A Case Study of Clients

with Mild Oxygenation

Problem

Submitted by:

Kaycee Ann Arevalo

CA1 BSN-4 NB

Submitted to:
Mildred Pinque, RN, MN
Philip Eli Nalzaro, RN, MN
Renzi Pepito, RN, MN
Lenny Baguio, RN, MN
Mary Grace Paayas, RN, MAN

July 8, 2016

Case Study:

A 24 year old hyperventilating woman came in ER Department. She is breathing calmly.

However, as you recheck her periodically, she says she still feels a little short of breath.
SpO2=98% on room air. You notice that her heart rate is 105 bpm and her respiratory rate is
24-28 each time you check. She denies any URI, flu, or asthma. She does smoke and takes
oral contraceptives. She became aware of her breathing during the last portion of her fifteen
hours of airplane flight and layovers while returning this morning from her vacation. She
thought it was just because she really doesnt like flying.
Reaction:

Given with this case, it is important to rule out what is currently happening with the
patient. Health care providers should immediately conduct a thorough assessment as well as to
consider risk factors to determine the disease condition of the patient so that it can be
immediately resolve and be treated. With this case, patient is currently hyperventilating but
breathing calmly with an SpO2 of 98% and a RR of 24-28 bpm and verbalizes feels a little
short of breath. No URI, flu, or even asthma. She is a smoker and takes oral contraceptives.
As always, assessment and stabilization of the patients airway, breathing, and circulation are
paramount. Application of high-flow supplemental oxygenation, establish peripheral
intravenous access and monitor vital signs is indicated for initial intervention of healthcare
providers. After thorough assessment and laboratory studies performed such as Chest X-ray,
ECG/EKG, and Blood studies such as ABG Analysis; it was found out that the patient is
currently experiencing pulmonary embolism which is evident of the signs and symptoms of
tachypnea, shortness of breath, and rapid or irregular heartbeat. Later on, the patient begun to
manifest signs and symptoms of cyanotic skin coloration, chest pain, excessive sweating,
wheezing, hypotension and decrease level of consciousness. In addition to the assessment,
patient is a smoker; for some reasons, smoking predisposes some people to blood clot
formation, especially when combined with other risk factors which the patient is currently
taking oral contraceptives. Researches shows that birth control pills and in hormone
replacement therapy can increase clotting factors in the blood, especially if you smoke or are
overweight. After confirming the diagnosis of patients current state of condition with the
newly discovered signs and symptoms, patient will then immediately undergo for an
anticoagulant or thrombolytic therapy. These stop the blood clot getting bigger while your
body slowly reabsorbs it, and reduce your risk of further clots developing. Also, this does not
lessen clot burden initially, but it does prevent any extension of a clot and allows the bodys
own fibrinolytic processes to dissolve an existing clot. As part of the treatment, you'll need
regular blood tests to check that the dose of warfarin you're receiving is correct. If the dose is
too high you may experience bleeding and if it's too low you may have further blood clots.
Most patients will be advised to avoid long periods of inactivity. Blood clots are more likely to
form during periods of inactivity, such as: Bed rest, being confined to bed for an extended
period makes you more vulnerable to blood clots. When the lower extremities are inactive for
long periods, the flow of venous blood slows and blood can pool in the legs. Another is Long
trips, sitting in a cramped position during lengthy plane or car trips slows blood flow in the
legs, which contributes to the formation of clots. Patient should ambulate and do short walks
more often and do simple leg exercise frequently such as regularly flexing your ankle, if not
contraindicated to the patients condition. In addition, patient can also wear elastic compression
stockings and cessation of smoking can also prevent the blood from clotting and put you into
higher risk which could lead to possible death. Other intervention for Pulmonary Embolism is
undergoing surgical management which is called Catheter Embolectomy or Placement of Vena
Cava filters, if and only if the primary health care provider suggest so, cause they are
weighing the advantages and disadvantages of the individual cases of each patient.
Questions:

1. Which of the following is a normal finding in the aging adult?

A. Anteroposterior diameter increases
B. Residual volume decreases
C. Airways close late
D. Ability to cough increases

2. Which clinical manifestation is the main sign of lung disease?

A. Dyspnea
B. Hemoptysis
C. Cough
D. Hoarseness

3. While the nurse interviews a patient, he verbalizes that he has difficulty breathing during
sleep and uses three pillows for relief. The nurse notes that he may be experiencing :
A. Paroxysmal nocturnal dyspnea
B. Orthopnea
C. Hyperventilation
D. Claudication

4. A 37-year-old patient is admitted to the ED with dyspnea, tachypnea and pink, frothy
sputum. The nurse determines that the patient is experiencing:
A. Lung abscess
B. Neck trauma
C. Cor pulmonale
D. Pulmonary embolism

5. A nurse is administering oxygen to a patient who has hypoxemia and hypercarbia. Which
oxygen delivery system is appropriate for this patient?
A. Nonrebreather mask
B. Nasal cannula at 2L/min
C. Nasal cannula at 4L/min
D. Simple facemask at 5L/min