Case Study 1 A previously healthy 7-month-old female present
Case Study 1 A previously healthy 7-month-old female presents to… Case Study 1A previously healthy 7-month-old female presents to the emergency department with fever, congestion, and cough. She has had poor fluid intake for 48 hours. At daycare, a few children were absent due to a viral infection. Symptoms were getting worse, and over the past 8 hours she had no fluid intake. The past medical history showed nothing significant, and she had received an influenza vaccine. A physical exam assessed as follows: heart rate 130 beats per minute, respiratory rate 60 breaths per minute, blood pressure 90/50 mm Hg, temperature 38.5°C, and an oxygen saturation of 87% on room air. She had copious clear rhinorrhea and a loose cough. Lungs had mild wheezing. She had intercostal retractions and nasal flaring but no abdominal breathing. The remainder of her physical examination was normal. The diagnosis of likely respiratory syncytial virus (RSV) and hypoxia was made. She was placed on oxygen at 2 L/minute by nasal cannula, and her saturations increased to 95%. She was admitted to the hospital for oxygen therapy and supportive care. The laboratory evaluation confirmed RSV. Over the next 24 hours, her oxygen requirement and work of breathing increased. Heated high-flow nasal cannula therapy was initiated at 10 L/minute at an FIO2 of 0.50 to maintain oxygen saturations >94%. Her condition stablized, and within 48 hours the oxygen and flow were slow and oral rehydration commenced.1. What important clinical indication for oxygen therapy was present in this scenario?2. Initially, was the nasal cannula the most appropriate choice of oxygen delivery device for this patient, or would you recommend a different one?3. What physiologic mechanism was causing hypoxemia for this child? CHAPTER 23 CASE STUDIESCase Study 2 A 13-year-old previously healthy boy was hit in the chest while playing baseball with friends and developed acute chest pain and dys-pnea. Shortly after the injury, he had a brief syncopal episode. He was driven to the emergency department by his parents and taken immediately to the trauma room. Oxygen by nonrebreathing mask was administered per their trauma protocol and a full assessment was completed. A physical exam shows the boy in respiratory distress with mild petechiae isolated to his chest. Vital signs were as follows: heart rate 136 beats per minute, respiratory rate 40 breaths per minute, blood pressure 90/50 mm Hg, temperature 37.4°C, and oxygen saturation of 94% on nonrebreathing mask. The boy has been in good health and is physically active. He has a medical history of seasonal allergies and an acute episode of pharyngitis. There is no family history of cardiac diseases. Cardiac examination revealed normal heart sounds and no murmur. He has normal radial pulses with delayed capillary refill. Breath sounds are coarse bilaterally. The remainder of the physical examination findings were normal. The boy is later admitted to the hospital for suspected cardiac contusion.1. How would you evaluate the oxygenation status of this patient given the information presented in this case?2. Could you recommend another oxygen delivery device given his presentation?3. What are some hazards associated with the use of a nonrebreathing mask? Health Science Science Nursing SCIENCE /RSPT
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