Unfolding Case Study
1.
Option 1: Respiratory infection; Option 2: Increased SOB and fever
Rationale: A respiratory infection would most likely be present in a patient with increased SOB and an elevated temperature. A panic attack or depression would most likely cause irritability, irrational thinking, lightheadedness, or dizziness. Asthma will most likely present with wheezing or tightness in the patient’s chest, not usually with a fever. Depression may present with irritability, a hopeless outlook, and possible crying. Medication side effects may present with the indications the patient is taking them for. For example, fever or irritability would not be the cause of the absence of taking the medications of a beta blocker, ARB, or statin.
2.
Rationale: The patient with pneumonia has a temperature of 101.2, which can indicate an infectious process and also has a positive blood culture result of Streptococcus pneumoniae. Lung fields will have crackles or decreased breath sounds, and the patient is not likely to experience wheezing. A fever is not likely to be present with COPD; increased SOB is most likely to be present. A patient with COPD can present with noted use of the accessory muscle, pursed lip breathing, and cyanosis. The anterior-posterior chest wall diameter can increase and become barrel shaped from the chronic air trapping as well as an increase in wheezing and cough. A pneumothorax occurs when a volume of air has entered the pleural space affects the degree of lung collapse. The patient will present with chest pain that increases with movement. Patients commonly report a rapid onset of dyspnea, cough, and intense chest pain that is worse with movement.
| Assessment Finding | Respiratory Infection | COPD | Pneumothorax |
| Pain in chest and intense chest pain that is worse with movement | X | ||
| Temperature: 101.2 | X | ||
| Tracheal deviation | X | ||
| Subcutaneous emphysema | X | ||
| Barrel-shaped chest | X |
Read the Electronic Health Record
1.
The patient’s low oxygenation saturation accompanied with SOB and pleuritic chest pain alongside positive ultrasound findings indicate a pneumothorax.
2.
The most concerning information is the decreased oxygenation. Air elimination, reduction of air leakage, and promoting re-expansion of the lung are the priorities.
3.
An expected finding is the presence of a small pneumothorax based on patient description of a recent fall and current symptoms. The nurse expects the provider to apply supplemental oxygen and perform a small needle biopsy.