Question

Group 2-ABGs

You are the R.N. caring for a 72-year-old woman with severe emphysema. Today she was walking at a mall when she suddenly grabbed her right side and gasped, “Oh, something just popped.” She whispered to her walking companion, “I can't get any air.” Her companion yelled for someone to call 911 and helped her to the nearest bench. By the time the rescue unit arrived, she was stuporous and in severe respiratory distress. She was intubated, started on intravenous lactated Ringer's at KVO (keep vein open), and transported to the nearest emergency department (ED). On arrival at the ED, you auscultate muffled heart tones, no breath sounds on the right, and faint sounds on the left. She is stuporous, tachycardiac, and cyanotic. The paramedics inform you that it was difficult to ventilate her. A portable chest x-ray (CXR) examination shows an 80% pneumothorax on the right.

Arterial Blood Gases (ABGs) on 100% O2:

pH	7.25
PaCO2	92 mm Hg
HCO3	27 mEq/l
PaO2	32 mm HG
SpO2	53%

1. Explain the most important areas you need to evaluate during your physical assessment? (USLO 1,6)

Answer 1

Pneumothorax is an accumulation of air or gas in the pleural space which can impair with ventilation,oxygenation or both.The patient may hav a normal physical assessment .if the pneumothorax is small.But here ,with large enough pneumothorax,there may be absent breath sounds on the right side,hyperresonance with percussion 9the side with the pneumothorax will resonate more),Breath sounds are reduced or absent on the affected side,The lower edges of the liver may be shifted inferiorly with a right -side pneumothorax,Check trachea that may be shifted toward the contralateral side if the pneumothorax is large.

Physical Assessment

-Appearance of the patient(Skin,Neck-jugular vein distension,lungs,heart,abdomen,Genito urinary,extremities-evaluate cyanosis)

Inspection :-Tracheal deviation,Distended neck vein,Unilateral chest movements.

Palpation :-Absent tactile fermitus

Percussion :-Hyper tympanic sound over the affected side,Hyperresonance

Auscultation :-Reduced or absent breath sound on right side.

-Assess the vital signs

-assess the patient airway,breathing,circulation