NURS 6550 Week 5: Conditions of the Respiratory System

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NURS 6550 Week 5: Conditions of the Respiratory System

Victor, a 40-year-old patient, presented to the emergency department with complaints of a high fever and breathing difficulty. Although his symptoms were typical for common respiratory conditions, the underlying cause was much more serious. After Victor lost consciousness and fell into a coma, it was discovered that he had bilateral pneumonia and acute respiratory distress syndrome (ARDS). What had begun as a quick visit to the emergency department for breathing difficulty resulted in a lengthy hospital stay and months of rehabilitation (Sharp Healthcare, 2014).

As Victor’s case demonstrates, patients who present to acute care settings with respiratory problems require immediate attention, because symptoms may worsen quickly and lead to severe health outcomes. In your role as advanced practice nurse, you must identify patients who may be at risk of serious underlying health conditions and respond appropriately.

This week, you will explore presentations of respiratory conditions in acute care settings, you will examine strategies for assessing, diagnosing, and treating patients with respiratory conditions.

Learning Objectives

By the end of this week, students will:

• Evaluate patients with respiratory conditions
• Develop differential diagnoses for patients with respiratory conditions
• Develop treatment plans for patients with respiratory conditions

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Discussion: Respiratory System

For this discussion you will select one of the following case studies. You will then discuss pertinent differential diagnoses and identify a leading diagnosis. Consider treatment strategies and develop a management plan for the patient. Please state appropriate dosages for any recommended pharmacologic interventions and/or provide specific orders for nonpharmacologic treatments. Discuss age specific strategies for educating patients and families on the respiratory disorder and the management plan.

Case #1

A 44 year old man seeks treatment due to sudden onset of shaking chills, fever, and productive cough. He states he has had some nasal congestion and achiness for about 1 week but was fine before that. The fever and chills started last night. He has had a couple of coughing fits and produced some yellow colored sputum. He has smoked 1 pack per day for 15 years. He normally does not take any medications. The patient is allergic to PCN and Keflex. 

Physical Exam: BP 132/77 HR 88 RR 20 T 102 oxygen saturation 100%

S1S2 regular rate and rhythm. No murmur, gallops, or thrills

Lungs are clear except for bronchial breath sounds and end inspiratory crackles in the R lower lobe.

Case #2

A 26 year old with history of asthma is brought to the ED by ambulance with complaints of severe shortness of breath that began about 30 minutes ago. The patient is unable to talk due to her SOB. EMS states they were called to her home by her mother. An albuterol inhaler was present and she has tried to use it twice. 

PE BP 140/78 HR 92 RR 34 T 98.2

Extremely short of breath and anxious

S1S2 with normal rate and rhythm

Expiratory wheezes are heard throughout the lung fields.

Case #3

A 38 year old woman is admitted for repair of a fracture left wrist. Patient states that she has a 3 month history of non-productive cough that has continued to get worse. The cough is nonproductive and worse at night or after exercise. She has gotten progressively more short of breath during her exercise routine and has had to stop exercising after 20 minutes due to coughing fits. She has never smoked and denies any nasal congestion, headache, fever, or weight loss. 

PE BP 134/87 HR 82 RR 22 T 98.2

S1S2 with normal rate and rhythm

Lungs are clear with expiratory wheezes heard in the bases

Chest x-ray is normal.

Case #4

A 58 year old man arrives in urgent care center with complaints of shortness of breath. He states that he has been short of breath in the past but only on exertion. He has become more short of breath over the past few months with in occurring at rest now. Over the past several nights, he has slept in the recliner. He reports a productive cough and usually the sputum is white in color. He has smoked 2 packs per day for 15 years. He does not have a primary physician or health insurance. He came in today because he couldn’t catch his breath this morning and got scared. 

PE – BP 135/85 HR 96 RR 28 T 97.6

He appears uncomfortable with labored respirations and cyanotic lips.

No lymphadenopathy, carotid bruits, or JVD. He is using accessory muscles to breath.

Wheezes and rhonci notes throughout all lung lobes.

S1S2 regular rate and rhythm.

No cyanosis, edema, or clubbing of the extremities.

Case #5

A 21 year old male who comes to the ER complaining of left sided rib pain with increasing shortness of breath over the last 24 hours. He has a non productive cough and T is 100.8 orally. He was recently released from the hospital after a motorcycle accident in which he sustained a clavicle fracture, and 2 left sided rib fractures, and a cerebral contusion.

On exam he appears cyanotic, has respiratory distress and inspiratory crackles over the left base. Current weight is 205 lbs. Height is 6’0” 

VS – BP 106/88 P 98 RR 38 T 102

Labs results:

• FIO2 0.21      Hb 14
• pH 7.56      Na 140
• pCO2 25      K 4.2
• PO2 40      Cl 106
• HCO3 20      CO2 20
• SaO2 78%
• Hg 12.6
• WBC 15,000

Case #6

A 65-year-old female suddenly becomes hypotensive one day following surgery for a fractured femur. Her ABG before surgery on room air showed a PaO2 of 84 and PaCo2 of 39. Current ABG is 

• FIO2 0.21      Hb 11.5
• pH 7.47
• pCO2 32
• pO2 57
• HCO3 23
• SaO2 83%

Case #7

Mr. B is a 65-year-old male brought to the ER with moderate respiratory distress. He smokes 2 packs of cigarettes daily X 45 years. He has severe COPD. Stated he was doing pretty good until two days ago when he developed a cough and dyspnea. ABGs results:

• FIO2 0.21      Hb 17
• pH 7.36      Na 140
• pCO2 60      K 4.2
• pO2 35      Cl 91
• HCO3 33      CO2 35
• SaO2 51%

Case #8 (Continuation of #7)

Mr. B does well on your regimen, but six hours later he is much less alert, falls asleep easily and responds only when vigorously stimulated. You repeat his ABGs: 

• pH 7.10
• pCO2 80
• pO2 40
• HCO3 24
• SaO2 64%

To prepare: NURS 6550: Advanced Practice Care of Adults in Acute Care Settings I Essay

• Select and review 1 of the 8 case studies provided. Analyze the patient information.
• Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
• Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.
• Consider strategies for educating patients and families on the treatment and management of the respiratory disorder.

Post on or before Day 3 the case you selected along with a discussion of the pertinent differential diagnoses and a leading diagnosis. Present treatment strategies and a management plan for the patient. Please state appropriate dosages for any recommended pharmacologic interventions and/or provide specific orders for nonpharmacologic treatments. Finally, discuss age specific strategies for educating patients and families on the respiratory disorder and the management plan.

Read a selection of your colleagues’ responses.

Respond on or before Day 6 to at least two of your colleagues on two different days who selected a different case study than you. Share additional insights or alternative perspectives.

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Assignment 1: Assessing, Diagnosing, and Treating Conditions of the Respiratory System

Many respiratory conditions have common symptoms and are often the result of underlying health disorders. Therefore, to ensure proper diagnosis, it is essential for advanced practice nurses to perform comprehensive assessments when patients present with respiratory complaints. For this Assignment, as you examine this week’s i-Human patient case study, consider how you might evaluate and treat patients presenting with respiratory conditions.

To prepare:

• Review this week’s Learning Resources. Consider how to assess, diagnose, and treat conditions of the eye, ear, nose, and throat.
• Review this week’s i-Human case studies. Based on the patient information provided, think about the health history you would need to collect from the patient
• Consider what physical exams and diagnostic tests would be appropriate to help you gather more information about the patient’s condition. Reflect on how the results would be used to make a diagnosis.
• Identify three to five possible conditions to consider in a differential diagnosis for the patient.
• Consider the patient’s diagnosis. Think about clinical guidelines that might support this diagnosis.
• Reflect on a treatment plan for the patient that includes health promotion and patient education strategies.

To complete:

As you interact with this week’s i-Human patient, complete the assigned case study. For guidance on using i-Human, refer to the i-Human Patients Case Player Student Manual in the Week 1 Learning Resources.

By Day 7

This Assignment is due.

Assignment 2: Midterm Practicum Evaluation

By Day 7

Submit your Midterm Practicum Evaluation to Meditrek.

Assignment 3: Board Vitals

This week you will be responding to twenty Board Vitals questions that cover the following topics:

• Respiratory System

NURS 6550 Week 5: Conditions of the Respiratory System

More NURS 6550: Advanced Practice Care of Adults in Acute Care Settings Walden Essays :

NURS 6550 Week 1: Medicolegal Considerations and the Role of the Advanced Practice Nurse

NURS 6550 Week 2: Psychosocial Health Conditions

NURS 6550 Week 3: Conditions of the Eye, Ear, Nose, and Throat

NURS 6550 Week 4: Conditions of the Cardiovascular System

NURS 6550 Week 5: Conditions of the Respiratory System

NURS 6550 Week 6: Conditions of the Gastrointestinal System

NURS 6550 Week 7: Conditions of the Genitourinary, Gynecologic, and Renal Systems and Acid/Base Disorders

NURS 6550 Week 8: Conditions of the Endocrine System and Infections

NURS 6550 Week 9: Conditions of the Skin and Musculoskeletal System

NURS 6550 Week 10: Conditions of the Neurologic System, Pain, and Toxic Exposures

NURS 6550 Week 11: Conditions of the Hematologic, Lymphatic, and Immune Systems