discuss the presenting problem and co-morbidities
Nursing Case study on asthma
Week 5
Respiratory Assessment
and Case Studies
Asthma case study
The tutorial will be conducted in two parts.
The tutor will:
give an introduction to Asthma and revisit respiratory assessment
review the clinical notes and records pertaining to Bens case study
discuss the presenting problem and co-morbidities
consider clinical terms and abbreviations
In groups students will:
discuss what is going on here? and what does it mean?
describe the physiology of the presenting symptoms
outline the subjective and objective data presented
explain physiological responses reflected by the vital signs and why they are occurring
https://binged.it/2pJIOBC
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Asthma
Common chronic inflammatory and obstructive airway disease characterised by:
Reversible
Bronchoconstriction
Oedema of airways
Mucous hypersecretion
Ænarrowing of airways leading to alveoli = air trapping/ hyperinflation of lungs = impaired
gas exchange
Triggers Risks
Allergens
Drugs and chemical
Aspirin and NSAIDs
Cold air
Exercise
Stress
Irritants (smoke)
Family history
History of allergies
Age (prevalent in children)
https://www.chrichmond.org/What-is-asthma.htm
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Pathophysiology of Asthma
Triggers
Airway inflammation
Excessive Mucus secretion
Bronchospasm/ Narrowing of airways
Airway muscle constriction Swelling of bronchial membranes
Immune activation
(IL-4, IgE production) Mast cell degranulation
Chest tightening
Wheezing
Coughing
Dyspnoea
Adapted from Brown and Edwards, 2015. p 567
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Asthma
What is Asthma Video
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http://www.frca.co.uk/article.aspx?articleid=100023
Lung function tests
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The Oxygen-haemoglobin dissociation curve
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Normal ABG values (Brown, Edwards, Seaton & Buckley, 2015)
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Case Study
PATIENT NAME:
Ben Marshall DOB: 05/03/1993 25 Years Male
PRINCIPAL DIAGNOSIS: Severe Asthma
SUMMARY OF EVENTS: Ben was out for a jog, where approximately
20 minutes into the run he developed severe shortness of breath and
tightness in the chest. An ambulance was called and transported him
to hospital.
SOCIAL: Ben, a university graduate, lives with parents and two
younger siblings. He is a very fit, young adult male who plays
competition football.
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Asthma Videos
Asthma attack
Lung Sounds
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PRESENTATION
Patient Complaints:
Severe dyspnoea
No Loss of consciousness
Meds: Salbutamol inhaler
Health History: Diagnosed with asthma as a child (age 7)
He has presented to hospital on two previous occasions for asthma
related symptoms.
Following his last admission 2 years ago he had Pulmonary Function
Tests: FEV1/PEFR 80% of predicted, PEFR variability 30%
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On Examination
Airway
Patient talking in single words, pursed lips
Breathing
Spontaneous, resting RR 34, severe dyspnoea
Short shallow breathes, with use of accessory muscles Tightness in chest Dry cough Peak expiratory flow rate ?140 ml Auscultation ?BS, with diffuse wheezes, auditory inspiratory and expiratory wheeze
Percussion: hyperresonant
SpO2 93% on 4L O2
Circulation
Resting PR128, BP 90/60, centrally warm and perfused
Elevated JVP +5 cm
Disability
GCS 15, PERL 3+
Environment
Temp 36.7, no complaints of chest pain
Fluids
RR 34, BP 90/60, resting PR128, Patient catheterized urine output low 40mls/hour
Glucose BSL 5.9 I Pulmonary function tests see above ECG Normal, no signs of ST elevation Bloods ABG: Ph7.35, PaCO2 45mmHg, PaO2 70mmHg, HCO3 24mmol, BE +4
Chest X-ray Normal, hyper-inflated with flattening of diaphragm
Bloods NAD
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Glossary of terms and abbreviations
NAD No abnormality detected
ABG Arterial Blood Gas
BP Blood pressure
ET End Tidal CO2 is the amount of CO2 in exhaled gas
GCS Glasgow comma scale
LOS Loss of consciousness
RR Respiratory rate
PERL Pupils equal and reacting to light
PMH Past or previous medical history
PR Pulse Rate
RR Respiratory Rate
SOB Short of breath
SpO2 Saturation of oxygen onto haemoglobin in arterial blood
# Fracture (L) Left (R) Right
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Group work
discuss what is going on here? and what does it
mean?
describe the physiology of Bens presenting
symptoms
the subjective and objective data presented
physiological responses reflected by the vital
signs and why they are occurring
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https://binged.it/2pL66rX
Framework for Practice Thinking
While there is a right answer now, it may be wrong tomorrow due to alterations in the information climate affecting the decisions (Siemens 2004)
What does this
mean?
What could/can be
done?
This person, this place, this
time and with these
resources
What should be
done?
Ethics/law
Resources
Personal preference
Whats going on here?
What IS
done?
So What?
Documentation
Referral
Unknowing
Ethical Knowing
Empirical Knowing
Personal Knowing
Aesthetic Knowing
Socio-Political Knowing
Adapted from KCAE,1984, & White,1990
Adapted from KCAE, 1984 & White 1990, Carper 1978, Munhall,1993, White, 1995, Chinn & Kramer, 2008, White 2013
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Questions?
https://binged.it/2GdyJYX
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Asthma Australia (2016). https://www.asthmaaustralia.org.au/qld/about-asthma/what-is-asthma-/statistics
Brown, D., Edwards, H., Seaton, L., & Buckley, T. C. T. (2015). Lewiss medical-surgical nursing : assessment
and management of clinical problems (Fourth Edition.. ed.): Chatswood, NSW : Elsevier Australia.
Craft, J., Gordon, C., Huether, S. E., McCance, K. L., Brashers, V. L., & Rote, N. S. (2015). Understanding
pathophysiology (2nd edition.. ed.): Chatswood, N.S.W. : Elsevier Australia.
Farrell, M., Dempsey, J., Smeltzer, S., & Bare, B. (2014). Smeltzer and Bares textbook of medical- surgical
nursing (Third Australian and New Zealand edition. ed.). Sydney: Lippincott Williams & Wilkins.
Fisher, M, Lecture April 4, 2018
McCance, K., Heuther, S., Brashers, V., & Rote, N. (2010). Pathophysiology: The biologic basis for disease in
adults and children (6th ed.). St. Louis: Mosby Elsevier.
McKenna, L., Lim, A. G., & Karch, A. M. (2015). McKennas pharmacology for nursing and health
professionals (Second edition. ed.). Sydney, N.S.W.: Wolters Kluwer/Lippincott Williams &
Wilkins.
Shlamovitz, G. Z. (2016). Tube Thoracostomy. Medscape; Clinical Procedures. Retrieved from
http://emedicine.medscape.com/article/80678-overview#a6
References
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