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Emergency Nursing Case Study

   

Added on  2021-04-17

10 Pages2451 Words84 Views
Running head: EMERGENCY NURSING CASE STUDYEmergency Nursing Case StudyName of StudentName of UniversityAuthor Note

1EMERGENCY NURSING CASE STUDYQuestion 1(a)The patient came into the emergency unit and was diagnosed with Chronic obstructivepulmonary disorder stage II (COPD). The patient was visibly distressed and could not speak insentences. The patient could only breathe with the help of accessory muscle and had prolongedexpiratory phase (Miravitlles, 2014). The Spirometric results showed that the patient’srespiratory rate was 28 beats per minute (bpm). The oxygen saturation of the patient was verylow, about 75%,. The pulse rate was 12bpm with sinus tachycardia. The blood pressure was183/97mmHg, which is very high, and the thermal temperature was hypothermic; about 38.1°C.The auscultation results also revealed inspiratory and expiratory wheezing and presence ofcrackles on the lower side of the right lung (Seeger et al., 2013). It is commonly observedsymptoms of people with COPD. COPD is also characterized by chronic bronchitis likesymptoms and emphysema in lungs. The patient’s tongue seemed bluish which is a symptoms ofthe “blue bloater” variant of COPD. The patient was administered with Bilevel positive airwaypressure. Which would allow the patient to inhale oxygen under the pressure of the systems andexhale without difficulty. (b)The analysis of arterial blood gas analysis reveals the hemodynamic condition of the respiratorycompartment. The test results of Arnold showed that his pulmonary compartment pH was 7.23which is a little high and the CO2 saturation is 78mmHg, which is quite high and partial oxygenpressure in lungs is 55mmHg. This causes the imbalance in the CO2 release (Byrne et al., 2014).The oxygen was not being able to compensate for the excess of carbon dioxide, which created an

2EMERGENCY NURSING CASE STUDYacidic environment in the pulmonary cavity. The base excess signifies that there not many non-carbonic ions to compensate the excess CO2 which further enhances the acidity of thecompartment (Vestbo et al., 2013). The breathing trouble is induced by the acidic condition ofthe respiratory cavity since the hypoxic condition is pressurizing the pulmonary myocytes andthat creates shortness of breath. The hemodynamic load present in the pulmonary cavity causesthe respiratory vessel to constrict and disruption of erythrocytes occurs, which causes theoverload to fluid in the respiratory cavity. The hemodynamic overload also causes the pulmonaryand arterial hypertension condition as seen in case of Arnold. The right ventricle of the heart failsin this condition due to excess overload and that causes the jugular vein hypertension, peripheraloedema, hepatic congestion and auscultations (Nasis et al., 2015). (c)The triage assessment of the patient in the emergency department showed that Arnold seemedvisibly distressed and drowsy. The patient had no sense of time or place. Assessment of theGlasgow Coma score was 13/15 with the eye opening score: 3; verbal response: 4; motorresponse: 6. The eye opening response of the patient suggested spontaneity, the verbal responseindicated confusion and motor response showed that the patient was able to follow the commandof the prompter. The overall score of the patient was analysed to be cause mild disorientation inbrain function (Reith et al., 2016). Even after arrangement of the intravenous line to improve thepatient’s health, the patient’s consciousness started to deteriorate and the coma score was then10/15. The eye opening was 3; verbal response was 2 and motor response was 5. Thesignificance of the score was that the eye opening was possible only after hearing the prompter’svoice, verbal response of the patient agitated and gutted and the motor response was localisedand reluctance to touching. The overall analysis of the GCS was found to be 10, which is

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