Pathophisiology

This week’s case study will introduce concepts related to the pulmonary system and shock states. Read the scenario and thoroughly complete the questions. Some of the answers will be short answers and may not require a lot of details. For example: what is the most common organism to cause a hospital acquired infection? The answer is pseudomonas aeruginosa. Answers to questions that relate to the pathogenesis of a disease must include specific details on the process. For example: How does hypoxia lead to cellular injury? Simply writing that a lack of blood flow, causes a lack of oxygen available to the cell and the cell cannot function without oxygen is not sufficient. This type of response is NOT reflective of an advanced understanding of the concept or graduate level work. This answer should discuss the cascade of events leading to the lack of oxygen and how it specifically impairs cellular function. All answers to these type of questions should address the effects at the cellular level, then the effects on the organ and then the body as a whole. Additionally describing the normal anatomical and/or physiologic processes underlying the pathogenesis will be necessary to thoroughly answer the question.

It is very likely that you will need to reference multiple sources to answer the questions thoroughly. Your text book will not necessarily have all the answers. Only professional sources may be used to complete the assignment. These include text books, primary and secondary journal articles from peer reviewed journals, government and university websites, and publications from professional societies who establish disease management guidelines and recommendations. Sources such as Wikipedia or other generic websites are not considered professional references and should not be used to complete the case studies.

· Reason for Consultation: Desaturation to 64% on room air 1 hour ago with associated shortness of breath.

History of Present Illness: Mrs. X is 73-year-old Caucasian female who was admitted to the general surgery service 3 days ago for a leaking j-tube which was surgically replaced 2 days ago. This morning at 07:30, the RN reported that the patient was sleeping and doing fine, then the CNA made rounds at 0900 and Mrs. X was found to be mildly dyspneic. Vital signs were checked at that time and were; temperature 38.6, pulse 120, respirations 20, blood pressure 138/38. O2 sat was 64% on room air. The general surgeon was notified by the nursing staff of the hypoxia, an order for a chest x-ray and oxygen therapy were given to the RN. The O2 sat is maintaining at 91-92% on 4L NC. The patient was seen and examined at 10:10 a.m. She reported that she has had mild dyspnea for 2 days that has progressively gotten worse. She does not use oxygen at home. Her respiratory rate at the time of this visit was 20 and she feels short of breath. She has felt this way in the past when she had pneumonia. She is currently undergoing radiation treatment for laryngeal cancer and her last treatment was 1 to 2 weeks ago. She reported that she has 2 to 3 treatments left. She denied any chest pain or previous history of CHF. Review of her vital signs showed that she had been having intermittent fevers since yesterday morning. Of note, she was admitted to the hospital 3 weeks ago for an atrial fibrillation with RVR for which she was cardioverted and has not had any further problems. The cardiologist at that time said that she did not need any anticoagulation unless she reverted back into A-fib.

Review of Systems: Constitutional: Negative for diaphoresis and chills. Positive for fever and fatigue. HEENT: Negative for hearing loss, ear pain, nose bleeds, and tinnitus. Positive for throat pain secondary to her laryngeal cancer. Eyes: Negative for blurred vision, double vision, photophobia, discharge and redness. Respiratory: Positive for cough and shortness of breath. Negative for hemoptysis and wheezing. Cardiovascular: Negative for chest pain, palpitations, orthopnea, leg swelling and PND. Gastrointestinal: Negative for heartburn, nausea, vomiting, abdominal pain, diarrhea, constipation, blood in stool and melena. Genitourinary: Negative for dysuria, urgency, frequency, hematuria and flank pain. Musculoskeletal: Negative for myalgias, back pain and falls. Skin: Negative for itching and rash. Neurological: Negative for dizziness, tingling, tremors, sensory change and speech changes. Endocrine/hematologic/allergies: Negative for environmental allergies or polydipsia. Does not bruise or bleed easily. Psychiatric: Negative for depression, hallucinations and memory loss.