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Gross anatomy of the chest case study

Gross anatomy of the chest case study. Elizabeth Kelley Buzbee AAS,NPS-RRT, RCP. Case study # 1. Your patient is an 18 year-old Latin American male [LAM] who has about a liter of fluid in the plural spaces secondary to renal [kidney] failure and congestive heart failure.

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Gross anatomy of the chest case study

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  1. Gross anatomy of the chestcase study Elizabeth Kelley Buzbee AAS,NPS-RRT, RCP

  2. Case study # 1 • Your patient is an 18 year-old Latin American male [LAM] who has about a liter of fluid in the plural spaces secondary to renal [kidney] failure and congestive heart failure. • His respiratory rate is 35 bpm. • His heart rate is 125 bpm. • Are his Vital Signs within normal limits?

  3. answer • No, his RR should be between 12-20 bpm. He is breathing fast—tachypnic • Nor is his heart rate normal. It should be between 60-100 bpm and it also is too fast--tachycardia

  4. The patient complains of pain on deep breathing. Why?

  5. answer • The parental pleura is filled with pain receptors and the swelling irritates them

  6. How could this problem effect his ability to breathe?

  7. answer • The fluid pressing on the lung will cause it to collapse. Collapsed air sac are harder to re-inflate • The interface between the pleura and the lung is filled with fluid so that the lung doesn’t follow the rib cage out during inspiration. To compensate for this, the patient must create more negative pressure in his chest. This, too, increases the WOB

  8. How does increased WOB cause him to have the retractions you see on his chest wall?

  9. answer • Retractions of the soft tissue of the ribs, and sternum and clavicles result from excessive negative pressure in the thorax created by the patient to get air into a stiff lung.

  10. You note that this patient’s skin is cool and damp [diaphrotic] Why is he sweating?

  11. answer • He is sweating because he is working hard to breath

  12. Before the chest tube was placed and 500 ml of fluid removed from the thoracic cavity, this patient’s Sp02 was 88% . • What is the significance of the 02 saturation?

  13. answer • He has lower than normal 0xygen bound to his blood hemoglobin. • He is hypoxic

  14. What would you suggest for this condition?

  15. answer • Give him supplementary 02 to get his Sp02 back to 90%

  16. Do you think that the presence of this fluid could interfere with this patient’s ability to take a deep breath and cough?

  17. answer • Yes, he cannot take a deep breath with all the fluid taking up space where lung should be

  18. When we listen to his breath sounds, we hear crackles in the upper lobes and diminished breath sounds in the lower lung fields. • Why?

  19. answer • We hear crackles because we are hearing the air sac pop open on inspiration • We hear diminished breath sounds in the basal areas because gravity causes the fluid to move down to the lower portion of the chest. The fluid is causing the lung to collapse and the fluid is damping down the breath sounds

  20. What would be your expectations regarding his Sp02 and his Vital Signs after the chest tube has been placed in his chest and the extra fluid drained off?

  21. answer • We expect that his RR to drop closer to normal • We expect the HR to drop closer to normal • We expect the Sp02 to rise closer to normal • We expect the sweating and the retractions to return to normal

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