Question

Case Study Joe Ritter, a 74-year-old retired bricklayer, has a 40-pack-year tobacco history and a history of chronic obstructive pulmonary disease (COPD). Today, he presents to the emergency department in respiratory distress with shortness of breath, retracting respirations of 26 breaths/min. BP is 154/76 mm Hg, pulse is 140 beats/min, rapid and irregular and temperature is 37°C. He also complains of chest discomfort and left leg pain (8 on 0-to-10 scale). His skin color is pale gray, his chest is barrel-shaped, and he uses accessory muscles to breathe; he appears anxious and is sitting in a tripod position. His nail beds are bluish in color: his oxygen saturation by pulse oximetry is 86%. Chest auscultation reveals wheezes and decreased-to-absent breath sounds in bilateral bases. Hyperresonance is noted upon chest wall percussion. Chest x-ray showed atelectasis bilaterally in the bases. Mr. Ritter coughs with minimal amounts of clear sputum. A 12-lead ECG recorded his heart rate as 140 beats/min, rapid, and irregular with an interpretation by the physician as atrial fibrillation. Upon further exam the left lower extremity is edematous warm and tender to touch

Answer 1

Q. what ques would you ask Mr. Ritter during interview portion of health assessment related to symptoms SOB,chest pain cardiac rate and rhythm?

ANS: Self awareness is important for any disease. Only the patient know how they feel on a particular day. So during an interview health provider should ask questions like

How your breathing feels?

When you get SOB? Is it during light physical activity or even when you rest?

  Do you make strange noises while you breath?

Do you feel uneven breathing or irregular breathing?

Do you have trouble in sleeping or eating?

How long have you been this edema? is it getting worse?

Q.What findings from given senario represents abnormal objective data?

ANS: respiratory rate : 26 b/m normal 12-20 bt/min

BP: 154/70 mmhg normal : 134l87mmhg

pulse oximetry 86% is low

Q.What are your priorities in care? what could be causing his symptoms?

ANS: Monitor heart rate , respiratory rate, BP, pulse oxmetry

symptoms might be caused due to the continous exposure to the irritants or chemicals that damage your lungs.

Q. Why shortness of breath problamatiC

ANS: SOB is sometimes harmless in case of anxiety or nasal congestion. But some times it may be due to some serious underlining heart or lung disease.

  

Q. What is the significance of hyperresonance in barrel shaped chest?

ANS: Barrel chest refers to broad and deep chest. have incresed rib cage size.

Accumulation of air pockets in thoracic cavit.y

Incresed pressure in chest