NSE 112 Final: nse112exam h

Mrs. Tom, a 79 year old female presents to the ER with complaints of a persistent productive cough, fatigue, fever and shortness of breath. Mrs. Tom reports that she has had a persistent cough and shortness of breath with activity for several months.  She was given a prescription for antibiotics for a presumed infection 4 weeks ago, with only slight improvement in symptoms.  Her past medical history includes stroke 6 months ago.  She also smokes 20 cigarettes per day.  On exam, she has a fever with decreased lung sounds bilaterally to auscultation with the right side slightly more obvious than the left.  She is obviously short of breath and presents with 4-word dyspnea.  Her vital signs are BP 110/70, HR 99, SP02 94% on 4 L of oxygen via nasal prongs, Temp 38.9

Mrs. Tom, a 79 year old female presents to the ER with complaints of a persistent productive cough, fatigue, fever and shortness of breath. Mrs. Tom reports that she has had a persistent cough and shortness of breath with activity for several months. She was given a prescription for antibiotics for a presumed infection 4 weeks ago, with only slight improvement in symptoms. Her past medical history includes stroke 6 months ago. She also smokes 20 cigarettes per day. On exam, she has a fever with decreased lung sounds bilaterally to auscultation with the right side slightly more obvious than the left. She is obviously short of breath and presents with 4-word dyspnea. Her vital signs are BP 110/70, HR 99, SP02 94% on 4 L of oxygen via nasal prongs, Temp 38.9.

1. Identify the infection of inflammatory response that Mrs. Tom is experiencing? (2)

2. Explain the pathology of how smoking affects the innate defense system of the lungs? (5)

3. What diagnostic tools could you expect to be used in this case? (xray,CT,laboratory data etc). (2)

4. Identify risk factors that Mrs. Tom has that are associated with the diagnosis? (3)

5. Internal medicine assesses Mrs. Tom and orders a STAT lactate and arterial blood gasses. Based on the patient’s vital signs above, what would you expect to see in the results of these tests? (5)

identify three (3) points to discuss with new mothers who are breastfeeding their newborn.