Assignment Instructions/ Description
Sandra and Bob were excited to board the plane for their first intercontinental flight since Bob�s retirement last summer. This was their first trip to Europe, and they were looking forward to the trip of a lifetime beginning with London and then visiting a variety of European cities.
They relaxed in their coach seats with Bob on the aisle and Sandra in the middle seat. Bob lifted the middle armrest to give Sandra some extra room since she had gained more than a few pounds during their long and happy marriage.
The 8-hour flight seemed to pass quickly for the couple. Bob slept through most of it while Sandra read her book. She only left her seat once to go to the restroom and didn�t want to disturb Bob.
The sudden jolt from the landing woke Bob from his sleep. A few minutes later, the couple was deboarding the plane and heading toward baggage.
�Just hold on a minute,� said Sandra to Bob. �I need to catch my breath. I must really be out of shape.�
Bob heard Sandra�s wheezing. He was all too familiar with her asthma attacks and reached into her bag for her inhaler.
�Let�s just sit for a while and you take a few puffs of this,� said Bob while he handed over the inhaler.
The Hotel
�Bob, wake up! Something is wrong,� said Sandra in a panicked tone.
�What�s wrong?� said a concerned Bob.
�I can�t catch my breath and I have pain on the left side of my chest. It is radiating into my left arm!�
�We�ll have to get you to the hospital!� said Bob reaching for the phone.
The Hospital
Sandra was wheeled into a room on a gurney. A nurse took her pulse and blood pressure, administered oxygen, and hooked her up to a heart monitor.
Sandra�s Vitals:
Pulse 102 bpm
BP 90/56
�Sandra, have you had leg swelling like this before?� asked the .
�Sometimes, but usually not this bad,� said Sandra.
�I see the swelling is worse in the right leg,� said the nurse.
Just then the ER doctor entered the room. He greeted the couple, viewed the records, and briefly examined Sandra.
�We�ll need to run some tests,� said the doctor. �You may be here for a while.�
Tests
Sandra was given a blood draw which was sent to the hospital lab for some tests.
The test results included:
Test Sandra Normal
Blood pH 7.25 7.35-7.45
Arterial PO2 78 80-100
Arterial PCO2 48 35-45
Creatine Phosphokinase 2.7 ng/mL 3 ng/mL
Breathing Rate 28 12-20
Breathing Sounds rapid, shallow breathing
Back in the ER room, the doctor read the test results.
I think we need to do some imaging,� said the doctor. �I�m ordering a CT and ultrasound of each leg along with a V/Q scan which I think will confirm my diagnosis.�
Case Study Questions
Which signs and symptoms would indicate a respiratory problem, and which would indicate a cardiovascular system problem?
How are Sandra�s breathing rate, blood pH, and PCO2 related?
Why would Sandra�s blood pressure be lower than normal and why would a CT and V/Q scan of the legs be indicated in Sandra�s case?
How would asthma cause changes in blood CO2 and pH?
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