Name:
RSPT 1429 Unit 3 SVN Case studies part ii
roster #
date:
2007
Case study # 1
Your patient is a 34-year-old LMF with a history of frequent respiratory tract infections.
She is febrile and Pseudomonas A has been cultured from her sputum. You hear bilateral
rhonchi and crackles over her RML and some scattered wheezes over the rest of the chest
a.
You suggest what drug to treat the infection?
Tobi
b.
What dose?
The entire unit dose
c.
How would you deliver this medication?
PARI neb
d.
How would you monitor this patient's response to this drug?
 Get heart rate before and after to see s/s increased WOB in reaction to this drug

Get respiratory before and after to see s/s increased WOB in reaction to this drug

The Sp02 will go up because of the increased Fi02 of the 6-8 lpm of the TX, will have to
get a Sp02 about 20 minutes later

Bilateral breath sounds before and after to check for bronchospasm that is a hazard of
this drug

After a week or so, a repeat sputum & X-ray could be done to assess the effectiveness of
this antibiotic
e.
Do you want to administer another drug? Which one and what dose?

If this patient starts to wheeze with this drugs, I would recommend a Beta II bronchodilator
such as 2.5 mg albuterol or .63 Xopenex
Case study # 2
Your patient is a 55-year-old WM who presents with diffuse inspiratory and expiratory
wheezing. He has a Sp02 of 93% on 3 lpm nasal cannula.
a. You suggest what drug?
 Start him on Albuterol or levalbuterol
b. What dose? 2.5 mg Albuterol or .63 mg levalbuterol
c. How would you deliver this medication?
 By pneumatic SVN, or BAN
d. How would you monitor this patient's response to this drug?
 Get heart rate before and after to see s/s increased WOB

Get respiratory before and after to see s/s increased WOB

The Sp02 will go up because of the increased Fi02 of the 6-8 lpm of the TX, will have to
get a Sp02 about 20 minutes later

Bilateral breath sounds before and after to check for relief of bronchospasm

Observation of the patient for retractions, and use of accessory muscles, observation of
skin for diaphoresis or cyanosis
e. Do you want to administer another drug? Which one and what dose?

Depending on this patient’s history, we may need to add an MDI of a inhaled steroid
Case study # 3
Your patient is an 18 mouth old infant with a recent history of cough, wheezing and fever.
He has inspiratory stridor and a nasal washing positive for RSV.
a. You suggest what drug?
 Start him on racemic epinephrine 2.25% for stridor
b. What dose?
 .05 ml/kg IBW
c. How would you deliver this medication?
 Pneumatic SVN
d. How would you monitor this patient's response to this drug?
 Get heart rate before and after to see s/s increased WOB

Get respiratory before and after to see s/s increased WOB

The Sp02 will go up because of the increased Fi02 of the 6-8 lpm of the TX, will have to
get a Sp02 about 20 minutes later

Bilateral breath sounds before and after to check for relief of bronchospasm

Observation of the patient for retractions, and use of accessory muscles, observation of
skin for diaphoresis or cyanosis
e. Do you want to administer another drug? Which one and what dose?
 We could give him a second SVN treatment with .63 levalbuterol or 2.5 mg Albuterol
for the wheezing

It is too late to start him on Ribavirin because the wash takes more than 24 hours
process
Case study # 4
Your patient is a 24 year old who has just been extubated [endotracheal tube pulled out].
You hear inspiratory and expiratory wheezing to all lobes.
a. You suggest what drug?
 Start him on 2.5 mg Albuterol or .63 mg levalbuterol
b. What dose?
 Start him on 2.5 mg Albuterol or .63 mg levalbuterol
c. How would you deliver this medication?
 By pneumatic SVN or BAN
d. How would you monitor this patient's response to this drug?
 Get heart rate before and after to see s/s increased WOB

Get respiratory before and after to see s/s increased WOB

The Sp02 will go up because of the increased Fi02 of the 6-8 lpm of the TX, will have to
get a Sp02 about 20 minutes later

Bilateral breath sounds before and after to check for relief of bronchospasm

Observation of the patient for retractions, and use of accessory muscles, observation of
skin for diaphoresis or cyanosis
e. Do you want to administer another drug? Which one and what dose?
 Reassess the breath sounds looking for stridor associated with pulling endotracheal tubes
out.. if so give 7 ml of 2.25% racemic epinephrine
Case study # 5
You patient is a 70 year old with COPD. He presents with wheezing to all lobes, rhonchi
and crackles in the bases. He is on 2 lpm nasal cannula with Sp02 of 93%.
a. You suggest what drug?
 Beta II and cholinergic combination
b. What dose? 2.5 mg Albuterol or .63 mg levalbuterol and 500 micrograms of ipratropium
bromide.
c. How would you deliver this medication?
 By pneumatic SVN or BAN
d. How would you monitor this patient's response to this drug?
 Get heart rate before and after to see s/s increased WOB

Get respiratory before and after to see s/s increased WOB

The Sp02 will go up because of the increased Fi02 of the 6-8 lpm of the TX, will
have to get a Sp02 about 20 minutes later

Bilateral breath sounds before and after to check for relief of bronchospasm

Observation of the patient for retractions, and use of accessory muscles, observation
of skin for diaphoresis or cyanosis
 Observation of sputum: is it too thich—
e. Do you want to administer another drug? Which one and what dose?
 add 3 ml mucomyst 10% added to other drugs if secretions are too thick

consider unit dose of Tobi if patient is growing Pseudomona A
Case study # 6
Your patient is comatose and on a tracheostomy collar. You hear bilateral diffuse
wheezes, crackles and diminished breath sounds. The secretions are thick and green.
His sputum culture is positive for Pseudomonas A. The doctor wants to give her 1 cc
mucomyst.
a. You suggest what needs to be done?
 Patient needs Beta II bronchodilator [Albuterol or levalbuterol]
b. How would you deliver this medication?
 By SVN to tracheostomy collar[Albuterol or levalbuterol]
c. How would you monitor this patient's response to this drug?
 Get heart rate before and after to see s/s increased WOB

Get respiratory before and after to see s/s increased WOB

The Sp02 will go up because of the increased Fi02 of the 6-8 lpm of the TX, will
have to get a Sp02 about 20 minutes later

Bilateral breath sounds before and after to check for relief of bronchospasm

Observation of the patient for retractions, and use of accessory muscles, observation
of skin for diaphoresis or cyanosis

Observation of sputum: is it still too thick?
d. Do you want to administer another drug? Which one and what dose?
 If secretions still too thick, you might need mucomyst 10% but be ready to suction
because this patient cannot protect his airway
e. Is there another drug he might need? What dose
 Needs unit dose of Tobi for Tx of pneumonia with Pseudomonas A
f. How do you deliver that drug?
 By PARI to tracheostomy collar [Tobi]