Med Surg Case Study #31: Justin Locus

Justin Locus | 48 years old

Chief Complaint: Progressive shortness of breath and chest pain for the past three days.

Medical History:

• Hypertension, managed with lisinopril 10 mg daily.

• Chronic Obstructive Pulmonary Disease (COPD)

• Type 2 diabetes mellitus, managed with metformin 500 mg BID.

• History of smoking (1 pack per day for 30 years), quit 5 years ago.

• No known drug allergies.

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Nurse's Note: Patient presented to the Emergency Department (ED) with complaints of progressive shortness of breath over the past week, and a sharp, intermittent chest pain on the right side. Pain increases with deep breaths and coughing. Patient appears anxious and is using accessory muscles to breathe. Oxygen saturation on room air is 89%.

Vital Signs:

• Blood pressure: 150/92 mmHg

• Heart rate: 110 bpm

• Respiratory rate: 28 breaths/min

• Temperature: 99°F (37.2°C)

• SpO2: 89% on room air

Provider Orders:

• Administer oxygen at 2 L/min via nasal cannula.

• Administer albuterol nebulizer treatment

• Obtain a chest X-ray.

• Obtain CBC & CMP
  

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Chest X-ray shows a large right-sided pleural effusion.

Nurse's Note: Patient reports slight improvement in breathing after albuterol treatment, but still experiencing chest pain. Oxygen saturation has improved with supplemental oxygen.

Vital Signs

• Blood pressure: 148/90 mmHg

• Heart rate: 104 bpm

• Respiratory rate: 26 breaths/min

• Temperature: 99.1°F (37.3°C)

• SpO2: 93% on 2L/min nasal cannula
  

Provider Orders:

• Prepare patient for urgent thoracentesis to drain pleural fluid
  

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Nurses Note: Thoracentesis completed; approximately 800 mL of pleural fluid drained.Patient reports significant relief from chest pain and improved breathing. Pleural fluid sent to lab for analysis.

Vital Signs:

• Blood pressure: 140/88 mmHg

• Heart rate: 96 bpm

• Respiratory rate: 22 breaths/min

• Temperature: 98.8°F (37.1°C)

• SpO2: 95% on room air
  

Provider's Orders:

• Discontinue oxygen therapy if SpO2 remains above 94% on room air

• Initiate antibiotic therapy (Ceftriaxone 1g IV daily) pending pleural fluid culture results

• Follow up with pulmonologist within 48 hours

Follow Up Questions:

Question 1: What are the possible causes of pleural effusion in a patient like Justin Locus?

Question 2: Why was a thoracentesis performed, and what is its significance in the management of pleural effusion?

Question 3: What complications should the nurse monitor for after the thoracentesis procedure?

Answers to Questions Below

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Answers

Question 1: What are the key diagnostic tests used to confirm myocarditis in Jill Yesmin?

The possible causes of pleural effusion in Justin Locus, given his medical history, could include heart failure (due to hypertension), infection (such as pneumonia, especially given his COPD), malignancy. Other causes could be liver or kidney disease.

Question 2: Why was a thoracentesis performed, and what is its significance in the management of pleural effusion?

Thoracentesis was performed to remove the accumulated fluid from the pleural space, which helps to relieve symptoms like shortness of breath and chest pain. It also allows for diagnostic analysis of the pleural fluid to determine the underlying cause of the effusion.

Question 3: What complications should the nurse monitor for after the thoracentesis procedure?

The nurse should monitor for complications such as pneumothorax (collapsed lung), bleeding, infection, re-expansion pulmonary edema, and hypotension.

Med Surg Case Study #31: Justin Locus