Case Study One

Discussion 6.1 – Case Study One

The patient is a 68 year old man who has had shortness of breath for the past 2 to 3 days. His past medical history includes a 40 years of smoking a pack as day – history, COPD, and heart failure. He reports that he became concerned when he woke from sleep because he could not breathe. Your physical assessment reveals crackles in the lower lobes bilaterally. His oxygen saturation is 84% without supplement oxygen.

What are some areas of focus to assess as part of this patient’s current history?

Whom should you contact and why?

What are some factors that may affect gas exchange for this patient?

What additional referrals might be appropriate for this patient?

Discussion 6.2 – Case Study Two

Your patient is the 68 year old man from the previous challenge who had shortness of breath for the past 2 to 3 days. His clinical condition deteriorated further, requiring intubation. The health care provider orders a CT scan of the chest.

What are responsivities when preparing the patient for the CT scan?

Why is it important to monitor your patient using capnography?

A large fluid collection on the left side is found during the CT scan and a thoracentesis is planned. What are your responsibilities in preparing for and assisting with this procedure?

Your patient was extubated after the left thoracentesis. Withing 12 hours he again develops respiratory distress, decreased breath sounds and a trachea that appears deviated to the right. What is your assessment?

Discussion 6.3 – Case Study Three

Your patient is a 41 year old woman with a significant closed head injury CHI from a motor vehicle crash MVC. She is not anticipated to be able to be weaned from the ventilator, and the physicians have asked the patient’s family for permission to create a tracheostomy. The family is concerned that the patient will not be able to speak again.

What is your response?

What are some possible concerns for patient care in the immediate postoperative period?

What can you do to minimize tracheal damage?

The patient’s family is concerned that the tracheostomy will be permanent and they are worried about her image. How do you respond?

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