Question

Jef with Acute Hypoxemic Respiratory failure. He is 52-year-old presented to the emergency department with a 10-day history of slight fever followed by rapidly progressive dyspnea for 3 days prior to admission. He indicated to the at-tending physician that he had always kept himself in good health and "very fit." He did admit to a loss of his usually good appetite and was unable to work for the past few days due to shortness of breath, overall weakness, and a slight sore throat_ A nonsmoker, he denied the use of alcohol and had no prior history of any medical illness other than borderline high blood pressure. He is 6 feet 2 Inches and weighs 195 lb.

On observation: The patient appeared to be in moderate-to-severe respiratory distress with mild central cyanosis. Vital signs showed a temperature of 101.0°F, resting respiratory rate of 30 breaths/ minute, and blood pressure of 100/65, Breath sounds revealed extensive fine Inspiratory crackles, Physical examination of the heart revealed a resting tachycardia of 120 beats/minute. The patient was immediately given supplemental oxygen via a nasal cannula at 4 L/ minute, and pulse oximetry revealed a saturation of 86%. An arterial blood as (ABC) test while receiving oxygen at 4 L/minute showed a pH of 7.48, Paco2 23 tom Pao2 48 torr, HCO-3 20 mEq/L, and Sao2 85%. A complete blood count (CBC) drawn in the emergency department revealed a hemoglobin level of 14.4 g/L. The patient had a white blood cell count of 30,000/mm³ with 84% neutrophils, 9% lymphocytes, 5% monocytes, and 2% eosinophils. A portable chest x-ray taken in the emergency department revealed diffuse bilateral alveolar infiltrates with normal cardiac size. After the ABC test, the patient received a non-rebreather mask at 12 L/minute and broad-spectrum intravenous antibiotics (erythromycin and levofloxacin). Because no significant improvement was noted clinically or with ABC measurements over the next 12 hours, the patient was transferred to the intensive care unit (ICU), with the anticipation of the need for mechanical ventilation. In the ICU, the patient was placed on continuous positive airway pressure (CPAP) with an initial setting of 5 cm H2O and an Fio2 of 60%. Within 1 hour of starting CPAP, there was a drastic improvement in the respiratory rate (falling from 30 to 18 breaths/minute) in addition to a significant improvement in ABCs. There were additional CPAP adjustments, with maximum CPAP of 8 cm I-120 administered during his hospital stay. Gradually, clinicians brought the level of CPAP down over several hours, as the patient's clinical condition and ABCs showed progressive improvement. He was discharged after a 12 day hospital stay, achieving a satisfactory ABG result on room air and advised to continue erythromycin for an additional period of 3 weeks. On 1-month follow-up, the patient was asymptomatic, with complete clearing of the previously noted infiltrate on standard chest x-ray.

1-List Subjective data of case scenerio ?

2- Objective ?

3- Vital signs ?

4-plan care ?

5- patient education?

Answer 1

1) Subjective data:

-Fever for 10 days

- dyspnea for 3 days

- loss of appetite

- shortness of breath

- overall weakness

- sore throat

2) The objective is that :

Mr. Jeff with maintain a normal saturation level without oxygen support and will recover from respiratory distress.

3) vital signs:

Temperature - 101 degree F

Respiratory rate - 30 breaths / mt

Blood pressure - 100/ 65 mmHg

Heart rate- 120 beats/ mt

4) Care includes the following:

* Administering oxygen via CPAP to minimize the respiratory distress and improve the breathing pattern

* Monitoring vitals signs to identify any abnormalities

* Administering Antibiotics as per order to prevent infections

* Administer Antipyretics to reduce the temperature

* Assist the Patient in doing the activities of daily living as he is in distress and in bed rest

* Teach him deep breathing exercises as it helps in lung expansion and better oxgenation

* Keep the patient on Nil per oral status and administer IV fluids as per order because taking orally while in distress can lead to aspiration.

* Monitor the blood test daily to assess for any improvement

* Provide him psychological support as he can be anxious

* At the time of discharge, explain him the importance of regular medicine and follow up

5) Patient education includes:

* Educate him on the need of oxygen therapy and antibiotic therapy

* Teach him deep breathing exercises

* Teach him the symptoms and complications of his disease

* Tell him to report any difficultly in breathing inspite of administering oxygen.

* Educate him about the need of taking his medications and follow up

* Educate him on lifestyle modification

* Advice him to maintain his blood pressure within normal limits and to maintain a healthy lifestyle