discuss the presenting problem and co-morbidities

discuss the presenting problem and co-morbidities

Nursing Case study on asthma

Week 5
Respiratory Assessment
and Case Studies
Asthma case study
The tutorial will be conducted in two parts.
The tutor will:
• give an introduction to Asthma and revisit respiratory assessment
• review the clinical notes and records pertaining to Ben’s case study
• discuss the presenting problem and co-morbidities
• consider clinical terms and abbreviations
In groups students will:
• discuss what is going on here? and what does it mean?
• describe the physiology of the presenting symptoms
• outline the subjective and objective data presented
• explain physiological responses reflected by the vital signs and why they are occurring
https://binged.it/2pJIOBC
The University of Sydney 2
Asthma
Common chronic inflammatory and obstructive airway disease characterised by:
• Reversible
• Bronchoconstriction
• Oedema of airways
• Mucous hypersecretion
Ænarrowing of airways leading to alveoli = air trapping/ hyperinflation of lungs = impaired
gas exchange
Triggers Risks
Allergens
Drugs and chemical
Aspirin and NSAIDs
Cold air
Exercise
Stress
Irritants (smoke)
Family history
History of allergies
Age (prevalent in children)
https://www.chrichmond.org/What-is-asthma.htm
The University of Sydney 3
Pathophysiology of Asthma
Triggers
Airway inflammation
Excessive Mucus secretion
Bronchospasm/ Narrowing of airways
Airway muscle constriction Swelling of bronchial membranes
Immune activation
(IL-4, IgE production) Mast cell degranulation
Chest tightening
Wheezing
Coughing
Dyspnoea
Adapted from Brown and Edwards, 2015. p 567
The University of Sydney 4
Asthma
• What is Asthma Video
The University of Sydney 5
The University of Sydney 6
http://www.frca.co.uk/article.aspx?articleid=100023
Lung function tests
The University of Sydney 7
The University of Sydney 8
The Oxygen-haemoglobin dissociation curve
The University of Sydney 9
Normal ABG values (Brown, Edwards, Seaton & Buckley, 2015)
The University of Sydney 10
The University of Sydney 11
The University of Sydney 12
Case Study
• PATIENT NAME:
• Ben Marshall DOB: 05/03/1993 25 Years Male
• PRINCIPAL DIAGNOSIS: Severe Asthma
• SUMMARY OF EVENTS: Ben was out for a jog, where approximately
20 minutes into the run he developed severe shortness of breath and
tightness in the chest. An ambulance was called and transported him
to hospital.
• SOCIAL: Ben, a university graduate, lives with parents and two
younger siblings. He is a very fit, young adult male who plays
competition football.
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Asthma Videos
• Asthma attack
• Lung Sounds
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PRESENTATION
Patient Complaints:
• Severe dyspnoea
• No Loss of consciousness
• Meds: Salbutamol inhaler
• Health History: Diagnosed with asthma as a child (age 7)
• He has presented to hospital on two previous occasions for asthma
related symptoms.
• Following his last admission 2 years ago he had Pulmonary Function
Tests: FEV1/PEFR 80% of predicted, PEFR variability 30%
The University of Sydney 15
On Examination
Airway
– Patient talking in single words, pursed lips
Breathing
– Spontaneous, resting RR 34, severe dyspnoea
• Short shallow breathes, with use of accessory muscles Tightness in chest Dry cough Peak expiratory flow rate ↓140 ml Auscultation – ↓BS, with diffuse wheezes, auditory inspiratory and expiratory wheeze
• Percussion: hyperresonant
• SpO2 93% on 4L O2
Circulation
– Resting PR128, BP 90/60, centrally warm and perfused
• Elevated JVP +5 cm
Disability
– GCS 15, PERL 3+
Environment
– Temp 36.7, no complaints of chest pain
Fluids
– RR 34, BP 90/60, resting PR128, Patient catheterized urine output low 40mls/hour
Glucose BSL 5.9 I – Pulmonary function tests – see above ECG – Normal, no signs of ST elevation Bloods – ABG: Ph7.35, PaCO2 45mmHg, PaO2 70mmHg, HCO3 24mmol, BE +4
Chest X-ray – Normal, hyper-inflated with flattening of diaphragm
Bloods – NAD
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Glossary of terms and abbreviations
• NAD No abnormality detected
• ABG Arterial Blood Gas
• BP Blood pressure
• ET End Tidal CO2 is the amount of CO2 in exhaled gas
• GCS Glasgow comma scale
• LOS Loss of consciousness
• RR Respiratory rate
• PERL Pupils equal and reacting to light
• PMH Past or previous medical history
• PR Pulse Rate
• RR Respiratory Rate
• SOB Short of breath
• SpO2 Saturation of oxygen onto haemoglobin in arterial blood
• # Fracture (L) Left (R) Right
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Group work
• discuss what is going on here? and what does it
mean?
• describe the physiology of Bens’ presenting
symptoms
• the subjective and objective data presented
• physiological responses reflected by the vital
signs and why they are occurring
The University of Sydney 18
https://binged.it/2pL66rX
Framework for Practice Thinking
While there is a right answer now, it may be wrong tomorrow due to alterations in the information climate affecting the decisions (Siemens 2004)
What does this
mean?
What could/can be
done?
This person, this place, this
time and with these
resources
What should be
done?
Ethics/law
Resources
Personal preference
What’s going on here?
What IS
done?
So What?
Documentation
Referral
Unknowing
Ethical Knowing
Empirical Knowing
Personal Knowing
Aesthetic Knowing
Socio-Political Knowing
Adapted from KCAE,1984, & White,1990
Adapted from KCAE, 1984 & White 1990, Carper 1978, Munhall,1993, White, 1995, Chinn & Kramer, 2008, White 2013
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Questions?
https://binged.it/2GdyJYX
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Asthma Australia (2016). https://www.asthmaaustralia.org.au/qld/about-asthma/what-is-asthma-/statistics
Brown, D., Edwards, H., Seaton, L., & Buckley, T. C. T. (2015). Lewis’s medical-surgical nursing : assessment
and management of clinical problems (Fourth Edition.. ed.): Chatswood, NSW : Elsevier Australia.
Craft, J., Gordon, C., Huether, S. E., McCance, K. L., Brashers, V. L., & Rote, N. S. (2015). Understanding
pathophysiology (2nd edition.. ed.): Chatswood, N.S.W. : Elsevier Australia.
Farrell, M., Dempsey, J., Smeltzer, S., & Bare, B. (2014). Smeltzer and Bare’s textbook of medical- surgical
nursing (Third Australian and New Zealand edition. ed.). Sydney: Lippincott Williams & Wilkins.
Fisher, M, Lecture April 4, 2018
McCance, K., Heuther, S., Brashers, V., & Rote, N. (2010). Pathophysiology: The biologic basis for disease in
adults and children (6th ed.). St. Louis: Mosby Elsevier.
McKenna, L., Lim, A. G., & Karch, A. M. (2015). McKenna’s pharmacology for nursing and health
professionals (Second edition. ed.). Sydney, N.S.W.: Wolters Kluwer/Lippincott Williams &
Wilkins.
Shlamovitz, G. Z. (2016). Tube Thoracostomy. Medscape; Clinical Procedures. Retrieved from
http://emedicine.medscape.com/article/80678-overview#a6
References
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