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. 

System Illness/Disease Signs/ Diagnostics/Labs Medical Surgical Nursing

Symptoms Management Managemen Intervention
(at least 6 t
clinical features)
Respirator Asthma  Shortness  Spirometry Medical Bronchial 1. Assess
y of breath.  Peak flow management thermoplast respiratory
 Cough. meter tests includes y status by
 Chest  Exhaled bronchodilators closely
tightness nitric oxide like beta-2 evaluating
or pain. test agonists and breathing
 Wheeze (a  Methacholin muscarinic patterns and
whistling e challenge antagonists monitoring
sound  Imaging (salbutamol and vital signs.
when you tests ipratropium 2. Administer
breathe).  Allergy bromide prescribed
 breathing testing respectively) and medications,
faster. anti- such as
 exhaustion inflammatories bronchodilato
or such as inhaled rs, anti-
dizziness. steroids (usually inflammatori
beclometasone es, and
but steroids via antibiotics.
any route will be 3. Promote
helpful). adequate
oxygenation
and a normal
breathing
pattern
4. Explain the
possible use
of
hyposensitiza
tion therapy
5. Help the
child cope
with poor
self-esteem
by
encouraging
him to
ventilate
feelings and
concerns.
Listen
actively as
the child
speaks, focus
on the child’s
strengths,
and help him
to identify the
positive and
negative
aspects of his
situation.
6. Discuss the
need for
periodic PFTs
to evaluate
and guide
 therapy and
to monitor
the course f
the illness.
7. Provide child
and family
teaching.
Assist the
child and
family to
name signs
and
symptoms of
an acute
attack and
appropriate
treatment
measures
8. Refer the
family to
appropriate
community
agencies for
assistance.
Coronary Artery  Chest pain  Coronary The goals of  Corona  Monitor blood
Disease or Angiography medical ry pressure,
Cardiovas discomfort  Echocardiog management are angiopl apical heart
cular (angina) ram (ECHO) to decrease the asty rate, and
 Weakness  Electrocardi oxygen demands and respirations
 light- ogram (ECG of the stent every 5
headednes or EKG) myocardium and placem minutes
s  Stress to increase the ent. during an
 nausea Echocardiog oxygen supply  Corona anginal
(feeling ram through ry attack.
sick to  Stress pharmacological artery  Maintain
your Thallium therapy and risk bypass continuous
stomach), Test factor control graft ECG
or a cold  Chest X-ray surger monitoring or
sweat. y obtain a 12-
 Pain or (CABG) lead ECG, as
discomfort . directed,
in the arms monitor for
or arrhythmias
shoulder. and ST
 Shortness elevation.
of breath.  Place patient
in
comfortable
position and
administer
oxygen, if
prescribed, to
enhance
myocardial
oxygen
supply.
 Identify
specific
activities
patient may
engage in
that are
below the
level at which
 anginal pain
occurs.
 Reinforce the
importance of
notifying
nursing staff
whenever
angina pain
is
experienced.
 Encourage
supine
position for
dizziness
caused by
antianginals.
 Be alert to
adverse
reaction
related to
abrupt
discontinuati
on of beta-
adrenergic
blocker and
calcium
channel
blocker
therapy.
These drug
must be
tapered to
 prevent a
“rebound
phenomenon”
; tachycardia,
increase in
chest pain,
and
hypertension.
 Explain to
the patient
the
importance of
anxiety
reduction to
assist to
control
angina.
 Teach the
patient
relaxation
techniques.
 Review
specific
factors that
affect CAD
development
and
progression;
highlight
those risk
factors that
can be
 modified and
controlled to
reduce the
risk.
Gastrointe Ulcerative Colitis  Frequent  Barium Treatments can  Procto  Promote
stinal diarrhea enema be broadly colecto nursing care
throughout  Colonoscopy considered as my of the client
the day  Stool those used to and who is
(usually analysis induce remission Brooke receiving
occurring 3 (at diagnosis or ileosto nothing by
or more for a subsequent my. mouth,
times) flare), such as 5-  Abdom receiving oral
 Headaches. aminosalicylic inal fluids, or on
 Body acid (5-ASA) colecto total
aches. agents, my parenteral
 Bloody or corticosteroids and nutrition
mucus- and biologics, and ilcorect during an
filled bowel those used for al acute
movement. long-term anasto exacerbation.
 Mild fever. maintenance of mosis.  Assess for
 Nausea remission such as  Procto fluid and
and 5-ASA agents, colecto electrolyte
vomiting. biologics and my imbalance.
thiopurines. and Administer IV
Kock fluids and
pouch. electrolytes
 Restor as indicated.
ative  Encourage a
procto low-residue,
colecto high-protein,
my high-calorie
with diet with
 ileal supplemental
pouch- vitamin
anal therapy and
anasto iron
mosis replacement.
(IPAA).  Implement
measures to
treat diarrhea
or
constipation.
 Address and
mediate the
client’s pain.
Promote
intermittent
rest periods
and bed rest
when the
client has
acute
exacerbations
.
Endocrine Hyperthyroidism    
Circulatory Arrhythmia  Pounding in  Electrocardiogr •  
your chest. am (ECG or
 Dizziness or EKG)
feeling  Ambulatory
lightheaded. monitors
 Shortness of  Stress test
breath.  Cardiac
 Chest catheterization
discomfort.  Echocardiogra
 Weakness or m
fatigue  Electrophysiolo
(feeling very gy study (EPS)
tired).  Tilt tables test
 Weakening of
the heart
muscle or low
ejection
fraction.
Lymphatic Lymphoma  Painless  Physical exam  
swelling of  Removing a
lymph nodes lymph node for
in your neck, testing
armpits or  Blood tests
groin  Removing a
 Persistent sample of bone
fatigue marrow for
 Fever testing
 Shortness of  Imaging tests
breath
 Unexplained
 weight loss
 Itchy skin