Respiratory Emergency and Neurological Emergency - Assignment Example

Case Studies (Author’s name) (Institutional Affiliation) Case Study 1: Respiratory Emergency Types of Respiratory Diseases Respiratory diseases are basically pathological conditions which affect the tissues and organs that are responsible for gaseous exchange (Hess, MacIntyre, Galvin & Mishoe, 2016). These include conditions that affect the pleural cavity, pleura, alveoli, bronchioles, bronchi, trachea, the upper respiratory tract, as well as the muscles and nerves that function for breathing. Respiratory diseases can thus be classified as chronic respiratory diseases, respiratory tract infections, pleural cavity diseases, neonatal diseases, pulmonary vascular diseases, tumors, and restrictive lung diseases. CRDs (chronic respiratory diseases) are those which affect the structures and airways of the lungs, and include COPD (chronic obstructive pulmonary disease), asthma, and acute respiratory distress syndrome. Restrictive lung diseases are those associated with the loss of lung compliance, leading to increased stiffness of the lungs and incomplete lung expansion. Pathogenic infections can also cause respiratory diseases, such as the common cold (from the rhino virus) (an example of an upper respiratory tract infection), as well as other lower respiratory tract infections like pneumonia (Streptoccocus pneumoniae) and tuberculosis (Bacillus tuberculosis) (Wyka, Mathews & Rutkowski, 2012). Tumors can lead to cancers of the respiratory system, including lung cancer, melanoma, and Kaposi’s sarcoma. Neonatal respiratory diseases are those known to affect newborns, such as pulmonary hyperplasia. On the other hand, respiratory diseases such as pulmonary edema and pulmonary embolism which affect pulmonary circulation are known as pulmonary vascular diseases. Pleural cavity diseases include pleural mesothelioma. Pathophysiology of COPD and Asthma COPD is characterized by the inflammation of airways and dysfunction of the mucociliary which are followed by changes to the structure of the airways. Due to the exposure to inhaled substances like tobacco and smoke, inflammation of the pulmonary vessels, lung tissues and airways occur (inflammatory cells such as macrophages and neutrophils accumulate). This leads to the release of inflammatory mediators such as the interferon gamma which initiate tissue damage and other systemic effects (Wyka, Mathews & Rutkowski, 2012). The sustained inflammation results in numerous changes in the structure of the respiratory system from over-multiplication of cells, scar tissue accumulation and peribronchial fibrosis. In addition, the mucociliary transport system that clears airway mucus is damaged by inflammation leading to mucus accumulation which further worsens the airflow by blocking the airways (Hess, MacIntyre, Galvin & Mishoe, 2016). On the other hand, asthma is associated with bronchoconstriction episodes, respiratory smooth muscles tightening and chronic inflammation in the respiratory pathways. As a result of the environmental triggers like pollen, dust or smoke, inflammation occurs in the airways causing the narrowing of airways and excess mucus production which makes breathing difficult (Scotese, 2017).. Asthma thus occurs due to an immune reaction in bronchial airways. Asthma patients have airways that are sensitive to certain stimuli/ triggers. Their immune response causes the contraction of the bronchi as inflammation ensues. The inflammation narrows the airways further while also causing excess mucus production (Hess, MacIntyre, Galvin & Mishoe, 2016). This results into breathing difficulties and coughing. The inhaled allergen activates the humoral immune response leading to inflammation. Supplemental Oxygen and Hypoxic Drive The hypoxic drive is a type of respiratory drive whereby instead of using carbon dioxide receptors, the body uses oxygen receptors in order to control the cycle of respiration. Supplemental oxygen should be avoided for patients like Hillary Clinton who have hypoxic drive. In their cases, the impact of supplemental oxygen will be an increased retention of carbon dioxide (Scotese, 2017). This retention may lead to headaches and drowsiness, and in serious instances, may retard respiratory functions resulting in death. The partial pressure of oxygen in the patient’s blood is low due to the COPD. Consequently, chances are high that the use of supplemental oxygen from treatment may have the serious effect of hyperplasia (increasing the concentration of carbon dioxide which is in the blood to levels that are potentially toxic) (Wyka, Mathews & Rutkowski, 2012). The accumulation of carbon dioxide levels in the patient’s blood may occur through a number of ways. The first mechanism is the ventilation or perfusion matching (Scotese, 2017). There is usually low oxygen content in the poorly ventilated lung which results to localized vasoconstriction that impedes blood flow to the lung tissues. This constriction is abolished by supplemental oxygen thus causing poor perfusion/ ventilation matching. The redirection of blood to regions of the lung that are poorly ventilated lowers the amount of CO2 that is removed from the respiratory system (Hess, MacIntyre, Galvin & Mishoe, 2016). The Haldane effect can also cause carbon dioxide accumulation as carbon dioxide is mostly transported in the blood in bicarbonate form and as bicarbonate production is promoted by deoxygenated hemoglobin. Therefore, increasing oxygen concentration in blood via supplemental oxygen lowers deoxygenated hemoglobin amounts which in turn also lower the blood’s capacity to transport carbon dioxide (Wyka, Mathews & Rutkowski, 2012). Thirdly, respiratory homeostasis in hypoxic drive patients means that the major stimulus for respiration is low oxygen level. Using supplemental oxygen thus lowers the stimulus to breathe leading to hypoventilation and carbon dioxide accumulation. Careful control of supplemental oxygen is advised, if used (Scotese, 2017). Case Study 2: Neurological Emergency Classification of Cerebrovascular Diseases Cerebrovascular diseases refer to vascular diseases affecting cerebral circulation, that is, the diseases are caused from problems with the brain’s blood vessels (Limmer, O'Keefe & Dickinson, 2012). There are various kinds of cerebrovascular diseases. The most common types of symptomatic cerebrovascular diseases include stroke, vascular dementia, transient ischemic attack (TIA) and subarachnoid hemorrhage (Morton & Fontaine, 2013). Stroke is a condition in which there is an interruption in the supply of blood to the brain. It commonly results to brain damage and even death. On the other hand, transient ischemic attack is caused by a temporary decline in the supply of blood to the brain, leading to oxygen deprivation in the brain. Although it does not last long, it may lead to a serious stroke. Subarachnoid hemorrhage is a condition in which there is a leakage of blood from the blood vessels of the brain. It is a serious medical condition that can result to severe complications, damage to the brain, and death. Vascular dementia is caused by problems with blood circulation in which regions of the brain do not receive sufficient oxygen and blood (Ropper, Gress & Diringer, 2015). Pathophysiology of Transient Ischemic Attack The pathophysiology of a transient ischemic attack and ischemic stroke are similar in several ways. In both instances, a clot impedes the supply of blood to a region of the brain. However, in transient ischemic attack, the blockage of blood supply lasts a brief period with no permanent damages in most cases (Limmer, O'Keefe & Dickinson, 2012). This is usually caused by the accumulation of plaques/ fat deposits in the vessels that supply nutrients and oxygen to the brain. The clot can also be transported in the blood from other parts of the body to the brain where it causes TIA. Cerebrovascular accident/ stroke/ brain attack is caused by a sudden interruption of the supply of blood to the brain which leads to neurological dysfunction that persists for more than 24 hours. Ischemic stroke results from complete or partial blockage of blood vessels by an embolism/ cerebral thrombosis, while hemorrhagic stroke occurs from the leakage of blood from blood vessels leading to the compression of blood vessels and brain tissues (Morton & Fontaine, 2013). Transient ischemic attack (TIA) is one of the commonest risk factors for stroke, alongside obesity, heart disease, cigarette smoking, diabetes, and so on. Causes of Cerebrovascular Accident Cerebrovascular accident can be caused by a piece of plaque/ debris which is formed in blood vessels and ends up in the brain through the bloodstream. The plaque then obstructs an artery leading to an embolic stroke. Also, a blood clot (thrombus) can form in a blood vessel (artery) hence impeding blood flow to the brain, leading to thrombotic stroke (Limmer, O'Keefe & Dickinson, 2012). In addition, an artery in the brain can be torn causing the spillage of blood. This is often due to high blood pressure and is generally known as hemorrhagic stroke/ cerebral hemorrhage. Cerebrovascular accident/ stroke can also be caused from certain small vessels of blood which service the brain becoming blocked. The patient that is mentioned in the study has had three previous experiences of transient ischemic attack. Transient ischemic attack is a known risk factor for stroke (Morton & Fontaine, 2013). The patient has had symptoms for over 24 hours which could be indicative of the TIA leading on to a stroke. Such a condition is further aggravated by the patient’s high blood pressure and previous history of excessive smoking. Areas of the Brain Involved Transient ischemic attack (TIA) and stroke can affect several regions of the brain. As has been noted, TIA is a neurological dysfunction episode due to the general flow of the blood to the brain becoming impeded causing tissue death and brain damage. According to Ropper, Gress & Diringer (2015), brain imaging studies such as those using computer tomography scans (CT scans), magnetic resonance imaging (MRI) and radionuclide angiography have continued to reveal that transient ischemic stroke predominantly affects either the retinal, spinal cord or the focal regions of the brain. The symptoms of TIA basically vary from person to person and based on the region of the brain that is affected. For example, depending on the area of brain that is affected, symptoms can include parethesia (tingling, numbness or loss of sensation), hemiparesis (one side of the body feeling weak), temporary loss of vision, aphasia (difficulty speaking), and severe headache, such as the ones experienced by the 86 year old Donald Trump (Limmer, O'Keefe & Dickinson, 2012). References Hess, D., MacIntyre, N. R., Galvin, W. F., & Mishoe, S. C. (2016). Respiratory Care: Principles and Practice. Burlington, MA: Jones & Bartlett Learning. Limmer, D., O'Keefe, M. F., & Dickinson, E. T. (2012). Emergency Care. Boston: Brady. Morton, P. G., & Fontaine, D. K. (2013). Critical Care Nursing: A Holistic Approach. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Ropper, A. H., Gress, D. R., & Diringer, M. N. (2015). Neurological and Neurosurgical Intensive Care. Philadelphia: Wolters Kluwer. Scotese, B. (2017). Advanced Medical Life Support: An Assessment-Based Approach. Burlington, MA.: Jones & Bartlett learning. Wyka, K. A., Mathews, P. J., & Rutkowski, J. A. (2012). Foundations of Respiratory Care. Clifton Park, NY: Delmar Cengage Learning. Read More