Med Surg Case Study #26: Hemalade Julius

Hemalade Julius | 42 years old

Chief Complaint: Hemalade presents with sudden onset chest pain and shortness of breath.

Medical History:

• Hemalade has a history of smoking and hypertension

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0800

Nurse's Note: Hemalade arrived at the emergency department complaining of sudden onset chest pain on the left side, which he rates as 8/10 in severity. He reports difficulty breathing and states that the pain worsens with deep inspiration. He denies any recent trauma or injury.

Vital Signs:

• Blood pressure: 160/90 mmHg

• Heart rate: 110 bpm

• Respiratory rate: 24 breaths/min

• Temperature: 98.9°F (37.2°C)

Provider Orders:

• Chest X-ray

• Obtain 12-lead electrocardiogram (ECG).

0845

Nurse's Note: On assessment, decreased breath sounds are noted on the left side of the chest, along with diminished chest expansion. Hemalade appears anxious and is experiencing increased difficulty breathing. ECG results returned as normal, showing no significant abnormalities.

Vital Signs

• Blood pressure: 160/92 mmHg

• Heart rate: 120 bpm

• Respiratory rate: 28 breaths/min

• Temperature: 99.1°F (37.3°C)
  

Provider Orders:

• Administer supplemental oxygen via nasal cannula at 4 liters per minute.

• Prepare for urgent chest X-ray.

0930

Chest X-ray confirms the presence of a left-sided pneumothorax, with partial collapse of the left lung.

Vital Signs:

• Blood pressure: 150/88 mmHg

• Heart rate: 116 bpm

• Respiratory rate: 30 breaths/min

• Temperature: 99.3°F (37.4°C)
  

Provider Orders:

• Insert a chest tube for decompression of the pneumothorax.

• Administer analgesia as needed for pain management.

Question 1: What are the common signs and symptoms of pneumothorax?

Question 2: Why is supplemental oxygen administered to Hemalade?

Question 3: What is the purpose of inserting a chest tube for Hemalade?

Question 4: How does chest X-ray assist in diagnosing pneumothorax?

Answers to Questions Below

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Answers

Question 1: What are the common signs and symptoms of pneumothorax?

Common signs and symptoms of pneumothorax include sudden onset chest pain, dyspnea, and decreased breath sounds on the affected side. The patient may appear anxious and may have tachypnea and tachycardia.

Question 2: Why is supplemental oxygen administered to Hemalade?

Supplemental oxygen is administered to Hemalade to improve oxygenation and alleviate hypoxemia associated with pneumothorax. Increasing the fraction of inspired oxygen helps compensate for the reduced lung function due to lung collapse.

Question 3:What is the purpose of inserting a chest tube for Hemalade?

The chest tube is inserted to decompress the pneumothorax by removing air or fluid from the pleural space. This allows the lung to re-expand and resume normal function. Chest tube insertion is a standard treatment for pneumothorax and helps prevent complications such as tension pneumothorax.

Question 4:How does chest X-ray assist in diagnosing pneumothorax?

Chest X-ray is a valuable diagnostic tool for pneumothorax as it can visualize the presence of air in the pleural space and the degree of lung collapse. It helps confirm the diagnosis and guides further management decisions, such as the need for chest tube insertion.

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