Unit 2 RSPT 1438Unit 2 RSPT 1438case studies in case studies in

communicationscommunications

By Elizabeth Kelley Buzbee By Elizabeth Kelley Buzbee AAS, RRT-NPS, RCPAAS, RRT-NPS, RCP

Your patient is a 45 year old white Your patient is a 45 year old white male who presents with respiratory male who presents with respiratory distress. His respiratory rate is rapid distress. His respiratory rate is rapid at 25 bpm. His heart rate is high at at 25 bpm. His heart rate is high at 128 bpm and he is using his 128 bpm and he is using his accessory muscles to breathe.accessory muscles to breathe.

At this point, you would be most At this point, you would be most concerned with which of his needs?concerned with which of his needs?A. safetyA. safety

B. self actuationB. self actuation

C. Sense of belongingC. Sense of belonging

answeranswer

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

To chart his respiratory rate, you To chart his respiratory rate, you would place this data into what part would place this data into what part of the SOAP charting?of the SOAP charting?

SS

OO

AA

PP

answeranswer

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

To chart his work of breathing you To chart his work of breathing you would go to what part of the SOAP?would go to what part of the SOAP?

AA

OO

AA

PP

answeranswer

O objective: again, this is data O objective: again, this is data collected with your sensescollected with your senses

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

OO

AA

PP

answeranswer

S: subjective. S: subjective. You place information that is someone’s You place information that is someone’s

opinion or some one’s guess here. opinion or some one’s guess here. If you described him as an “obese elderly If you described him as an “obese elderly

gentleman”—this is only your opinion. You gentleman”—this is only your opinion. You don’t don’t reallyreally know if he’s middle-aged or know if he’s middle-aged or elderly.elderly.

If you know his exact age, you put that into If you know his exact age, you put that into Objective, because it is a number Objective, because it is a number

If you know his exact weight, again that goes If you know his exact weight, again that goes into the Objective because it is a numberinto the Objective because it is a number

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

SSOOAAPP

answeranswer

Objective: it is a numberObjective: it is a number

You have orders to start this gentleman You have orders to start this gentleman on supplementary oxygen. You start it on supplementary oxygen. You start it and in 20 minutes you repeat your and in 20 minutes you repeat your assessment.assessment.

In what part of the SOAP charting do In what part of the SOAP charting do you place the results of the therapy?you place the results of the therapy?SSOOAAPP

answeranswer

A: appearance. A: appearance. ““It appears that the oxygen cannula It appears that the oxygen cannula

at 2 lpm was helpful because the at 2 lpm was helpful because the respiratory rate dropped back to 22 respiratory rate dropped back to 22 bpm and the heart rate dropped to bpm and the heart rate dropped to 95 bpm. The pulse oximetry reading 95 bpm. The pulse oximetry reading rose from 88% to 90%”rose from 88% to 90%”

If you decide to suggest to the If you decide to suggest to the doctor to increase the oxygen this doctor to increase the oxygen this patient is getting, you would chart patient is getting, you would chart where?where?

SS

OO

AA

PP

answeranswer

Plan: Plan: it is your plan for the future that he be it is your plan for the future that he be

“placed on 5 lpm of 02 by cannula “placed on 5 lpm of 02 by cannula because the Sp02 is still only 90%. “because the Sp02 is still only 90%. “

““Increase the oxygen and continue to Increase the oxygen and continue to monitor the respiratory rate and the monitor the respiratory rate and the heart rate and the pulse oximetry. If his heart rate and the pulse oximetry. If his pulse oximetry gets to 100% on this, pulse oximetry gets to 100% on this, decrease the oxygen by 1 lpm.” decrease the oxygen by 1 lpm.”

TDPTDPIs the patient

Breathing?

noYes, but rate is less than 8 bpm

Yes, rate is 8-20 bpm

Mask bag at 100%

Mask bag at 100%

Yes, rate is more than 35 bpm

Give supplementary 02

And assess for a need to bag

No, don’t bag

Using the above TDP, respond to the Using the above TDP, respond to the following patient situation:following patient situation:

Your patient is a 33 year old who has Your patient is a 33 year old who has inhaled toxic chemicals. He is inhaled toxic chemicals. He is breathing 40 bpm and is using his breathing 40 bpm and is using his accessory muscles. His skin is pale accessory muscles. His skin is pale and his nail beds are cyanotic [blue]and his nail beds are cyanotic [blue]

answeranswer

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

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

answeranswer

Bag him with 100% 02 unless he has Bag him with 100% 02 unless he has a DNR on his charta DNR on his chart

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

answeranswer

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