Eidram0329
Case Presentation Selena is a 19 year old female patient who…
Case Presentation
Selena is a 19 year old female patient who presented to the emergency department complaining of an acute onset of shortness of breath, wheezing and feeling fatigued. She stated “my chest feels tight and I cannot catch my breath”. She reported that she was visiting her friend who has 2 pet cats prior to the episode of her asthma attack. Selena has an allergy to cats and ragweed. On assessment you noted that Selena appears to be in moderate to severe respiratory distress with 2- 3 word dyspnea.
Past Medical History
? Diagnosed with asthma at age 4 years
? Social smoker
Medications
? Salbutamol MDI 4 inhalations every 4-8 hours PRN
? Ipatropium bromide MDI 2 inhalations QID
Allergies
? Cats and ragweed ? sneezing, nasal congestion & wheezing. Physical examination findings
Blood pressure Pulse Respirations Temperature SaO2
Skin & mucous membranes
Vital Signs
140/80
120
26 laboured & shallow 36.2 0C
88% on room air
2|Page
? Flushed and diaphoretic
? Cool & clammy to touch
Respiratory
? dyspnea
? Diffuse bilateral wheezing on expiration
? Coughing +++
? Decrease breath sounds to the bases of the lungs
? Use of accessory muscles prominent
Cardiovascular
? Heart sounds are normal ? tachycardia
Extremities
? peripheral pulses 2+ bilaterally in all extremities
? extremities clammy on palpation
? cap refill < 2sec Gastrointestinal ? no nausea & vomiting ? no abdominal pain Laboratory Results White blood cell count Reb blood cell Serum sodium Serum chloride Serum potassium Blood urea nitrogen (BUN) Serum Creatinine 12.0 × 109 /L 4.8 X 1012/L 135 mmol/L 98 mmol/L 3.8 mmol/L 7.0 mmol/L 100 µmol/L 4.0-10.0 × 109 /L 4.0 - 5.2 X 1012/L 135-145 mmol/L 98 - 106 mmol/L 3.5-5.0 mmol/L 2.5-8.0 mmol/L 70 - 120 µmol/L Tests Results Normal value 3|Page Chest X-ray ? hyperinflated lungs with no indication of an infection/pneumonia Diagnosis Selena was diagnosed with acute asthmatic exacerbation. She was ordered the following medications: ? salbutamol (Ventolin®) 5 mg q1hr PRN by nebulizer ? Ipatropium bromide (Atrovent®) 500 mcg by nebulizer PRN (max. 3 doses) ? Prednisone 50 mg po Discussion Questions What is the most likely trigger of Selena`s asthma attack? What type of asthma is she experiencing- extrinsic or intrinsic? Explain your answer in detail. Provide the pathophysiology of how airway obstruction develops in Selena with the type of asthma exacerbation identified in Question 1. What are the three (3) pathophysiologic changes related to inflammation during an acute attack would you expect in the patient. Explain in detail. Provide a detailed rationale for the abnormal vital signs noted in your patient on physical examination. List the signs and symptoms in your patient that is indicative of an acute asthmatic attack. The patient's chest x-ray reported hyperinflated lungs. Explain the pathophysiology for this finding in the patient. Explain each medication in detail (mechanism of action, therapeutic effect and side effect) in the treatment and management of Selena's asthmatic exacerbation. References Please.
