NRSG370 Assessment Task 2: Case Study – High Dependency

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NRSG370 Assessment Task 2: Case Study – High Dependency

NRSG370 Assessment Task 2: Case Study – High Dependency

Mrs. Connie Brownstone

Mrs. Connie Brownstone is a 79-year-old woman admitted to the Emergency Department (ED).  Connie was brought into the ED by her daughter with a one-day history of fluctuating shortness of breath/dyspnoea unrelieved by medication.

Triage Nurse Assessment:

  • Vital signs: RR 35, SpO2 90% (room air), HR 125bpm, RR 35, Temp 39.4° Celsius, BP 168/70;
  • Physical assessment: Dyspnoea, very anxious, audible expiratory wheeze;
  • Past history: Asthma, allergies to pollen and dust mite, ICU admission 5 years ago (endotracheal intubation and ventilation for 2 days – status asthmaticus).
  • Medications: (1) Ventolin, and (2) Ipratropium bromide.

Due to her respiratory distress, Connie was triaged as a category 2, as per the Australasian Triage Scale, and brought directly from the waiting room into a HDU monitored cubicle where you are the ED nurse allocated to her care (Department of Health and Aging, 2009). Oxygen of 6L/min was applied via the Hudson Mask.

Cubicle Nurse Assessment:

  • Vital signs: RR 35, SpO2 89% (6L oxygen), HR 125bpm, RR 35, Temp 39.4° Celsius, BP 172/75;
  • Physical assessment: Pt. seated and leaning forward, use of accessory muscles evident (sternocleidomastoid, scalene, and intercostal muscles), bilateral expiratory wheeze on auscultation, height 145cm;
  • Peak Flow 210 L/min (last normal reading 320 L/min)
  • Secondary survey revealed no other abnormalities.

Investigations/Results:

FBE                                                     Within normal limits

Urea & Electrolytes                             Within normal limits

C-Reactive Protein                             Within normal limits

Blood Cultures                                    Pending

Troponin                                              Within normal limits

Chest XRAY                                       Hyperexpanded lungs, no consolidation or effusion

 

Arterial Blood Gas (ABG)                   pH 7.48, PaO2 60, PaCO2 30, HCO3 24 (Respiratory Alkalosis)

Normal ABG Ranges                          pH 7.35-7.45, PaO2 85-90, PaCO2 35-45, HCO3 22-26

(Vincent, 2011)

References

Vincent, J. L., Abraham, E., Kochanek, P., Moore, F. A., & Fink, M. (2017). Textbook of Critical Care (7th ed.). St. Louis, Missouri: Elsevier.