40

The patient, Patrick Engle, is an active 25 year old male who runs five miles a day, 5 days a week. He has had no prior medical history and lives with his two young adult roommates who are frequently out of town. His immediate family all lives in Michigan and he has no family support in the area. He works as an accountant and commutes three miles each way to work on a bike. One day on his way home from work, he was passing an off ramp on a busy freeway and was struck by a car that failed to stop at the stop sign at the bottom of the off ramp. He was hit from the side and flew off his bike. Paramedics were called and arrived on scene. He was transported by ambulance to the local county hospital and was diagnosed with a fractured femur. He was taken to surgery where the fracture was repaired with open reduction and internal fixation (ORIF) surgery. He was discharged home two days after surgery.

The day after discharge, Patrick experienced shortness of breath, chest pain and weakness while preparing food in the kitchen. He immediately called his mom in Michigan who advised him to return to the emergency room (ER). He was not able to drive due to his broken leg and his roommates weren’t home so he called 911 and paramedics arrived on scene within 10 minutes. He was taken to the ER and his vital signs were as follows: HR 123, BP 90/64, RR 22, O2 88%. He was agitated, restless, anxious, diaphoretic, and complained of 8/10 chest pain. He had diminished lung sounds on the right side. ABGs were drawn and revealed a pH of 7.30, PaO2 of 82, and a PaCO2 of 50.

Discussion questions:

1. How would you interpret his ABG values?

2. What other diagnostics would you expect to be ordered for this patient?

3. If you were the nurse case manager what are your main concerns for the patient during the hospital stay and after discharge.

References

Rana, S. (2016). Acute pulmonary episode in young: Case reports. The Journal of Association of Chest Physicians, 5, 46-50. doi:10.4103/2320-8775.196657

Unbound Medicine, Inc. (2017). Nursing Central (1.31) [Mobile application software]. Retrieved from https://itunes.apple.com/us/app/nursing-central/id300420397?mt=8