Hadi Ghazini is 19yo. He has recently
Hadi Ghazini is 19yo. He has recently come to Australia to go to university. He lives with his aunt and uncle. It is October, the grasses are flowering, and cricket season has started. He has been brought to the local urgent care centre by his uncle because he has become increasingly breathless, with a cough, over the past two days. Collect cues Medical history: No previous surgeries Recent presentation to medical clinic with breathlessness which developed during cricket training. At the time allergic rhinitis (hayfever) was also identified. Lung function test results six weeks ago: FEV1/FVC 72% 10 minutes post administration of a bronchodilator FEV1/FVC 86% Current medications: budesonide (inhaled corticosteroid) 100 micrograms by inhalation via dry powder inhaler: 1 dose twice daily salbutamol (beta-2 adrenergic agonist) 100 micrograms by inhalation via pressurised metered dose inhaler (pMDI) with spacer: 2 doses as required and prior to exercise. Physical assessment: Respiratory rate = 30 bpm SpO2 = 92% (room air) BP = 130/85 mmHg: MAP 100 mmHg Heart rate = 98 bpm Temp = 36.2oC Respiratory assessment: Non-productive cough Complaining of dyspnoea States he is feeling exhausted Inspection: accessory muscle use, respirations shallow, pausing during sentences to “catch his breath”, pallor Auscultation: equal air entry with expiratory wheeze Venous blood gases: pH 7.31 (ref range: 7.31 – 7.41) pO2 28 mmHg (ref range: 30 mmHg – 40 mmHg) pCO2 53 mmHg (ref range: 41 mmHg – 51 mmHg) Bicarbonate 26 mmol/L (23 – 29 mmol/L) Actions salbutamol (beta-2 adrenergic agonist) 100 micrograms by inhalation via pMDI with spacer: 6 doses every 20 minutes ipratropium (anticholinergic/muscarinic antagonist) 21 micrograms by inhalation via pMDI with spacer: 8 doses every 20 minutes prednisolone (corticosteroid) 50mg orally; once daily for next 5 days Case study of Hadi Ghazini SCIENCE HEALTH SCIENCE NURSING CNC 240
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