Interstitial Lung Disease Admitting History 46 year old, Abe Smith arrived to the emergency department at ACN General Hospital at 1300. Patient was complaining of shortness of breath and chest pain. Patient also noted an intermittent, dry cough for the past couple months. He has no other known illnesses, but has worked in construction and demolition for numerous years. He is afraid he has been exposed to numerous types of dust and harmful substances. He has broken five fingers at work during his career. He denies smoking or other substance use. Mr. Smith also said he has been fairly healthy his whole life and does not recall any hospitalizations.
Physical Examination Patients is SOB with chest pains and an intermittent non productive cough. Heart rate was 114 BPM upon arrival to ER. Respiratory rate was 30 breaths per minute. His breaths were rapid and shallow and he was using accessory muscles. His oral temperature was 37 degrees Celcius. His blood pressure was 140/95 mmHg. The patient's pulse oximeter was reading 85% with no cyanosis present and the patient is orientated to time, place, and day. His arterial blood gases drawn after entering ER were: pH-7.35PaCO2- 55PaO2- 55HCO3- 30SaO2- 85%
SOAP
S=Patient's work of breathing is high. On a scale of 1 to 10, dyspnea is at a 7. Patient states he feels like "the wind has been knocked out of me." The patient also described the chest pain he had as "excruciating". He stated that the shortness of breath started with a dry, intermittent cough, but he stated that it got worse with time. He says now dyspnea is felt with no exertion at all.
O=Heart rate is 114 beats per minute, respiratory rate is 30 breaths per minute, oral temperature is 37 degrees Celsius, blood pressure is 140/95 mmHG, SpO2 85%. The patient appears to be short of breath with noted accessory muscle use. The patient keeps grabbing his chest due to chest pain. Upon auscultation, faint crackles were heard throughout the bases. And a nurse stated that, "it sounds like velcro being pulled apart". During palpation and percussion nothing abnormal was noted. ABG results revealed: pH of 7.35, PaCO2 of 55, PaO2 of 55, HCO3 of 30 and an SaO2 of 85%. The chest x-ray reveals bilateral diffuse densities, calcified plaques or a honeycomb effect throughout the lungs. Electrolyte concentrations showed:
Sodium
145 mEq/L
Potassium
4.2 mEq/L
Chloride
99 mEq/L
BUN
15 mEq/L
Creatinine
1.1 mEq/L
Cholesterol
162 mg/dl
Glucose
85 mg/dl
The Complete Blood Cell Count showed:
RBC Count
5.5
Hemoglobin
14.8 g/dl
Hematocrit
49%
WBC Count
11,000
A= After assessing this patient you can conclude that the patient has an increased work of breathing because he is using accessory muscle use and he complains of dyspnea on exertion. His vital signs show that he has some signs of tachycardia and tachypnea. He is not oxygenating because his SpO2/SaO2 reads 85% and his PaO2 from the ABG is 55. His ABG shows signs of compensated respiratory acidosis with moderate hypoxemia. The chest x-ray suggests some sort of fibrosis and his work history suggests that he has had exposure to asbestos. His electrolyte concentrations show no signs of abnormality with every thing in the normal range. The complete blood cell count shows all normal, but the white blood cell count is pushing the high end of normal. The electrolytes and CBC value help to conclude that the main focus of the disease is respiratory. This helps limit treatment options.
P= Our plan for this patient is to decrease his work of breathing. We will do this by giving him an albuterol treatment to help open up his airways. Supplemental oxygen should help with his low oxygen readings. We may also have the patient started on a steriod to help with the inflammation in his lungs, such as Prednisone. For the unproductive cough, humidification via LVN and chest percussion may be used.
Questions?
What are the two beginning warning signs of ILD?
What specific findings on a chest xray differentiates Asbestosis from other diseases in this category?
Are the effects of ILD mainly restrictive or obstructive as evidenced by PFT? Which test on a PFT is first to decline with this disease?
True or False: Prednisone and supplemental oxygen are a proven to help patients with interstitial lung disease. .
Group Members:
Interstitial Lung Disease
Admitting History
46 year old, Abe Smith arrived to the emergency department at ACN General Hospital at 1300. Patient was complaining of shortness of breath and chest pain. Patient also noted an intermittent, dry cough for the past couple months. He has no other known illnesses, but has worked in construction and demolition for numerous years. He is afraid he has been exposed to numerous types of dust and harmful substances. He has broken five fingers at work during his career. He denies smoking or other substance use. Mr. Smith also said he has been fairly healthy his whole life and does not recall any hospitalizations.
Physical Examination
Patients is SOB with chest pains and an intermittent non productive cough. Heart rate was 114 BPM upon arrival to ER. Respiratory rate was 30 breaths per minute. His breaths were rapid and shallow and he was using accessory muscles. His oral temperature was 37 degrees Celcius. His blood pressure was 140/95 mmHg. The patient's pulse oximeter was reading 85% with no cyanosis present and the patient is orientated to time, place, and day. His arterial blood gases drawn after entering ER were:
pH-7.35PaCO2- 55PaO2- 55HCO3- 30SaO2- 85%
SOAP
Questions?