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Top 2 nursing priority diagnosis

Top 2 nursing priority diagnosis

Phlebotomy Essentials
Phlebotomy Essentials
6th Edition
ISBN:9781451194524
Author:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Publisher:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Chapter1: Phlebotomy: Past And Present And The Healthcare Setting
Section: Chapter Questions
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Top 2 nursing priority diagnosis
Case Study Assignment: A 21-year-old man with a past medical history of asthma presented with acute worsening shortness of breath overnight with no identifiable trigger. The patient had experienced this symptom for three weeks although less severe initially. He also stated that the symptom was accompanied by cough, chest tightness, and pain across the anterior chest but could not clearly describe the characteristics of the pain. The difficult breathing was worsened with lying flat. He denied any history of smoking. On initial presentation, his vital signs included a temperature of 36.7°C, a blood pressure of 119/83 mmHg, a heart rate of 105 beats/min, respiratory rate of 18 breaths/min, and an oxygen saturation of 97% on room air. The patient was 170.2 cm tall and weighed 57.2 kg and BMI of 19.79 kg/m³. Physical examination revealed a distressed and ill- appearing male. Cardiopulmonary examination was notable for tachycardia, tachypnea, and decreased breath sounds in both upper lung fields. Laboratory results showed mild leukocytosis with a white blood cell count of 12.9 x 10° cells/L, 72% neutrophils, and 16% lymphocytes. His hemoglobin level was 16.2 g/dl with a hematocrit of 48.6% and platelet count of 243 x 10° cells/L. The blood biochemical profiles were unremarkable. Chest X-ray (CXR) (Figure 1) showed bilateral large pneumothorax (>2cm) with minimal bilateral pleural effusions and significantly compressed mediastinum. A diagnosis of Simultaneous Bilateral Primary Spontaneous Pneumothorax (SBPSP) was made. Chest tubes were placed bilaterally with immediate improvement in breathing and tachycardia. The right- and left-sided chest tubes drained serosanguinous fluids, 5 ml and 10 ml, respectively. Patient's clinical condition continued to improve and a follow-up CXR immediately following the procedures (Figure 2) showed a decrease of pneumothorax in both sides. However, during the hospital course, the chest tubes continued to have an air leak and the follow-up CXR continued to demonstrate residual pneumothorax without full lungs expansion. Computed tomography (CT) scan without contrast of the chest revealed subpleural blebs in both upper lobes. Due to continuous air leak without full lung expansion with conservative management, the patient was referred to thoracic surgery evaluation.
Transcribed Image Text:Case Study Assignment: A 21-year-old man with a past medical history of asthma presented with acute worsening shortness of breath overnight with no identifiable trigger. The patient had experienced this symptom for three weeks although less severe initially. He also stated that the symptom was accompanied by cough, chest tightness, and pain across the anterior chest but could not clearly describe the characteristics of the pain. The difficult breathing was worsened with lying flat. He denied any history of smoking. On initial presentation, his vital signs included a temperature of 36.7°C, a blood pressure of 119/83 mmHg, a heart rate of 105 beats/min, respiratory rate of 18 breaths/min, and an oxygen saturation of 97% on room air. The patient was 170.2 cm tall and weighed 57.2 kg and BMI of 19.79 kg/m³. Physical examination revealed a distressed and ill- appearing male. Cardiopulmonary examination was notable for tachycardia, tachypnea, and decreased breath sounds in both upper lung fields. Laboratory results showed mild leukocytosis with a white blood cell count of 12.9 x 10° cells/L, 72% neutrophils, and 16% lymphocytes. His hemoglobin level was 16.2 g/dl with a hematocrit of 48.6% and platelet count of 243 x 10° cells/L. The blood biochemical profiles were unremarkable. Chest X-ray (CXR) (Figure 1) showed bilateral large pneumothorax (>2cm) with minimal bilateral pleural effusions and significantly compressed mediastinum. A diagnosis of Simultaneous Bilateral Primary Spontaneous Pneumothorax (SBPSP) was made. Chest tubes were placed bilaterally with immediate improvement in breathing and tachycardia. The right- and left-sided chest tubes drained serosanguinous fluids, 5 ml and 10 ml, respectively. Patient's clinical condition continued to improve and a follow-up CXR immediately following the procedures (Figure 2) showed a decrease of pneumothorax in both sides. However, during the hospital course, the chest tubes continued to have an air leak and the follow-up CXR continued to demonstrate residual pneumothorax without full lungs expansion. Computed tomography (CT) scan without contrast of the chest revealed subpleural blebs in both upper lobes. Due to continuous air leak without full lung expansion with conservative management, the patient was referred to thoracic surgery evaluation.
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