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Nursing Case Study: Oxygenation

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  • 0:04 Oxygenation Case Study
  • 0:33 Part 1
  • 2:23 Part 2
  • 6:15 Lesson Summary
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Lesson Transcript
Instructor: Artem Cheprasov

Artem has a doctor of veterinary medicine degree.

In this lesson, you're going to explore a case study involving an issue with a person's oxygenation. You'll be asked questions along the way to test your knowledge and critical thinking skills.

Oxygenation Case Study

In this lesson, we're going to go over a nursing case study involving concepts surrounding oxygenation. Of course, we can't simply ignore other important parts that will come up in this case scenario, but we will mainly focus on a case where a person's oxygenation is impaired. As we go through this case study, you'll encounter a few pauses here and there that will test your knowledge. Try to answer the questions on your own prior to proceeding any further. This will help with your critical thinking skills.

Part 1

History, Signs, and Symptoms

And here we go! Linda is a 45-year old woman who presents with the following signs and symptoms at a Chicago hospital:

  • Dyspnea, or labored breathing
  • Chest pain, especially upon inhalation
  • Pain, described as a cramping pain, in her calf
  • Mild swelling of her calf

Linda is not on any medication and does not have a history of any notable medical problems. She mentions that her symptoms began a couple of days ago, and that she just flew back from a business trip to Hong Kong three days ago.

Vital Signs

You assess Linda and find the following:

  • A heart rate of 110 beats per minute
  • A respiratory rate of 28 breaths per minute
  • A blood pressure of 110/75 mmgHg
  • A temperature of 37.0 degrees Celsius
  • Pulse oximetry oxygen saturation (SP02) of 92%

Test Yourself

Question:

Of the vital signs mentioned, which are abnormal?

Answer:

  • A normal resting heart rate for adults is commonly held to be 60-100; thus Linda is tachycardic - she has an abnormally fast heart rate.
  • A normal resting respiratory rate for adults is about 12-20 breaths a minute; thus, Linda's respiratory rate is high.
  • Normal blood pressure is between 90/60 mmHg - 120/80 mmHg, so her blood pressure is within normal limits.
  • The normal temperature range is about 36.1 - 37.2 degrees Celsius. This means her temperature is normal.
  • Finally, her oxygen saturation is 91%, while normal values are usually 95% or greater.

Part 2

Initial Diagnostics and Treatment

Because of the SP02 reading, you apply a simple face mask with supplemental oxygen. You are also concerned about the fact that Linda has this chest pain and the tachycardia. This might mean heart trouble, so you perform an ECG (an electrocardiogram) to analyze the electrical activity of the heart. Blood tests are also taken and an x-ray will occur shortly. The chest pain is addressed with nitroglycerin.

Linda mentions that the supplemental oxygen is making it easier for her to breathe; however, the nitroglycerin has done nothing for her chest pain. The ECG reveals an S1Q3T3 pattern, the blood tests reveal a raised d-dimer, and the x-ray doesn't show anything of significance.

Vital Signs

Linda's vital signs are now as follows:

  • A heart rate of 125 beats per minute
  • A respiratory rate of 28 breaths per minute
  • A blood pressure of 91/70 mmgHg
  • A temperature of 36.8 degrees Celsius
  • SP02 of 92%, with oxygen supplementation

Test Yourself

Question:

By putting everything together, what do you think is going on?

Answer:

In this instance, if you suspected primary heart trouble, a respiratory infection, or pulmonary embolism somewhere along the line, you're doing great! All of those were reasonable conclusions at one point in time. However, by this point, you should have narrowed down the list of three or more to one.

The best suspicion at this point is a pulmonary embolism (PE) - a blood clot in the lungs. Why? Reasons for this include:

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