PAUL N 106 - PROBLEM BASED LEARNING

In the Emergency Department (ED) or Emergency Room (ER), patient usually seek medical intervention because of dyspnea.
List down all diseases that will cause DYSPNEA. Please categorize according to system. 

Signs/Symptoms
System Illness/Disease (at least 6 clinical Diagnostics/Labs Medical Management Surgical Management Nursing Intervention
features)
RESPIRATORY Chronic Bronchitis Dyspnea particularly  Arterial blood gas test  Bronchodilators  Lung volume reduction  Administer
with exertion  Sputum culture  Inhaled surgery to remove bronchodilators,
Chronic cough (often  Chest X-ray or CT corticosteroids damaged lung tissue and corticosteroids, and
with mucus production), scan  Antibiotics to treat improve lung function antibiotics as ordered
Wheezing, Chest bacterial infections  Bullectomy to remove large  Monitor respiratory
discomfort or tightness,  Oxygen therapy to air sacs (bullae) that can rate, effort, and
and Fatigue increase oxygen obstruct airflow oxygen saturation
levels in the blood  Lung transplant for severe  Assess and monitor
cases for signs of
 Bronchoscopy with respiratory distress
removal of excess mucus and potential
or other obstructions complications such as
pneumonia or
respiratory failure
 Encourage coughing
and deep breathing
exercises to clear
mucus from airways
 Provide emotional
support and
counseling to help
patient cope with
anxiety and stress
related to the disease
 Educate patient and
family on proper
airway clearance
techniques and
infection control
measures.
Tracheobronchitis Dry, Irritating cough  Chest Xray  Antibiotics  ET intubation in cases of  Encourage bronchial
Expectorates a scanty  Sputum Test (depending on acute tracheobronchitis hygiene such as
amount of mucoid  Paired Serology symptom, sputum leading to acute increased fluid intake
sputum purulence and respiratory failure. and directed
Fever results of the coughing.
Chills sputum culture and  Encourage patient to
Night Sweats sensitivity) take full course of the
Headache  Fluid Intake antibiotic therapy.
General Malaise Increased  Encourage patient to
Dyspnea (as infection  Cool Vapor Therapy avoid overexertion
 progresses)  Advise patient to rest.
With noisy inspiration
and expiration
Asthma Dyspnea (particularly  Spirometry test to  Short-acting  Bronchial thermoplasty to  Administer
during or after physical measure lung bronchodilators, reduce the thickness of the bronchodilators,
activity or exposure to function and such as albuterol, to smooth muscle in the corticosteroids, and
triggers), Wheezing, identify airway relieve acute airways other asthma
Chest tightness, obstruction symptoms medications as
Coughing (particularly  Chest X-ray or CT  Long-acting ordered
at night or early in the scan to rule out bronchodilators,  Monitor respiratory
morning), and Rapid other lung such as salmeterol, rate, effort, and
breathing conditions to prevent oxygen saturation
symptoms  Assess and monitor
 Inhaled for signs of
corticosteroids to respiratory distress
reduce airway  Encourage patient to
inflammation maintain good
 Leukotriene nutrition and
modifiers to reduce hydration
inflammation and  Provide emotional
improve airflow support and
counseling to help
patient cope with
anxiety and stress
related to the disease
 Educate patient and
family on proper use
and care of asthma
medications and
devices.
Chronic Obstructive Dyspnea (particularly  Arterial blood gas  Bronchodilators,  Lung volume reduction  Administer
Pulmonary Disease during physical activity test to measure  Inhaled surgery bronchodilators,
(COPD) or exertion), Chronic oxygen and corticosteroids  Bullectomy corticosteroids, and
cough with mucus carbon dioxide  Oxygen therapy  Lung transplant for severe antibiotics as ordered
production, Wheezing, levels in the blood  Antibiotics cases  Monitor respiratory
Chest tightness, and  Sputum culture rate, effort, and
Fatigue to identify any oxygen saturation
bacterial or viral  Assess and monitor
infections for signs of
 Chest X-ray or CT respiratory distress
scan to rule out and potential
other lung complications
conditions  Encourage coughing
and deep breathing
exercises
 Teach patient and
family how to
recognize and respond
to worsening
symptoms
  Provide emotional
support and
counseling
 Educate patient and
family on proper
airway clearance
techniques, smoking
cessation, and
avoiding triggers.
Pneumonia Dyspnea (particularly  Chest X-ray or CT  Antibiotics  Thoracentesis to remove  Administer antibiotics
with exertion or when scan to identify  Antiviral excess fluid from around and oxygen therapy
lying flat), Cough (often areas of medications to treat the lungs as ordered
with phlegm inflammation or viral infections  Pleural biopsy to obtain a  Monitor respiratory
production), Chest pain infection in the  Bronchodilators tissue sample from the rate, effort, and
or discomfort lungs  Oxygen therapy lining of the lungs for oxygen saturation
(particularly when  Blood tests to  Pulmonary diagnosis and treatment  Assess and monitor
breathing deeply or measure white rehabilitation to planning for signs of
coughing), Fever and blood cell count improve lung  Surgery to remove respiratory distress
chills, Rapid breathing, and identify any function and quality abscesses or infected lung and potential
Fatigue and weakness bacterial or viral of life tissue complications such as
infections  Lobectomy or sepsis or respiratory
 Sputum culture pneumonectomy to remove failure
to identify the severely damaged or  Encourage coughing
specific bacteria infected lung tissue and deep breathing
or virus causing exercises to clear
the infection mucus from airways
 Arterial blood gas  Educate patient and
test to measure family on proper
oxygen and infection control
carbon dioxide measures and vaccine
levels in the blood recommendations.
Pulmonary Embolism Dyspnea (sudden onset),  Chest X-ray or CT  Anticoagulant  Catheter-directed  Administer
Chest pain or discomfort scan to identify medications, such thrombolysis, which is a anticoagulants and
(particularly with deep areas of as heparin or minimally invasive oxygen therapy as
breaths or coughing), inflammation or warfarin, to prevent procedure to dissolve blood ordered
Rapid breathing, Rapid infection in the blood clots from clots with medication  Monitor respiratory
heartbeat, and Cough lungs getting larger  Thrombectomy or rate, effort, and
(often with blood)  Blood tests to  Thrombolytic Embolectomy to remove oxygen saturation
measure white medications, such the blood clot from the  Assess and monitor
blood cell count as alteplase, to pulmonary artery for signs of
and identify any dissolve blood clots respiratory distress
bacterial or viral  Oxygen therapy and potential
infections complications such as
 Sputum culture pulmonary infarction
to identify the or pulmonary
specific bacteria hypertension
or virus causing  Encourage early
the infection ambulation and leg
 Arterial blood gas exercises to prevent
test to measure further blood clots
 oxygen and  Educate patient and
carbon dioxide family on the
levels in the blood importance of
adherence to
anticoagulant
therapy.
Pulmonary Dyspnea (particularly  Echocardiogram  Calcium channel  Atrial septostomy to create  Administer
Hypertension during physical activity to measure the blockers, such as a small hole between the vasodilators and
or exertion), Fatigue and pressure in the nifedipine or left and right atria to oxygen therapy as
weakness, Rapid pulmonary artery amlodipine, to reduce pressure in the ordered
heartbeat, and Chest  Pulmonary reduce blood lungs  Monitor respiratory
pain or discomfort function tests to pressure in the  Lung transplant for severe rate, effort, and
measure lung lungs cases oxygen saturation
function  Oxygen therapy  Balloon pulmonary  Assess and monitor
 Chest X-ray or CT  Diuretics to reduce angioplasty to widen for signs of
scan to rule out fluid buildup in the narrowed pulmonary respiratory distress
other lung lungs arteries and potential
conditions  Anticoagulant complications such as
 Blood tests to medications right-sided heart
measure oxygen  Digoxin to failure or syncope
and carbon strengthen the heart  Encourage patient to
dioxide levels in and improve its maintain good
the blood ability to pump nutrition and
blood hydration
 Vasodilators to relax
the blood vessels
and improve blood
flow
Pulmonary Fibrosis Dyspnea (particularly  Pulmonary  Corticosteroids to  Lung transplant for severe  Administer
during physical activity function tests to reduce inflammation cases corticosteroids,
or exertion), Chronic dry measure lung  Immunosuppressant  Bullectomy to remove large immunosuppressants,
cough, Fatigue and function and medications, such air spaces in the lungs and oxygen therapy
weakness, Chest pain or identify airway as azathioprine or that can interfere with  Monitor respiratory
discomfort, and Rapid obstruction cyclophosphamide, breathing rate, effort, and
breathing  High-resolution to prevent the  Lung volume reduction oxygen saturation
CT scan to immune system surgery to remove  Assess and monitor
identify areas of from attacking damaged lung tissue and for signs of
scarring or healthy lung tissue improve lung function respiratory distress
inflammation in  Oxygen therapy  Tracheostomy to bypass and potential
the lungs  Pulmonary the upper airway in severe complications such as
 Bronchoscopy to rehabilitation to cases pulmonary
collect a tissue improve lung  Bronchoscopy with hypertension or
sample for function and quality removal of excess mucus respiratory failure
analysis of life or other obstructions  Encourage patient to
 Blood tests to maintain good
measure oxygen nutrition and
and carbon hydration
dioxide levels in
the blood
Cystic Fibrosis Dyspnea (particularly  Sweat chloride  Bronchodilators,  Lung transplant for severe  Administer
 during physical activity
or exertion), Chronic
cough with mucus
production, Wheezing,  Pulmonary
Recurrent lung
infections, Difficulty
breathing or chest pain
 Chest X-ray or CT
Obstructive Sleep Dyspnea (particularly  Arterial blood gas
Apnea (OSA) during sleep or upon
waking up), Loud
snoring, Gasping or
choking during sleep,
Restless sleep, Morning  Physical exam to
headache, and Daytime
sleepiness or fatigue
 Polysomnography
test to measure  Mucolytic cases bronchodilators,
the amount of medications, such  Nasal and sinus surgery to antibiotics, and
salt in sweat as dornase alfa, to improve breathing and pancreatic enzyme
help break up and reduce inflammation replacements as
function tests to clear mucus from  Bronchoscopy with ordered
measure lung the lungs removal of excess mucus  Monitor respiratory
function and  Antibiotics or other obstructions rate, effort, and
identify airway  Pancreatic enzyme  Surgery to remove infected oxygen saturation
obstruction supplements to or damaged lung tissue  Assess and monitor
improve digestion for signs of
scan to identify and nutrient respiratory distress
areas of absorption and potential
inflammation or  Oxygen therapy complications such as
infection in the pneumothorax or
lungs respiratory failure
 Encourage coughing
and deep breathing
exercises to clear
mucus from airways
 Educate patient and
family on proper
airway clearance
techniques, nutrition,
and infection control
measures.
 Continuous positive  Uvulopalatopharyngoplasty  Administer
test to measure airway pressure (UPPP) to remove excess continuous positive
oxygen and (CPAP) machine to tissue from the throat and airway pressure
carbon dioxide deliver air pressure improve airflow (CPAP) therapy as
levels in the blood to keep the airway  Tonsillectomy ordered
open during sleep  Palatal Implants Surgery,  Monitor respiratory
identify any  Oral appliances to minimally invasive strategy rate, effort, and
physical reposition the jaw for treating snoring and oxygen saturation
obstructions in and tongue to keep mild cases of OSA  Assess and monitor
the airway the airway open  Tracheostomy to bypass for signs of
during sleep the upper airway in severe respiratory distress
is the gold cases and potential
standard test for complications such as
diagnosing OSA. hypertension or
During this test, cardiovascular
you'll be hooked disease
up to a machine  Teach patient and
that monitors family how to
your heart rate, recognize and respond
breathing, brain to worsening
waves, and other symptoms
body functions  Encourage patient to
while you sleep. maintain good sleep
The results will hygiene and avoid
help to determine alcohol and sedatives
 Provide emotional
the severity of support and
your OSA and counseling to help
inform treatment patient cope with
decisions. anxiety and stress
related to the disease
 Educate patient and
family on proper
CPAP device use and
maintenance.