Pneumonia and Pneumothorax

Pneumonia and Pneumothorax

Dona Ana Community College

Respiratory Therapy Program

Fall Case Study

Kelsie A Parra

October 24-25th 2017.

• Blood work: WBC: 6.28, RBC: 2.78; HgB: 8; HCT: 23.9 and platelet count: 50. Electrolytes; Sodium: 128, Potassium: 3.6, chloride 92, and calcium 4.5.
• Arterial Blood Gas at 5:18am
• chest x-ray at 4:39
• Arterial Blood Gas at 17:39
• Ventilator changes
• Arterial Blood Gas at 20:35
• Ventilator changes
• Arterial Blood Gas at 23:35
• Ventilator changes

October 26th, 2017.

October 18th 2017

• Chest x-ray at 4:52am
• Arterial Blood Gas at 5:00am
• Ventilator Changes
• Blood Work: WBC: 3.53; RBC: 3.10; HgB: 9.2; HCT: 28.3 and platelet count of 14.
• Developed DIC
• Went into PEA
• Pronounced deceased at 17:05
• Cause of death was septic shock caused by the burkholderia cepacia

Patient History

• Former smoker 1 pack per day
• Quit smoking 3 years ago
• Membranous glomerulonephropathy or MGN
• Severe hypoalbuminemia and edema
• dyslipidemia
• Presumed COPD and was taking albuterol at home

• Patient assessment
• Arterial Blood Gas
• Chest x-ray at 8:11 am (Pneumothorax)
• Chest tube insertion
• Intubation
• Initial ventilator setting
• Post arterial blood gas
• Changes to ventilator

Pneumonia

Patient Profile

References

• What is it?
• Common Causes
• How do you diagnosis it?
• Clinical Management

• pleurodesis. (n.d.) Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. (2003). Retrieved November 21, 2017 from https://medical-dictionary.thefreedictionary.com/pleurodesis
• What is Pneumonia? (2016, January 1). American Journal of Respiratory and Critical Care Medicine.Vol. 193, No. 1. Retrieved November 21, 2017 from http://www.atsjournals.org/doi/abs/10.1164/rccm.1931P1
• Currie, G. P., Alluri, R., Christie, G. L., & Legge, J. S. (2007). Pneumothorax: an update. Postgraduate Medical Journal, 83(981), 461–465. http://doi.org/10.1136/pgmj.2007.056978
• Anemia. (2017, August 08). Retrieved November 25, 2017, from https://www.mayoclinic.org/diseases-conditions/anemia/symptoms-causes/syc-20351360
• What Is Disseminated Intravascular Coagulation? (2011, November 02). Retrieved November 26, 2017, from https://www.nhlbi.nih.gov/health/health-topics/topics/dic
• Fungal Pneumonia Overview of Fungal Pneumonia. (2017, October 18). Retrieved November 26, 2017, from https://emedicine.medscape.com/article/300341-overview#a1
• Burke, D. ( 2016, February 25). Membranous Glomerulonephritis. Retrieved November 26, 2017 from https://www.healthline.com/health/membranous-nephropathy#overview1

• 69 year old Hispanic Female

• Admitted to ER on 10/16/2017

• Weighs 65 Kg

• Length 155cm

Pneumothorax

October 17th 2017

• Vital Signs
• Arterial Blood Gas
• High Flow nasal Cannula
• Chest x-ray
• Sputum culture positive for Candidia Albicans
• BiPAP initial settings

• Air in between the parietal and visceral pleura
• Common Causes
• Different Types
• Clinical Management

Admission to ICU

• Chief Complaint: Shortness of breath
• Sent from her doctor due to respiratory difficulty and hypoxemia.
• Arterial blood gas was drawn at 13:57
• Chest x-ray was obtained at 1402
• Second Arterial Blood Gas
• Blood cultures were also obtained and found Burkholderia cepacia
• Admitted for interstitial pulmonary disease (interstitial pneumonia), hypoxemia, and acute on chronic respiratory failure.

Burkholderia cepacia - An unusual

organism for sepsis in ICUs

• Journal of Clinical and Diagnostic Research
• How common this is in development of pneumonia.
• Sepsis causing bacteria