EEC 1734 Test 1 Study Guide M1S1 Children’s Well Being

For each of the following cases, identify one or two likely conditions based on the data. Most importantly, include your rationales as to why you chose that disorder. Lastly, discuss any additional interventions needed to confirm the diagnosis. Case #1: M.N., age 40, was admitted with acute cholecystitis. After undergoing an open cholecystectomy, she is being admitted to your surgical floor. She has a nasogastric tube to continuous low wall suction, one peripheral IV, and a large abdominal dressing. Two days later her morning vital signs are: blood pressure 148/82 mm Hg; heart rate 118 beats/min; respiratory rate 24 breaths/min; temperature 100° F (37.7°C); SaO2 88%. You auscultate decreased breath sounds and fine crackles in the right base posteriorly. Her right middle and lower lobes percuss slightly dull. She splints her right side when attempting to take a deep breath. She does not have a productive cough, chest pain, or any anxiety. Case #2: The sister of C.K. brought her 71-year-old brother to the primary care clinic after he came down with a fever 2 days ago. She said he has shaking chills, a productive cough, and he can’t lie down to sleep because “he can’t stop coughing.” Your assessment findings are as follows: C.K.’s vital signs are 154/82, 105, 32, 103° F (39.4° C), SaO2 84% on room air. You auscultate decreased breath sounds in the left lower lobe anteriorly and posteriorly and hear coarse crackles in the left upper lobe. His nail beds are dusky on fingers and toes. He has cough productive of brown-colored sputum and complains of pain in the left side of his chest when he coughs. He is a lifetime nonsmoker. Past medical history includes coronary artery disease and myocardial infarction (MI) with a stent; he is currently on metoprolol, amlodipine, lisinopril, and furosemide; for his type 2 diabetes mellitus, he is also taking metformin and rosiglitazone. Case #3: A.W., a 52-year-old woman disabled from severe emphysema, was walking at a mall when she suddenly grabbed her right side and gasped, “Oh, something just popped.” A.W. whispered to her walking companion, “I can’t get any air.” Her companion yelled for someone to call 911 and helped her to the nearest bench. By the time the rescue unit arrived, A.W. was stuporous and in severe respiratory distress. She was intubated, an IV of lactated Ringer’s (LR) to KVO (keep vein open) was started, and she was transported to the nearest emergency department (ED). On arrival at the ED, the physician auscultates muffled heart tones, no breath sounds on the right, and faint sounds on the left. A.W. is stuporous, tachycardic, and cyanotic. The paramedics inform the physician that it was difficult to ventilate A.W. Case #4: D.Z., a 65-year-old man, is admitted to a medical floor for shortness of breath. He has a past medical history of emphysema and hypertension, which has been well controlled by enalapril for the past 6 years, has had pneumonia yearly for the past 3 years, and has been a 2-pack-a-day smoker for 38 years. He appears as a cachectic man who is experiencing difficulty breathing at rest. He reports cough productive of thick yellow-green sputum. D.Z. seems irritable and anxious; he complains of sleeping poorly and states that lately feels tired most of the time. His vital signs (VS) are 162/84, 124, 36, 102 ° F, SaO2 88%. Wheezing and diminished breath sounds are auscultated bilaterally. Per the rubric, a thoughtful initial response and at least one peer response are required before the due date.

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