case study question

/in /by

Mrs. Kendall is an 81-year-old female from
nursing home brought in by ambulance to ED
at 0500hrs.Ventolin nebulisers given enroute.
Severe SOB, productive cough. Denies any
urinary or bowel symptoms, fever or chest pain.
Appears unwell. Pleasantly confused, thinks
she is 42 years old.
• Poor historian? Due to confusion.
• Past Medical History: IHD – multiple
NSTEMI’s, Previous ICU admissions for
exacerbation of asthma, Atrial Fibrillation, DM,
dementia, HFpEF- previous admission for APO
last year.
• On anticoagulation- Apixaban. On digoxin.
• Spirometry 3 months ago demonstrated
restrictive defect.
• Fully vaccinated against COVID

 

ASSESSMENT
Airway. – Patent, unable to speak in full sentences.
Breathing. – Spontaneous, RR-30/mt, SPO2-95% on 4L NP, was on 15L NRB weaned, bi-basal crepts,
widespread wheeze, moderate work of breathing.
Circulation- Appears flushed, tepid peripheries, BP-195/155 mmHg, HR- 120/mt, irregular,
b/l pitting pedal edema+++, peripheral edema- upto 2/3 shins b/l
Disability – GCS-14 E4V4M6, not oriented to time, place or person, PEARL- 2mm.
Exposure – Temperature 37.8 deg Celsius. Abdomen soft and non-tender, b/l pitting pedal edema+++,
peripheral edema- up to 2/3 shins b/l,
Fluids – Unable to tolerate oral fluids, on 1.2 L fluid restriction
Glucose – BGL- 13.7

 

INVESTIGATIONS
• ABG: pH: 7.34, PaO2- 66 mm Hg, PaCO2- 32 mmHg, HCO3: 16 mmol/L, Base Excess: –
(minus)8.1mmol/L, Lactate: 1.5 mmol/L
• Bloods: Hb- 120 gm/L, WCC: 10.3×10^9/L, digoxin level: <0.1 μg/L, Troponin I: 96 ng/mL
• CXR: wet, APO, upper lobe diversion
• ECG: some p waves visible, irregularly irregular, ?ST with premature atrial complexes
• Diagnosis: Acute Pulmonary Edema due to exacerbation of CCF, acute exacerbation of asthma
• A MET call was activated at 0630hrs.

 

 

 

Assessment requirement

Discuss TWO diagnostic results and relate them to the underlying pathophysiology. My choice EXRAY AND ABG RESULTS.

 

500 words

Peer reviewed articles from 2021-2026.

Intext reference apa7

Apa7 reference list

Minimum 3 references.

PLEASE NO AI. TURNIT IN CHECK. Thanks

 

case study question

/in /by

Mrs. Kendall is an 81-year-old female from
nursing home brought in by ambulance to ED
at 0500hrs.Ventolin nebulisers given enroute.
Severe SOB, productive cough. Denies any
urinary or bowel symptoms, fever or chest pain.
Appears unwell. Pleasantly confused, thinks
she is 42 years old.
• Poor historian? Due to confusion.
• Past Medical History: IHD – multiple
NSTEMI’s, Previous ICU admissions for
exacerbation of asthma, Atrial Fibrillation, DM,
dementia, HFpEF- previous admission for APO
last year.
• On anticoagulation- Apixaban. On digoxin.
• Spirometry 3 months ago demonstrated
restrictive defect.
• Fully vaccinated against COVID

 

ASSESSMENT
Airway. – Patent, unable to speak in full sentences.
Breathing. – Spontaneous, RR-30/mt, SPO2-95% on 4L NP, was on 15L NRB weaned, bi-basal crepts,
widespread wheeze, moderate work of breathing.
Circulation- Appears flushed, tepid peripheries, BP-195/155 mmHg, HR- 120/mt, irregular,
b/l pitting pedal edema+++, peripheral edema- upto 2/3 shins b/l
Disability – GCS-14 E4V4M6, not oriented to time, place or person, PEARL- 2mm.
Exposure – Temperature 37.8 deg Celsius. Abdomen soft and non-tender, b/l pitting pedal edema+++,
peripheral edema- up to 2/3 shins b/l,
Fluids – Unable to tolerate oral fluids, on 1.2 L fluid restriction
Glucose – BGL- 13.7

 

INVESTIGATIONS
• ABG: pH: 7.34, PaO2- 66 mm Hg, PaCO2- 32 mmHg, HCO3: 16 mmol/L, Base Excess: –
(minus)8.1mmol/L, Lactate: 1.5 mmol/L
• Bloods: Hb- 120 gm/L, WCC: 10.3×10^9/L, digoxin level: <0.1 μg/L, Troponin I: 96 ng/mL
• CXR: wet, APO, upper lobe diversion
• ECG: some p waves visible, irregularly irregular, ?ST with premature atrial complexes
• Diagnosis: Acute Pulmonary Edema due to exacerbation of CCF, acute exacerbation of asthma
• A MET call was activated at 0630hrs.

 

 

 

Assessment question

Discuss TWO diagnostic results and relate them to the underlying pathophysiology. My choice EXRAY AND ABG RESULTS.

 

500 words

Peer reviewed articles from 2021-2026.

Intext reference apa7

Apa7 reference list

Minimum 3 references.

PLEASE NO AI. TURNIT IN CHECK. Thanks