Diagnostic Case Discussion: Patient with Acute Respiratory Failure Brief Patient History Mr. B is. Question
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Diagnostic Case Discussion: Patient with Acute Respiratory Failure
Brief Patient History
Mr. B is a 63-year-old man with a long history of chronic obstructive pulmonary disease associated with smoking two packs of cigarettes each day for 40 years. During the past week, Mr. B has experienced a flulike illness with fever, chills, malaise, anorexia, diarrhea, nausea, vomiting, and a productive cough with thick, brownish, purulent sputum.
Clinical Assessment
Mr. B is admitted to the intermediate care unit with acute respiratory insufficiency. He is sitting up in bed, leaning forward, with his elbows resting on the over-bed table. He is breathing through his mouth, taking rapid shallow breaths, using accessory muscles to breathe. During exhalation, Mr. B. uses pursed-lip breathing and his intercostal muscles bulge. He appears anxious and is able to speak only one or two words between each breath. Auscultation reveals crackles posteriorly over both lower lung fields.
Diagnostic Information
His baseline vital signs are as follows: blood pressure of 110/60 mm Hg, heart rate of 108 beats/min, respiratory rate of 30 breaths/min, and temperature of 101.3 F. His baseline ABG values on a 28% Venturi face mask are: Pao2 of 58 mm Hg, Paco2 of 33 mm Hg, pH of 7.52, HCO3 level of 28, and O2 saturation of 88%.
Medical Diagnosis
Community-acquired pneumococcal pneumonia is diagnosed.
Questions
What is the clinical definition of Acute Respiratory Failure
Why is COPD normally classified as Type 1 or Type 2 respiratory failure?
What is the significance of the current blood gases in relation to his present condition?
What information is present that validates the Diagnosis of Pneumococcal Pneumonia? What information is present that validates the Acute Respiratory Failure?
What additional clinical data would you like to see?
What are the significant risk factors for Community-acquired pneumonia? Which of these findings were present in this patient (history and clinical data)?
What signs and symptoms do you expect of this physical presentation? Which ones are present in your patient?
Neurological
Respiratory
Cardiovascular
Skin
Gastro-intestinal
Genito-urinary
What major outcomes do you expect to achieve for this patient?
What problems or risks must be managed to achieve these outcomes?
What interventions must be initiated to monitor, prevent, manage, or eliminate the
problems and risks identified?
What types of orders would you expect to see?
Monitoring
Classification of meds (ie, anti-infectives, anti-emetics, etc)
IV / oxygen
Additional diagnostic studies
Treatments
What would be your “worst case” complication for this patient?
What are the warning signs and symptoms that your patient might be reaching this level? (include clinical and diagnostic findings).
What possible learning needs would you anticipate for this patient?
What cultural and age-related factors might have a bearing on the patient’s plan of care?
SCIENCE
HEALTH SCIENCE
NURSING
UNRS 411
Diagnostic Case Discussion: Patient with Acute Respiratory Failure Brief Patient History Mr. B is
