Shortness of breath - Nursing Case Study

Pathophysiology

• Primary mechanism: Inadequate oxygen supply - Conditions like lung disease, heart disease, or anemia can reduce the amount of oxygen that reaches the blood, causing shortness of breath. The body responds by increasing the rate and depth of breathing in an attempt to get more oxygen.

• Secondary mechanism: Increased carbon dioxide levels - Conditions such as COPD or severe asthma can trap air in the lungs, causing a buildup of carbon dioxide. The body reacts by trying to expel the excess carbon dioxide through rapid, shallow breathing, resulting in shortness of breath.

• Key complication: Anxiety - The physical sensation of shortness of breath can trigger anxiety or panic attacks, which in turn can further exacerbate the feeling of breathlessness. This forms a vicious cycle that can be difficult to break without medical intervention.

Patient Profile

Demographics:

45-year-old female, office worker

History:

• Key past medical history: Asthma during childhood, no issues in recent years

• Current medications: Multivitamins

• Allergies: No known allergies

Current Presentation:

• Chief complaint: Shortness of breath

• Key symptoms: Mild shortness of breath especially during exertion, occasional dry cough, no chest pain or discomfort, no fever

• Vital signs: Blood pressure 120/80 mmHg, Heart rate 75 bpm, Respiratory rate 18/min, Oxygen saturation 98% on room air, Body temperature 98.6°F

Section 1

Initial Assessment Findings:

On further examination, the nurse notices that the patient's skin is cool and slightly clammy. The patient is also using her accessory muscles to breathe, which indicates some respiratory distress. Her breath sounds are clear with no wheezes or crackles noted. Her heart sounds are normal, with no murmurs, rubs, or gallops. Her pulse is strong and regular. Her capillary refill time is less than 2 seconds, indicating good peripheral circulation.

The nurse also performs a peak flow meter test, which measures how well the patient's lungs are functioning. The patient's peak flow rate is 320 L/min, which is slightly below average for her age and height. This suggests some degree of airway obstruction, possibly a mild exacerbation of her childhood asthma. The nurse documents these findings and informs the doctor, who orders further diagnostic tests to confirm the diagnosis and determine the severity of the patient's condition. The nurse educates the patient about the importance of regular monitoring of her peak flow rate at home, especially during episodes of shortness of breath.

Section 2

New Diagnostic Results:

The doctor orders a spirometry test to measure the patient's lung function. The results of the test show a Forced Vital Capacity (FVC) of 3.2 L and a Forced Expiratory Volume in the first second (FEV1) of 2.6 L, giving an FEV1/FVC ratio of approximately 81%. The results are slightly reduced compared to the average for her age and height, which is suggestive of an obstructive airway disease like asthma.

A chest X-ray was also ordered to rule out other conditions that could be causing the patient's symptoms. The radiologist reports no signs of pneumonia, lung cancer, or other abnormalities. However, there is a slight hyperinflation of the lungs, which is often seen in asthma patients.

These diagnostic results, in combination with the patient's history and physical exam findings, provide strong evidence of a mild asthma exacerbation. The nurse will need to apply this information to her clinical reasoning, considering interventions that will help alleviate the patient's respiratory distress and prevent future asthma attacks. The nurse also understands that these results will influence the next steps in the patient's treatment plan, which will likely involve medication adjustments and possible lifestyle modifications.

Section 3

Initial Assessment Findings:

Upon her initial assessment, the nurse finds the patient to be slightly tachypneic with a respiratory rate of 22 breaths per minute, which is higher than the normal range of 12-20 breaths per minute. The patient's oxygen saturation is 95% on room air, which is within the normal range of 95-100%. However, the patient reports a persistent dry cough and occasional wheezing, particularly at night and in the early morning. The patient's heart rate is 78 beats per minute and her blood pressure is 118/72 mmHg, both within normal limits.

The nurse also conducts a thorough health history and finds that the patient has a history of seasonal allergies and reports occasional exposure to secondhand smoke. The nurse notes that these factors may be contributing to the patient's respiratory symptoms and could possibly trigger an asthma exacerbation. The nurse plans to educate the patient about the possible triggers and discuss ways to avoid them. These initial findings provide valuable information to guide further diagnostic testing and intervention planning.

Section 4

Following the initial assessment, the nurse proceeded to conduct a pulmonary function test (PFT) to better understand the patient's respiratory status. The PFT results indicated a mildly decreased forced expiratory volume in one second (FEV1) of 75% of the expected value, suggesting potential airflow obstruction. The ratio of FEV1 to forced vital capacity (FVC) was also slightly decreased at 0.7, which is less than the normal range of 0.8 to 1.0. These findings suggest the patient could be in the early stages of a respiratory condition, such as asthma.

The nurse then initiated an intervention by administering a short-acting bronchodilator, as per the physician’s orders, to see if there would be a significant improvement in the patient's FEV1. The patient was reassessed after 20 minutes, and her FEV1 had increased by 15% to 86%, which is a significant improvement and indicative of a reversible airway obstruction. The patient also reported a reduction in her wheezing and coughing, and her respiratory rate decreased to a more normal rate of 18 breaths per minute.

The nurse will continue to monitor the patient’s response to the bronchodilator and will plan to provide further education on managing triggers and understanding the importance of medication adherence in asthma management. The nurse also plans to discuss the impact of secondhand smoke on respiratory health and provide resources for smoking cessation for the patient's family members. This will aid in creating a healthier environment for the patient and potentially reduce the risk of future asthma exacerbations.

Section 5

After an hour, the patient started to experience an increased frequency of coughing and reported feeling a tightness in the chest. The nurse promptly reassessed the patient's vital signs and noted a respiratory rate of 23 breaths per minute, a slight increase from the previous assessment, and a pulse oximetry reading of 92%, which was lower than the normal range of 94-100%. The patient also mentioned that she was feeling more anxious due to her breathing difficulty.

In response to the change in the patient's status, the nurse administered a second dose of the short-acting bronchodilator as directed by the physician. Simultaneously, the nurse also provided reassurance to the patient to help alleviate her anxiety. The nurse then contacted the physician to report the changes and to discuss the possibility of additional diagnostic tests or changes to the patient’s management plan. The nurse anticipated that the physician might order a chest x-ray or a complete blood count to rule out any infections or other complications. The nurse also recognized the need for further patient education on anxiety management techniques in conjunction with asthma management to improve the patient's overall well-being and quality of life.