Discussion 6.1 – Case
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 â€“ 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
patientâ€™s current history?
Whom should you contact and why?
What are some factors that may affect gas exchange for this
What additional referrals might be appropriate for this
Discussion 6.2 – Case
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
Why is it important to monitor your patient using
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
Discussion 6.3 – Case
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
patientâ€™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 patientâ€™s family is concerned that the tracheostomy will
be permanent and they are worried about her image. How do you respond?