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LITERARY ANALYSIS ABOUT MY FATHER GOES TO COURT, Lab Reports of English Language

Pangasinan State University (PSU)English Language

LITERARY ANALYSIS LITERARY ANALYSIS ABOUT MY FATHER GOES TO COURT

Typology: Lab Reports

2020/2021

Uploaded on 02/17/2022

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CASE STUDY (ASTHMA)
I. Patient Profile
E.S. is a 35-year-old mother of two school-age boys who arrives via ambulance in the emergency
department (ED) with severe wheezing, dyspnea, and anxiety. She was in the ED 6 hours earlier with an
asthma attack.
II. Subjective Data
• Treated during previous ED visit with nebulized albuterol and responded quickly
• Allergic to cigarette smoke
• Began to experience increasing tightness in her chest and shortness of breath when she returned
home following her previous ED visit
• Used the albuterol several times after she returned home with no relief
• Diagnosed with asthma 2 years ago
• Does not have a health care provider and is not on any medications
III. Objective Data
a. Physical Examination
• Sitting upright and using accessory muscles to breathe
• Talks in one- to three-word sentences
• RR: 34 and shallow
• Audible wheezing
• Auscultation of lung fields reveals no air movement in lower lobes
• HR: 126 bpm
• Noted to be extremely anxious and restless
b. Diagnostic Studies
• ABGs: pH 7.46, PaCO2 36 mm Hg, PaO2 76 mm Hg, O2 saturation 88%
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CASE STUDY (ASTHMA)

I. Patient Profile E.S. is a 35-year-old mother of two school-age boys who arrives via ambulance in the emergency department (ED) with severe wheezing, dyspnea, and anxiety. She was in the ED 6 hours earlier with an asthma attack. II. Subjective Data

  • Treated during previous ED visit with nebulized albuterol and responded quickly
  • Allergic to cigarette smoke
  • Began to experience increasing tightness in her chest and shortness of breath when she returned home following her previous ED visit
  • Used the albuterol several times after she returned home with no relief
  • Diagnosed with asthma 2 years ago
  • Does not have a health care provider and is not on any medications III. Objective Data a. Physical Examination - Sitting upright and using accessory muscles to breathe - Talks in one- to three-word sentences - RR: 34 and shallow - Audible wheezing - Auscultation of lung fields reveals no air movement in lower lobes - HR: 126 bpm - Noted to be extremely anxious and restless b. Diagnostic Studies - ABGs: pH 7.46, PaCO2 36 mm Hg, PaO2 76 mm Hg, O2 saturation 88%
  • Chest x-ray: bilateral lung hyperinflation with lower lobe atelectasis
  • CBC with differential and electrolytes: within normal limits
  • An IV is started in her left forearm with normal saline infusing at 100 mL/hr. Discussion Questions: Using a separate sheet of paper, answer the following questions:
  1. What other assessment information should be obtained from E.S.?Blood Pressure, presence of perspiration, PEFR, neck vein distention presence of GERD, frequent lung sounds, ABGs as ordered, pulmonary function studies to determine the reversibility of bronchoconstriction (using bronchodilators) after the acute situation; Asthma Control Test; serum IgE level; sputum culture and sensitivity may be done; fractional exhaled nitric oxide (FENO) may be measured. 2. Priority Decision: What is the priority of collaborative intervention for E.S.? Oxygen therapy needs to be started immediately. The goal is to get E.S's oxygen saturation above 90% and to maintain it at or above that level. Although oxygen could be administered using a nasal cannula or face mask, it is important to ensure that E.S.is receiving the oxygen supplement. Her SpO2 or PaO needs to be monitored closely. Also, the nurse must assess whether the patrient with a nasal cannula or face mask device keeps it on (some patients complain that the mask is suffocating them). 3. What data obtained from the brief history, physical examination, and diagnostic studies indicate that E.S.is experiencing a severe or life threatening asthma attack? E.S. is using accessory muscles, has audible wheezing, a respiratory rate >30, and a pulse >120. Her responses to questions are very short (one- to three-word sentences). She is sitting upright and is extremely anxious and restless. Her breath sounds are not audible in the bases of her lungs and her oxygen saturation is <90%. These are all manifestations of a severe asthma attack. Other observations that might be evident during severe attacks are agitation, PEFR <150 mL, neck vein distention, and a pulsus paradoxus of ≥40 mmHg. Patients with life- threatening asthma are usually too dyspneic to speak and are perspiring profusely. They may be drowsy and the ABGs will reveal further deterioration (lower PaO2, lower O2 saturation, rising PaCO2, and pH that is acidotic). Breath sounds may be very difficult to hear and wheezing may no longer be present (very little airflow). These patients become bradycardic and may require airway intubation, mechanical ventilation, and admission to the ICU.
  1. Priority Decision: Based on the assessment data presented, what are the priority nursing diagnoses? What are the collaborative problems? a. Nursing Diagnoses: ⦁ Ineffective airway clearance related to bronchospasm and fatigue ⦁ Anxiety related to difficulty breathing and fear ⦁ Deficient knowledge related to lack of information and education about asthma ⦁ Ineffective health maintenance related to lack of primary health care provider. b. Collaborative Problems: ⦁ Potential complications: Severe acute asthma, life- threatening asthma