...This is the second case study that is required for the class. Please submit a paper (doesn’t have to be long; you could even give me bullet-point answers to the questions listed below) that answers all of the questions posed after Case Study 1. I have included an easy second case study which, if you complete it, will be worth extra credit. Answers to the first Case Study are worth 25 points and responding to Case Study 1 is required work for the course. The extra credit, which is not required, will be worth a total of 10 points. Both are due at the beginning of class on Tuesday, March 10, 2015. Case 1 R.S. has smoked for many years and has developed chronic bronchitis, a chronic obstructive pulmonary disease (COPD). He also has a history of coronary artery disease and peripheral arterial 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 using an inhaled ß2 agonist and theophylline to manage his respiratory disease. At this clinic visit, it is noted on a chest x-ray that R.S. has an area of consolidation in his right lower lobe that is thought to be consistent with pneumonia. Discussion Questions 1. What clinical findings are likely in R.S. as a consequence of his COPD? How would these differ from those of emphysematous COPD? Chronic Obstructive Pulmonary Disease (COPD) is comprised primarily of two related diseases: Chronic Bronchitis...
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...Assessment Case Study Introduction The focus of this case study is to examine further focused assessments that should be undertaken after Mr S's initial presentation of acute exacerbation of asthma. Reasoning for recommended focused assessments will be discussed with consideration of Mr S's presentation of symptoms, history, pathophysiology and risk factors for asthma exacerbation. Research on current asthma assessment protocols will guide recommendations, and assessment parameters will be described. Follow up care and self-management options for Mr S will also be explored. Asthma Asthma is a chronic inflammatory disease of the lungs. It is characterised by airflow obstruction and lung inflammation (Johnson, 2010). Asthma symptoms include wheezing, chest tightness, shortness of breath and cough (Johnson, 2010). Potential triggers for asthma include allergens, viral respiratory infections, irritants, stimuli such as cold air or exercise and gastro-oesophageal reflux (Estes et al, 2013). Airway obstruction in asthmatics is variable and reversible. However poorly managed asthma can leave lasting structural changes in the cells and tissues of the lower respiratory tract, resulting in airway remodelling and permanent fibrotic damage (Kaufman, 2011). There is currently no cure for asthma, therefore the disease needs to be managed (NACA, 2014). Pathophysiology and assessment parameters It is important to understand the underlying pathophysiology of Mr Saunders’ presentation to...
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...Case Study 2: Session 7 R.J. is a 15-year-old boy with a history of asthma diagnosed at age 8. His asthma episodes are triggered by exposure to cats and various plant pollens. He has been using his albuterol inhaler 10 to 12 times per day over the last 3 days and is continuing to wheeze. He normally needs his inhaler only occasionally (2 or 3 times per week). He takes no other medications and has no other known medical conditions. Physical examination reveals moderate respiratory distress with a respiratory rate of 32, oximetry 90%, peak expiratory flow rate (PEFR) 60% of predicted, and expiratory wheezing. Discussion: 1. A. What is the underlying mechanism of R.J.'s asthma? R.J.’s asthma is known to be triggered by allergies caused from cats and plant pollen. This type of reaction would be known as allergic asthma. The mechanism or R.J.’s asthma are IgE-mediated triggers. B. What are the three airway responses that occur during an asthma episode? The three airway responses that occur during an asthma episode is airway obstruction which is caused by bronchospasm. Second would be excess mucus production and third would be edema of the bronchial mucosa. 2. In addition to bronchodilator therapy with intermittent albuterol, what other pharmacotherapy is important in the management of asthma? Other pharmacotherapy that is important in managing asthma would be long term control medications such as inhaled corticosteroids, long-acting beta-2 agonist...
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...Importance of Research When writing college papers, grants or just presentations for work research is the most important process of the writing process. This paper will discuss the three segments of the TEDTalks: Award –Winning Teenage Science in Action video. The three segments discuss carcinogens, chemotherapy and asthma. Segment 1 Lauren Hodge conducted a research study on carcinogens in grilled chicken. The hypothesis developed by Lauren was “could possibly the carcinogens be decreased due to a marinade and could it be due to the differences in pH?” ( ). This topic was important to Lauren, because while in the doctor’s office she read an article that discussed a lawsuit pertaining to California’s Proposition 65. The magazine article discussed the hidden danger of carcinogens in the food we eat. Lauren was surprised to find that more people had no idea about the dangers of carcinogens in our food. Lauren collected data for analyzation in three different stages. In the first stage Lauren marinated all of the chicken at home in five different marinades. The second stage was completed at Penn State University and she extracted the chemicals, changed the pH, and ran it through the lab equipment which in turn separated the compounds. In the third and final stage Lauren ran the samples through a high pressure liquid chromatography mass spectrometer, which separated the compounds and analyzed the chemicals, and told her exactly how much carcinogens she had in the chicken. Lauren’s...
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...What is asthma? Asthma is a chronic inflammation of the bronchial tubes (airways) that causes swelling and narrowing (constriction) of the airways. The result is difficulty breathing. The bronchial narrowing is usually either totally or at least partially reversible with treatments. Bronchial tubes that are chronically inflamed may become overly sensitive to allergens (specific triggers) or irritants (nonspecific triggers). The airways may become "twitchy" and remain in a state of heightened sensitivity. This is called "bronchial hyperreactivity" (BHR). It is likely that there is a spectrum of bronchial hyperreactivity in all individuals. However, it is clear that asthmatics and allergic individuals (without apparent asthma) have a greater degree of bronchial hyperreactivity than nonasthmatic and nonallergic people. In sensitive individuals, the bronchial tubes are more likely to swell and constrict when exposed to triggers such as allergens, tobacco smoke, or exercise. Amongst asthmatics, some may have mild BHR and no symptoms while others may have severe BHR and chronic symptoms. Asthma affects people differently. Each individual is unique in their degree of reactivity to environmental triggers. This naturally influences the type and dose of medication prescribed, which may vary from one individual to another. CAUSES What all people with asthma have in common is chronic airway inflammation and excessive airway sensitivity to various triggers. Research has focused on why...
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...Nursing Care Plan The patient is , a 72 year old man who has been admitted for dyspnea or shortness of breath. reported that he has been coughing for the past week and his coughing has accompanied sputum discharge. His past medical history includes emphysema and chronic bronchitis. He used to smoke but has stopped since a year ago for economical reasons as well as it is also bad for his asthma. His bowel movements have also been irregular since his admission. He also reported that he is feeling depressed and fearful about the future. Further examination revealed that he has crackles in his left lower lobe with diffuse expiratory wheezing throughout his chest. Chest percussion also revealed his left lower lobe to be dull. Needs / Problems Goals Interventions Evaluation Dyspnea or shortness of breath Use the visual analog scale (VAS) to make an objective assessment of dyspnea. The VAS is a 100-mm vertical line with end points of 0 and 10. zero is equated with no dyspnea and 10 is equated with the worst brethlessness the client has experienced ( & , 2004) Dyspnea is difficult to quantify and to treat (Potter & Perry, 2004). Interventions need to be individualized for each patient, and more than one therapy is usually implemented. The underlying process that causes or worsens dyspnea must be treated and stabilized initially. Three additional therapies have to be implemented: pharmacological measures, physical techniques,...
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...Pulmonary function tests Email this page to a friend Share on facebook Share on twitter Bookmark & Share Printer-friendly version Pulmonary function tests are a group of tests that measure how well the lungs take in and release air and how well they move gases such as oxygen from the atmosphere into the body's circulation. How the Test is Performed Spirometry measures airflow. By measuring how much air you exhale, and how quickly, spirometry can evaluate a broad range of lung diseases. In a spirometry test, while you are sitting, you breathe into a mouthpiece that is connected to an instrument called a spirometer. The spirometer records the amount and the rate of air that you breathe in and out over a period of time. For some of the test measurements, you can breathe normally and quietly. Other tests require forced inhalation or exhalation after a deep breath. Sometimes you will be asked to inhale the substance or a medicine to see how it changes your test results. Lung volume measurement can be done in two ways: * The most accurate way is to sit in a sealed, clear box that looks like a telephone booth (body plethysmograph) while breathing in and out into a mouthpiece. Changes in pressure inside the box help determine the lung volume. * Lung volume can also be measured when you breathe nitrogen or helium gas through a tube for a certain period of time. The concentration of the gas in a chamber attached to the tube is measured to estimate the lung volume. To...
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...COPD All respiratory diseases characterized by chronic obstruction to airflow fall under the broad classification of COPD, also known as chronic airflow limitations (CAL). COPD is a condition of chronic dyspnea with expiratory airflow limitation that does not significantly fluctuate. Within that broad category, the primary cause of the obstruction may vary; examples include airway inflammation, mucous plugging, narrowed airway lumina, or airway destruction. The term COPD includes chronic bronchitis and emphysema. Although asthma also involves airway inflammation and periodic narrowing of the airway lumina (hyperreactivity), the condition is the result of individual response to a wide variety of stimuli/triggers and is therefore episodic in nature with fluctuations/exacerbations of symptoms. Asthma: Also known as chronic reactive airway disease, asthma is characterized by reversible inflammation and constriction of bronchial smooth muscle, hypersecretion of mucus, and edema. Precipitating factors include allergens, emotional upheaval, cold weather, exercise, chemicals, medications, and viral infections. Chronic bronchitis: Widespread inflammation of airways with narrowing or blocking of airways, increased production of mucoid sputum, and marked cyanosis. Emphysema: Most severe form of COPD, characterized by recurrent inflammation that damages and eventually destroys alveolar walls to create large blebs or bullae (air spaces) and collapsed bronchioles on expiration (air-trapping)...
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...(Chief of Department) MEDICINE __________________________________________ DATE ______________ (PIC/Designee) NURSING ___________________________________________ DATE ______________ (Director of Nursing Practice) ADMINISTRATION ___________________________________ DATE ______________ (Medical Group Administrator) IV. PRACTITIONERS FUNCTION UNDER THIS STANDARDIZED PROCEDURE: Current list of authorized personnel are on file in the office of the Medical Group Administrator and department manager. PROTOCOLS: Childhood Asthma Acute Asthma Chronic Asthma References: Attached CHILDHOOD ASTHMA PROTOCOL I. RATIONALE This protocol will assist in the history, symptoms, physical exam, diagnostic tests, treatment, and follow-up visit for Childhood Asthma II. SYMPTOMS A. Acute 1. Dyspnea 2. Hypoxemia 3. Tachypnea 4. Use of accessory muscles 5. Loud wheezing 6. Fatigue 7. Diaphoresis 8. Anxiety 9. Apprehension 10. Respiratory failure...
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...over a shorter time compared to inspiration. During inspiration, muscular effort is needed and the pattern of the flow shows that period of inspiration is longer than expiration. 3. RV cannot be determined by ordinary spirometry because it is physically not possible to exhale the RV. The RV is there because during inspiration a lower pressure is created in out lungs. If the RV is not present, our lungs would collapse. While spirometry cannot determine this, special techniques have been made to determine this, such as nitrogen washout. 4. The experimental values are significantly lower than the predicted values. This could because to the person having weak lung muscles because of regular smoking. It may also be because the person has asthma, or has a lower fitness level. 5. The ratio tells us the maximum amount of air that can be forcefully pushed out by the lungs and how efficient the lungs are at exhaling forcefully as...
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...Asthma Case Study Lisa, a four-year-old with status asthmaticus, is admitted from the emergency room via a wheelchair to a medical pediatric unit. She is accompanied by her parents who both have anxious, tense facial expressions. Lisa’s vital signs are T-36.9° C, P- 140 (apical, regular), R 38 (regular but shallow), BP 118/78. She is pale but has no evidence of cyanosis. Her breath sounds are normal in upper lobes, with inspiratory and expiratory wheezing and scatter crackles in all lobes. Breath sounds in lower lobes are diminished. She has moderate intercostal retractions, some nasal flaring, and an occasionally loose, productive cough. Lisa has thin, whitish nasal discharge and tears are dried on her cheeks. She is irritable and appears frightened. Other significant data include: Wt 19 kg, Hemoglobin 12.5, Hematocit 37.3, theophylline level 10.5 mg/dl before treatment in ER. The chest x-ray films show that her lungs are hyper inflated with some infiltrates but no atelectasis or consolidation. Three days ago, Lisa came home from the day care center with the sniffles. By evening, she had rhinorrhea and a cough but no fever. This developed into a head cold. Two days ago, she helped her father rake leaves and then played in the leaves pile with a friend. About noon today, the day care center called Lisa’s mother because she said she couldn’t catch her breath and was tired. At home, Lisa’s mother gave her an Albuterol treatment, which helped for about 30 minutes...
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...Neighborhood Scholarly Paper: Effective Control of Asthma Using Peak Flow Monitoring Tammy Harris Alvernia University Neighborhood Scholarly Paper: K.Y. Management of Asthma Using Peak Flow Monitoring The client focus of this paper is K. Y. She is an eight-year-old, typical third grader at the local elementary school, where she enjoys playing with her friends. K.Y. lives at home with her father, mother and two brothers. She takes swimming lessons, piano lessons, and enjoys family outings. Bur most of all, K.Y. loves anything that involves animals. Prior to her eighth birthday, K.Y. suffered from ongoing issues with reactive airway disease. This is a term used to describe a history of coughing, wheezing and/or shortness of breath, often used when Asthma is suspected but the diagnosis is unconfirmed. Recently, K.Y. has been officially diagnosed with Asthma, and is having a difficult time understanding why her breathing problem is keeping her from enjoying all the things that she loves. Prior to K.Y.’s diagnosis, the family had two cats that they have since removed from the home. Her mother is well educated on her medications and how to use them. With her daughters’ recent diagnosis, she has also learned how to monitor K.Y.’s peak flow and how to use these results to administer the medications at the most appropriate times. Although K.Y. knows she has a “breathing problem”, there is a great deal of education needed for her to understand her illness and what kind of impact it will...
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...Asthma Evidence Based Pharmacology Asthma is a chronic debilitating disease which affects children and adults. According to the National Heart, Lung, and Blood Institute (NHLBI), “asthma affects people of all ages, but it most often starts during childhood. In the United states, more than 25 million people are known to have asthma. About 7 million of these people are children.” Asthma is most commonly diagnosed during childhood. Pathophysiology and Age Continuum Implications Asthma is a disorder that affects the airways; it is an obstruction of the airways that takes place due to inflammation, chronic airway hyperactivity, and remodeling of the airway. According to Maddox & Schwartz (2002), “the etiology of asthma is complex and multifactorial. It involves the interaction between genetic factors and environmental stimuli” (p. 477). Therefore, patients suffering from asthma are not only susceptible to un-modifiable genetic factors but also environmental factors that trigger the airway obstructions. Essentially asthma is an inflammation of the airways in which there is an infiltration into the walls of the airway by mast cells, eosinophils, T-helper cell type two (Th2), and T-lymphocytes (Bonsignore, Profita, Gagliardo, Riccobono, Chiappara, Pace, and Gjomarkaj, 2015). According to Bonsignore, et al. (2015), “persistence of chronic inflammation may alter the homeostasis of lung tissue, leading to airway remodeling. Tissue remodeling includes epithelial alterations (epithelial...
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...Abrar Haneef Memorial University Introduction Various diseases like sinusitis, bronchitis, asthma, hypertension, overweight, hay fever, allergies such as rhinitis, eczema and other respiratory diseases are caused by numerous factors such as inadequate ventilation system, chemicals, inefficient heating and Colling system, dampness due to leakage, moulds, pollen grain, smoke and other pollutants. The World Health Organization (WHO) estimated that 30% of excess winter deaths in Europe are due to cold homes. Energy conservation can be related to health because it often involves repairing or replacement of heating and cooling equipment to increase efficiency and reduce the generation of pollutants such as carbon monoxide improvement of ventilation to remove contaminants air sealing and improvement of building envelopes, which can often reduce moisture leaks from the exterior, and reducing moisture from the dwellings (Wilson et al., 2014). We spend our most of the time indoors and a study on indoor risk factors for asthma and allergies in the home environment among adults and children have focused mainly on building dampness and indoor mould and environmental tobacco smoke. Another sources of indoor contamination is associated with adult asthma includes storage of household waste for several days. Chemical indoor factors at home associated with adult asthma include formaldehyde, volatile organic compounds and emissions from indoor paint and household cleaning...
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...the second page. Save file on your hard drive as “your_name.doc”, NOT as docx or any other format! Submit it as assignment similar as you would send an attachment via e-mail. Jessica, a fifty-nine year old mother of four, moved from a ranch in Colorado to Los Angeles, after the death of her husband, to be closer to her oldest son and his family. She has been in Los Angeles for 18 months and has noticed that she is experiencing shortness of breath which has worsened over the last six months, and sleep apnea. For the last week, she has been coughing and bringing up yellow mucus. She also noticed edema in her ankles so she decided to visit a physician about her condition. Jessica's family and medical history include a negative history of asthma or allergies, lack of occupational or home exposure to asbestos, a previous smoking history (one package of cigarettes per day between the ages of 16 and 52), episodes of bronchitis and bronchopneumonitis, treated with antibiotics on an outpatient basis, and a positive history of pancreatitis (father at 52) and meningomyelitis (brother at 56). Jessica has no history of serious illness, including heart disease, and her weight is within five pounds of her "desired" weight. She usually coughs in the morning to "clear her throat", but there is usually only a small amount of white mucus. Her nurse practitioner conducts a general physical examination with the following results. Jessica's skin is normal (no rashes or cyanosis) and her nervous...
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