Ms Amy Apple, 23 years old, presents to the Emergency Department in the early phase of an acute asthma attack. She is complaining of spasms in her chest, chest tightness and has an audible wheeze. She is dyspnoeic and is coughing despite being in the highFowler’s position. Her vital signs are:
Blood pressure: 150/90 mm Hg
Pulse: 126 bpm
Respirations: 30 and shallow
Temperature: 37.3 C What is the significance of Ms Apple’s Emergency Department test results?
NURSING CASESTUDY
Assessment 2 Case study
Format dissertation
Due date 11/10/2015 (Week 10)
Weighting 35%
Pass mark N/A
Length 2,000 words
Details Ms Amy Apple, 23 years old, presents to the Emergency Department in the early phase of an acute asthma attack. She is complaining of spasms in her chest, chest tightness and has an audible wheeze. She is dyspnoeic and is coughing despite being in the highFowler’s position. Her vital signs are:
Blood pressure: 150/90 mm Hg
Pulse: 126 bpm
Respirations: 30 and shallow
Temperature: 37.3 C
She is given Ventolin 5 mg via the nebuliser and IV therapy 5% dextrose is commenced at 100 ml/hour. An arterial blood gas (ABG) is done and her results are pH 7.49, pO2 74 mmHg, pCO2 22 mmHg, HCO3- 22mEq. Her pulse oximetry reading is 92%. Sputum and blood tests reveal elevated levels of eosinophils and elevated IgE. Oxygen via nasal prongs at 2 L/minute is commenced. Ms Apple continues to complain of chest tightness so a stat dose of Atrovent is administered and aminophylline 1 g in 100 ml of 5% dextrose IV fluid is commenced over 1 hour.
The patient progresses to status asthmaticus. Adrenaline 0.5 ml of 1:1000 SC is given, resulting in temporary relief of the symptoms. She is ordered hydrocortisone 100 mg IV bolus in 50 ml 5% dextrose stat. She is transferred to the Intensive Care Unit (ICU) in a stable condition.
Her laboratory results in ICU are:
Serum glucose: 5.0 mmol/L
Blood urea nitrogen: 6.2 mmol/L
Serum creatinine: 68 micromol/L
Serum sodium: 136 mEq/L
Serum potassium: 4.5 mEq/L
WBC count 8,000/mm3
RBC count 4,400,000/mm3
Platelet count: 300,000/mm3
Haemoglobin: 132 g/L
Haematocrit: 34.7%
Initial pulse oximeter reading: 85%
Current arterial blood gas: pH 7.32, pO2 55 mm Hg, pCO2 60 mm Hg, HCO3- 27 mEq FEV1/FVC: 65%1. What is the significance of Ms Apple’s Emergency Department test results?
2. What is the significance of her test results in the Intensive Care Unit?
3. What are the purposes of her prescribed medications?
4. What are the most common adverse events (side effects) of her prescribed medications, and what are the potential drug-drug, and drug-food/herbal interactions of her prescribed medications?ASSIGNMENT OBJECTIVES
1. Students will develop and demonstrate knowledge of the significance of laboratory results for a given disease.
2. Students will demonstrate an appreciation of the purposes of selected medications.
3. Students will indicate an understanding of the common side effects and potential drug interactions involving these medications.
Submission
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Students are also expected to keep a copy of all their submitted assignments in the event that re-submission is required.
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