Question

1. A 20 year old male complains of sudden onset shortness of breath at 24 times per minute and his pulse aximetry is 85%

aCoach him on slowing his rate of respiration

bApply oxygen via nasal cannula at 4lpm - correct

cAdminister oxygen via nonrebreather mask at 15lmp

dVentilate the patient at a rate of 12 breaths per minute

2.A thin 75 year old male complains of difficulty breathing. He states he has smoked "3 packs of cigarettes a day for 30 years." He has bilateral wheezes

aLung cancer

bChronic bronchitis

cEmphysema

dAsthma

Answer 1

1.

Here, this young guy has only complaints of 85% of oxygen saturation in pulse oximetry.his breathing pattern is normal.so the best treatment is

B, apply oxygen via nasal cannula at 4 lpm

Nasal cannula is used when patient requires a low or medium concentration of oxygen. Suggested flow rate is 1- 6 lpm. More than that may cause drying of nasal mucosa.as the patient's breathing changes the amount of inspired oxygen also changes.

A non rebreather mask is not needed in this case .non rebreather mask ensures 100 % oxygen but the flow rate is 12 lpm , so it would be better for some more complicated condition.

Also ,no need to ventilate this patient as he can breath normally.

2. This old man has history of chronic smoking.so the most likely disease would be

C , emphysema , in which an abnormal distention of the airspaces beyond the terminal bronchioles and destruction of the walls of the alveoli.this will impair oxygen diffusion,which leads to hypoxemia.In this condition patient has clinical manifestations of hyperinflation chest,marked dyspnea on excertion and weight loss.

In lung cancer , wheezing would be unilateral in most cases.in chronic bronchitis it is rhonchi as chronic bronchitis is end stage of COPD, chronic obstructive pulmonary disease.