Acute Care Nursing NRSG378
- Subject Code :
NRSG378
NRSG378Assessment3CaseStudy Patient Details:
Lily Tran is a 42-year-old female who presented to the Emergency Department (ED) via ambulance this morning with severe shortness of breath, chest tightness, and cyanosis. She is accompanied by her partner, Alex, who reports that Lily had a history of worsening symptoms over the past 48 hours, including persistent cough and increasing fatigue. Alex states that Lily has been unwell with flu-like symptoms for the past week, but they became alarmed when she began struggling to breathe and her lips turned blue.
Lilyhasaknownhistoryofchronicobstructivepulmonarydisease(COPD)andseasonal asthma, but Alex reports that she has been non-adherent to her prescribed inhalers. Alex also mentions that Lily has been smoking about 15 cigarettes per day since her teenage years and only recently began trying to quit using nicotine patches.
On arrival, Lily was visibly distressed and speaking in broken sentences due to breathlessness. She was placed on supplemental oxygen en route to the ED.
AssessmentFindings:
- Appearance: Pale,diaphoretic,andvisiblyLipsandnailbedsare cyanotic.
- Positioning: Sittingupright,leaningforwardwithherhandsonherknees(tripod position).
- Respiratory:Audible wheezing and crackles in bilateral lower lobes on auscultation. Prolonged expiratory phase noted evidenced by pursed lip
- Cardiovascular: Tachycardiawithweak
- Neurological: Alertbutfatigued,orientedtotime,place,and
- Skin: Cooland
HealthAssessmentFindingsandLaboratoryResultsatPresentation:
|
Parameters |
Results |
NormalValues |
|
HeartRate(HR) |
132bpm |
60100bpm |
|
BloodPressure(BP) |
145/90mmHg |
SystolicBP100-139mmHg; diastolic BP 60-89mmHg |
|
RespiratoryRate(RR) |
34breaths/min |
1220breaths/min |
|
Temperature |
37.8C |
36.537.5C |
|
SpO?onroomair |
85% |
>95% |
|
CapillaryRefillTime |
3seconds |
<2> |
|
ArterialBloodGas (ABG) |
||
|
pH |
7.29 |
7.357.45 |
|
PaO? |
60mmHg |
75100mmHg |
|
PaCO? |
55mmHg |
3545mmHg |
|
HCO? |
24mmol/L |
2228mmol/L |
|
WBC |
13.2x10?/L |
411x10?/L |
|
|
C-reactiveprotein (CRP) |
30mg/L |
<5> |
|
|
Lactate |
3.2mmol/L |
<1> |
|
PatientHistory:
Lily lives in a small apartment in Brisbane with her partner, Alex, and works full-time as a graphic designer. She has a 25-year history of smoking and has been diagnosed with COPD for the past 8 years. Alex states that Lily often neglects her health due to work demands.
FamilyHistory:
- Father deceased (lung cancer at age 68).
- Mother living with Type 2 diabetes
- Medical History:
- Chronic Obstructive Pulmonary Disease (COPD).
- Seasonal
- Hypertension(baselinesystolicBPisaround165mmHg)
Medicationsathome:
- SalbutamolMDI46puffsPRN(infrequentlyused).
- Fluticasone/Salmeterolinhaler(non-adherent).
- Amlodipine5mg
InitialManagementOrdersfromajuniorEDresident:
- Administernebulised salbutamol 5 mg and ipratropium bromide 500 mcg STAT.
- Titrate oxygen delivery to target oxygen saturations between 88-92%.
- Administer IV hydrocortisone 100 mg
- Perform ABG analysis 2 hours post supportive respiratory
- Strict monitoring: Hourly vital signs and respiratoryEscalate to JMO/ Senior Nurse according to hospital early warning system criteria
- Urgent chest Xray
