Acute Respiratory Mrs Cox

Questions: Mrs Amanda Cox is 29 years old, she presented to ED with acute onset chest pain and dyspnoea. Amanda describes the pain as sharp, and states it is worse when she tries to breathe in and she rates the pain 7/10. Amanda states prior to presenting to hospital, she was involved in an Assault where she was hit in the chest. An assessment was performed on Amanda the findings are: BP: 99/50mmHg, HR: 145, RR: 26, Temp: 36.8, Oxygen sats: 90% on room air (RA), absent chest movement on left side.Before considering Amandas condition, its important to recall complex physiology related to breathing and respiration:The Alveoli/Capillary exchange is known as the functional unit of the lungs. 1. Discuss the role of this functional unit and what can happen to the patient when it doesnt function effectively:2. What is the role of Oxygen in the body? (i.e.: what is it used for?)3. The 4 phases of Respiration are: Breathing (Pulmonary Ventilation), External Respiration, Transport, and Internal Respirati on. Define a disorder/disease that would interfere with each phase of respiration.4. Given the signs and symptoms suffered by Amanda, hypothesise what is the most likely condition that Amanda may be suffering from?5. Discuss the pathophysiology of a traumatic pneumothorax.6. Outline other clinical manifestations that may present in a patient with this condition a traumatic pneumothorax. 7. The doctor inserts an Intercostal Catheter (ICC) into Amandas left side. Explain what an Intercostal Catheter is and the purpose of it.8. Amanda mobilises out of bed and inadvertently removes the chest drain. Prioritise three (3) immediate nursing actions? Answers: 1. The condition of dys-functioning of Alveoli/capillary exchange can be referred to as pulmonary contusion or acute valvular insufficiency. In normal physiological condition, the oxygen is intended to pass the air-blood barrier into the capillaries, which is hampered. Bodys circulation for oxygen is essential, as it helps the cells to consume oxygen and maintain the regular physiological functioning. Dys-functioning of this kind will lead, fatigue, hypoxia, cyanosis, fainting and dull appearance. It should be noted that the problem is not only concentrated with improper functioning of lungs, but also depends upon the bodys poor ability to carry blood and circulate the oxygen transportation. Zoeller, K. A. (2013). Pulsatile flow does not improve efficacy in ex vivo lung perfusion (Doctoral dissertation, University of Louisville). 2. Oxygen plays vital role in breathing and metabolism within the physiological system. Mainly the nutrient compounds are oxidized with the help of oxygen in conjunction to complex enzymatic process. Appropriate level of oxygen is thus vital for the support of cellular respiration. It is the oxidation process, which is metabolically regularized for the generation of energy in body. Oxygen is used as electron acceptor in the mitochondria of cells to generate ATP molecules. Other than this, oxygen is also essential for the proper functioning of neurons in brain. Mills, D. B., Canfield, D. E. (2014). Oxygen and animal evolution: Did a rise of atmospheric oxygen trigger the origin of animals?. BioEssays, 36(12), 1145-1155. 3. Lower respiratory infection is defined as the collection of diseases and disorders, which have the potential to infect the all the four phases of respiration. These include infection, restrictive pulmonary disorder, lung cancer and obstructive pulmonary disorder. Specification related to each phase is described in following section: Breathing It causes accumulation of cough, which brings up phlegm and mucus. Other possible symptoms that are included in such complications include congestion and tight feeling in chest, increased rate of breathing, wheezing and breathlessness. External respiration With infection, the alveoli gets swollen and hence the gaseous exchange between alveolar space and blood becomes inefficient. This can cause increase in pH of blood, hypoxia state and fatigues. Transport Infection and lung cancer affects the epithelium of respiratory tract. This will cause production of abnormal transport protein and thus the ion section of cells will be hampered along with the secretion of sweat glands. The secreted mucus also form a thin layer over the ciliated cells, thus the respiratory secretion will be hampered. Internal respiration In the overall complication, the oxygen supply to the cell will be hampered. This will cause inefficiency of oxygen molecules to act as electron acceptor in mitochondria. Because of this, the energy production process of the cells will be poor. Chang, A. B., Chang, C. C., O'Grady, K., Torzillo, P. J. (2009). Lower respiratory tract infections. Pediatric clinics of North America, 56(6), 1303-1321. 4. The present condition in linked with pulmonary contusion and haemothorax. With the history of hit on chest, there is possibility that the alveolar tissues might undergone tear and hence leads to ulmonary haemorrhage, oedema and confluent infiltration. The diagnosis can be confirmed thoroughly with CT scan of chest. Richardson, J. D., Adams, L., Flint, L. M. (1982). Selective management of flail chest and pulmonary contusion. Annals of surgery, 196(4), 481. 5. Traumatic pneumothorax, usually happens with motor vehicle accident, stabbing or trauma related condition. This leads to pulmonary contusion, implosion and inertial force over the alveolar tissue is reduced because of tear. The large potential volume of blood may lead to circulatory collapse and shock. Condition like dyspnea is also very common in such situation. In many a case volume replention and drainage of pleural space is needed. Furthermore, for the objective of persistent drainage, thoracic surgery evaluation is very much essential. Johnson, G. (1996). Traumatic pneumothorax: is a chest drain always necessary?. Journal of accident emergency medicine, 13(3), 173-174. 6. Clinical manifestation in conjunction to traumatic pneumothorax can be summarized in the following rebuttal points: Breathing shortness Soft under skin bulges. These are trapped air which are present beneath the skin in the region of neck and chest. Pain in chest in resting state and in breathing Chest movement becomes uneven while breathing Heartbeat becomes rapid Cough and accumulation of mucus in the respiratory tract Majercik, S., White, T. W., Van Boerum, D. H., Granger, S., Bledsoe, J., Conner, K., ... Weaver, L. K. (2014). Cleared for takeoff: The effects of hypobaric conditions on traumatic pneumothoraces. Journal of Trauma and Acute Care Surgery, 77(5), 729-733. 7. Intercostal Catheter is small tube like structure that can be inserted in the body to prevent surgical procedures. The purpose of this is to supplement for the intervention related to fluid therapy in traumatic pneumothorax. In majority of cases, the fluid should be withheld from the patient. Care should be taken that enough fluid should be present to ensure blood flow. It is hence people not requiring large fluid should use catheter to be placed in the pulmonary artery to measure the pressure inside it. It is hence this pressure measurement will help the clinicians to decide the amount to fluid to be present inside to prevent shock and to compensate the condition of edema. Obeid, F. N., Shapiro, M. J., Richardson, H. H., Horst, H. M., Bivins, B. A. (1985). Catheter aspiration for simple pneumothorax (CASP) in the outpatient management of simple traumatic pneumothorax. Journal of Trauma and Acute Care Surgery, 25(9), 882-886. 8. Three immediate nursing actions are: Chest physical therapy is essential part of nursing support, which includes breathing exercise, stimulation of coughing, percussion, movement, vibration and increase in oxygenation. Pain control is another means, which also helps in facilitation of secretion. Simpler example is pain while coughing. Pain control and management is one of the essential and immediately required nursing practice measures, which have the potential to improve the patient condition. Information about medication, such as analgesic for pain management and antibiotic for recovery of tissue injury is essential to be delivered to patient. Patient education in this regard will be helpful for the purpose of self-management and quick measures of health restoration. MacDuff, A., Arnold, A., Harvey, J. (2010). Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010. Thorax, 65(Suppl 2), ii18-ii31.