Respiratory Case Study 6
Instructions: Read the case study. Use the Rosdahl, Timby and drug books. For each question answered,
cite the page number(s) of your reference(s). All questions apply to this case study. Your response should
be brief and to the point. When asked to provide several answers, they should be listed in order of priority
or significance. Do not assume information that is not provided.
A. K. is a 38-year old woman who runs 3 miles every morning. She comes to the Family Nurse
Practitioner Clinic with complaints of a burning feeling in her throat and upper airway that begins shortly
after she starts running. She states that she gets increasingly more winded and sometimes has to stop
running to catch her breath.
1. As the intake nurse working in the clinic, what routine information would you want to obtain
from A. K.?
--- Her jogging, and her routine(every morning).
2. What two body systems do you suspect might be involved in A. K.’s problem?
--- Respiratory and Cardiovascular system.
3. What would you do to differentiate between problems in the two body systems?
--- Cardiovascular systems are designed for transportation and communication throughout the body.
(Roshdal pg. 254)
--- Respiratory system is responsible for drawing air into the lungs, exchanging oxygen, for carbon
dioxide, and removing carbon dioxide and other gaseous wastes. (Roshdal pg. 290)
You assess A. K. and note the following: S1 S
2 with no murmurs, clicks, or rubs; on inspiration her heart
rate speeds up and you think you hear a split S2; and on expiration her heart rate slows down and you
don’t hear the split.
4. Discuss the significance of these findings.
--- The first heart sound (S1) represents closure of the atrioventricular (mitral and tricuspid) valves as the
ventricular pressures exceed atrial pressures at the beginning of systole, The second heart sound (S2)
represents closure of the semilunar (aortic and pulmonary) valves (point d). S2 is normally split because
the aortic valve (A2) closes before the pulmonary valve
Her lungs are clear throughout and percuss resonance. You measure height and weight to calculate her
estimated peak expiratory flow rate (PEFR). You then measure A. K.’s actual PEFR using a peak flow
meter (PFM).
5. Explain the purpose of the PEFR measurement.
--- test measures how fast a person can exhale.
6. You record A. K.’s PEFR measurement and note that it is within 5% of estimated normal PEFR.
Discuss the significance of her pulmonary evaluation and these findings.
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The FNP confirms your examination findings and after reviewing A. K.’s PEFR measurements, discusses
the possibility of exercise-induced asthma (EIA) with A. K. She directs A. K. to record her PEFR then go
for her usual morning run. If she experiences the burning feeling in her throat and upper airway and/or
becomes short of breath, she should stop running and immediately measure and record her PEFR. Repeat
measurements should be taken at 5 minute intervals for 20 to 30 minutes. Ask A. K. to bring her PEFR
record with her next time.
7. What is the FNP hoping to learn from the presymptom to postsymptom PEFR measurement?
--- Normal adult peak flow scores range between around 400 and 700 litres per minute, although scores in
older women can be lower and still be normal. The most important thing is whether your score is normal
for you.
A. K. returns in 1 week for a follow-up visit. She hands you a list of PEFR measurements. You calculate
that A. K.’s postrun measurements range from 75% to 85% of her prerun values and her PEFR returned to
normal within 25 minutes of stopping activity.
8. What does this patterns of change indicate?
--- 80 to 100 percent of your usual or "normal" peak flow rate signals all clear. A reading in this zone
means that your asthma is under reasonably good control.
The FNP gives A. K. an albuterol (Ventolin) metered-dose inhaler (MDI) with a spacer and instructs her
to take 2 puffs 15 minutes before she exercises. The FNP is called to see another patient and asks you to
complete the discharge teaching with A. K.
9. What information should you discuss with her?
--- Ensuring safe transitions from hospital to home requires a systematic approach that
includes the patient and family in the discharge process.
10. A. K. says she doesn’t like to be dependent on medication. How would you respond to her
statement?
--- Verifying the medication history list against the medications ordered on admission
11. A. K. asks if it is possible for her to develop full-blown asthma. How would you respond?
--- Inform her profesionally about her questions.
A. K. was motivated to take her MDI so she could maintain her exercise regimen. At a follow-up visit,
she tells you she saw, “Lots of folks using an MDI at last Saturday’s race.”
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