1000 word Systematic Assessment
In 1000 words, comprehensively undertake a Respiratory Assessment: including how your findings relate to your patient’s underlying respiratory physiology and pathophysiology.
Your assignment must also include the findings from your patient’s ABG and how these results relate to your patient. (You do not need to describe how to interpret an ABG; however, you must be able to relate the findings to your patient. i.e. if your patient has a respiratory acidosis how does this finding relate to your patients presentation and clinical assessment?)
You MUST relate your discussion to the context of your patient, their presentation and your assessment findings. You must also use current literature to support your discussion.
About the patient:
A 47-year-old lady had her lap band re-inserted, she was morbidly obese but all of her previous anaesthetic notes classified her as a Grade 1 view for intubation. Her weight was very close to the last time she had an anaesthetic. Cricoid pressure was used because of her obesity and reflux issues. However, a bougie was required as the anesthetists had a grade 2 view. Preoperative all routine bloods were in reference range.
Through out surgery all of the patient’s vitals were in stable. Once the patient’s surgery was completed there was a lot of fluffing around to get the patient on their bed. The anaesthetist asked for the bed immediately to transfer the patient so extubation could take place sitting up. There were a lot of medical students in the theatre and trolleys. We had to ask everyone to move out the way to get the bed but there was an unacceptable and preventable time lapse where the patient was lying flat. The patient ‘s saturations went down to 60% this was corrected very quickly and the patient was safely extubated. The patient had easy access for arterial blood as the patient had a arterial line. ABG’s were ordered for PACU to rule out respiratory acidosis. The results were normal and poor chest expansion for a short period was to blame.
Results were:
• PH 7.4
• PCO2 38
• P02 84
• BIC 27
• Osat 98%
Teacher’s comments to me:
This patient sounds suitable. Even if there were no changes to the ABG, you can discuss the types of factors in the ABG you would review such as PCO2 etc and the same for an x-ray – what would you review it for? The main consideration is to show your clinical thinking.
My comments:
• Can we please mention what steps the anaesthetist would do to correct the oxygen saturation i.e. with the ventilator
• Talk about why the ABG’s were ordered (see teachers comment)
• Talk about an X-ray being an option and what we would look at (see teachers comment)
• Please don’t focus on the intubation, this assignment is respiratory assessment and the teacher wants a good understanding about the patients underlying respiratory physiology and pathophysiology.
• Also please refer to the assignment guide as that is how the assignment will be marked
