is happening with T.R. Explain the manifestations. https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453674544 hypoventilation - causes an increase in CO2, which will lead to a decreased SpO2 even with being on O2 at 15L/min.]]> 2020-03-03 15:03:29 UTC https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453674544 2. a) Which clinical findings are likely in RS as a consequence of his bronchitic COPD. b) How would these differ from emphysematous COPD? https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453674755 a) Bronchitic COPD:

Inspired irritants result in airway inflammation with infiltration of neutrophils, macrophages, and lymphocytes into the bronchial wall. Continual bronchial inflammation causes bronchial edema, an increase in the size and number of mucous glands and goblet cells in the airway epithelium, smooth muscle hypertrophy with fibrosis, and narrowing of airway. Thick, tenacious mucus is produced and cannot be cleared because of impaired ciliary function. The lungs defence mechanisms are therefore compromised increasing susceptibility to pulmonary infection and injury and ineffective repair.

Emphysematous COPD:

Inspired irritants result in airway inflammation with infiltration of neutrophils, macrophages, and lymphocytes into the bronchial wall. Continual bronchial inflammation causes bronchial edema, an increase in the size and number of mucous glands and goblet cells in the airway epithelium, smooth muscle hypertrophy with fibrosis, and narrowing of airway. Thick, tenacious mucus is produced and cannot be cleared because of impaired ciliary function. The lungs defence mechanisms are therefore compromised increasing susceptibility to pulmonary infection and injury and ineffective repair.

b) Both emphysema and chronic bronchitis are long term conditions 90% of time associated with smoking. both are part of COPD. Emphysema main symptom is SOB and fatigue. no/little cough normally. chronic bronchitic main symptoms is frequent cough with mucous, and fever.

]]> 2020-03-03 15:03:43 UTC https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453674755 2. What do the above signs indicate? https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453675450 severe pulmonary edema ]]> 2020-03-03 15:04:33 UTC https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453675450 3. Describe the pathophysiologic mechanism contributing to T.R.'s problem in #2. https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453675754 fluid in the alveoli ]]> 2020-03-03 15:04:54 UTC https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453675754 4. Later that day, the nurse reports decreased air entry to the right medial lobe and T.R. reports dyspnea with RR of 28 breaths per minute and shallow. A CXR is ordered and reveals an area of atelectasis. T.R. asks what that means. https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453676383 - collapse of lung tissue
- hypoventilation of the lung d/t obstruction or removal of air from the alveoli - inhalation of gas (e.g. anesthetic) -> the pt is shallow breathing so there is no anesthetic being removed from the bases of the lungs
- inadequate effect at breathing post-op ]]> 2020-03-03 15:05:36 UTC https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453676383 Explain R.Js manifestations and ABG results CaityKingsbury https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453677645 - Metabolic acidosis + respiratory alkalosis ( mixed acid- base disorder)?
- Asthma attack; AEB tightness of chest, hypersecretion of sputum, dyspnea, expiratory wheezing, use of accessory muscles, and chest retraction; uncompensated.]]> 2020-03-03 15:07:04 UTC https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453677645 3. Interpret R.S's laboratory results. a) How would his acid-base disorder be classified? b) What does the Hct indicate? c) What is the most likely cause of this RBC alteration? https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453677837 a) Partially compensated respiratory acidosis.
b) The hematocrit indicated the volume of RBC in the blood. For men the average is 48% to 54% therefore, R.S is within normal range, which indicates he is not anemic.
c) ]]> 2020-03-03 15:07:17 UTC https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453677837 How should R.J's current problem be managed? What parameters should be assessed to monitor response to therapy? CaityKingsbury https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453680706 He should still be using his albuterol inhaler as needed, incorporating some pharmacotherapy such as bronchodilators, corticosteroids and anti-inflammatory bronchodilators to reduce bronchospasm are used for controlling sudden attacks; they cause the muscles around the airway to relax. Spirometry measures both how much and how fast air moves through your lungs. The results are expressed as FEV, forced expiratory volume. peak flow meters would be useful. ]]> 2020-03-03 15:10:15 UTC https://padlet.com/melanie_filion/RespiratoryTuesdayClass/wish/453680706