Unit 2 RSPT 1438 case studies in communications

1. Unit 2 RSPT 1438case studies in communications By Elizabeth Kelley Buzbee AAS, RRT-NPS, RCP

2. Your patient is a 45 year old white male who presents with respiratory distress. His respiratory rate is rapid at 25 bpm. His heart rate is high at 128 bpm and he is using his accessory muscles to breathe. At this point, you would be most concerned with which of his needs? A. safety B. self actuation C. Sense of belonging

3. answer • A. safety: if the patient is feeling short of breath [SOB] he doesn’t feel safe—and he most likely isn’t safe. Correct his distress

4. To chart his respiratory rate, you would place this data into what part of the SOAP charting? S O A P

5. answer O for objective. All data discovered by your senses [see, hear, feel or smell] belong here. You looked at him to count his respiratory rate. As a general rule, numbers are objective data

6. To chart his work of breathing you would go to what part of the SOAP? A O A P

7. answer • O objective: again, this is data collected with your senses

8. When you ask him how he feels, your patient tells you that he feels “hot” and “tired” and it is “difficult to breathe.” You would place this data where? S O A P

9. answer • S: subjective. • You place information that is someone’s opinion or some one’s guess here. • If you described him as an “obese elderly gentleman”—this is only your opinion. You don’t really know if he’s middle-aged or elderly. • If you know his exact age, you put that into Objective, because it is a number • If you know his exact weight, again that goes into the Objective because it is a number

10. You perform a pulse oximetry reading to get this patient’s exact oxygen level in his finger. This data would be placed where in the SOAP? • S • O • A • P

11. answer • Objective: it is a number

12. You have orders to start this gentleman on supplementary oxygen. You start it and in 20 minutes you repeat your assessment. In what part of the SOAP charting do you place the results of the therapy? S O A P

13. answer • A: appearance. • “It appears that the oxygen cannula at 2 lpm was helpful because the respiratory rate dropped back to 22 bpm and the heart rate dropped to 95 bpm. The pulse oximetry reading rose from 88% to 90%”

14. If you decide to suggest to the doctor to increase the oxygen this patient is getting, you would chart where? S O A P

15. answer • Plan: it is your plan for the future that he be “placed on 5 lpm of 02 by cannula because the Sp02 is still only 90%. “ “Increase the oxygen and continue to monitor the respiratory rate and the heart rate and the pulse oximetry. If his pulse oximetry gets to 100% on this, decrease the oxygen by 1 lpm.”

16. TDP

17. Using the above TDP, respond to the following patient situation: Your patient is a 33 year old who has inhaled toxic chemicals. He is breathing 40 bpm and is using his accessory muscles. His skin is pale and his nail beds are cyanotic [blue]

18. answer • Start him on 02 but if the 02 doesn’t slow his breathing down, consider bagging him with 02 because the respiratory rate of 36bpm is considered a sign of respiratory failure—call the doctor, with all the other problems, he no longer fits the TDP

19. Your patient is a 65 year old who presents with no chest movement. What do you do?

20. answer • Bag him with 100% 02 unless he has a DNR on his chart

21. Your patient is deeply cyanotic and his respiratory rate is 15 bpm, his heart rate is 115 bpm

22. answer • According to the protocol, you don’t bag him, but his skin color requires you to call the doctor for orders---he doesn’t fit the protocol—call for help