Nurs2003 Pathophysiology And Pharmacology For Assessment Answers

Explanation of pathophysiology/pharmacology of illness in the scenario:

Pathophysiology

Leigh Richard was restrained passenger in a rally care and after the motor vehicle accident, he was trapped by a car intrusion that pinned his leg. The car was finally cut to free his leg. He came to the emergency department in a disoriented state and series of x-rays revealed he had suffered left pneumothorax along with above mentioned injuries. Pneumothorax or collapsed lung is a clinical condition in which air leaks into the pleural space (space between the lung and chest wall). In such condition, air pushes on the outer side of the lung and makes it collapse. It is mainly caused by a blunt chest injury or due to underlying lung  disease (Hsu, and Chen, 2015). In Leigh Richard’s case, he suffered pneumothorax due to injury sustained during the accident by a blunt trauma force. People diagnosed with pneumothorax possess symptoms of chest pain, shortness of breath, rapid heart rate, cough, fatigue, cyanosis and other symptoms (Baumann 2009). Leigh Richard was also found to be short of breath during emergency admission and he had difficulty in speaking full sentences. This occurs because this condition reverses the normal intrapleural pressure. It is reversed because of inward lung and outward lung chest wall recoil. In case of pneumothorax, air enters the pleural space from outside the chest and it leads to decreases in lung volume and decrease in intrapleural pressure (Kirmani, and Page 2014).

Intervention for pneumothorax

Patients with pneumothoraces mostly require transcatheter aspiration or tube thoracostomy. Chest tube is given if catheter aspiration is not successful.. Spontaneous pneumothorax is treated by simple aspiration only (Benns et al. 2015). As Leigh Richard also suffered a traumatic pneumothorax due to motor vehicle accident, he was also given chest tube drainage. This is because the injury led to entering of air in his pleural space.  If this air is not drained out, it leads to collapse of lungs. This is a life threatening condition and it might lead to rapid clinical deterioration in patient (Tsotsoli et al. 2015). Hence, treatment with Chest drain or UWSD (Under water sealed drains) is necessary to allow draining of pleural space of air, blood or fluid. It promotes restoration of negative pressure in the thoracic cavity and facilitates expansion of lungs. It also reduced chances of back flow of air and appropriate chest drain management provides respiratory and hemodynamic stability to patient (Hawley et al. 2014). Hence, for this reason, UWSD treatment was provided to Leigh.  Two intercostals drain was inserted into Leigh’s leural space and attached to under water sealed drains (UWSD). The lower drain was draining serous fluid from Leigh’s lung and the other tube was draining air as there was only intermittent bubble from the tube.

Pharmacological intervention-

Apart from chest tube drainage, pharmacological interventions like antibiotic administration is also necessary for traumatic pneumothorax patients to prevent infection. Due to symptoms of breathlessness, oxygen therapy is provided to reduce the risk of complication in patients (Zakhour et al. 2016). In the case scenario of Leigh Richard, he was prescribed fentanyl PCA (patient-controlled analgesia), Ibuprofen, cephalothin, metronidazole, Oxycodone and Paracetamaol while he was in hospital.

Fentanyl was given to him while he was in theatre because it is an opioid analgesics that relieves patient from pain after surgical procedure. The goal is to reduce pain in patients. Hence, it provide relief from pain. (Shrestha et al. 2014). Richard had sustained severe fracture in the left leg which might result in intense pain and ibuprofen was given as it is a anti-inflammatory drug that act to decrease the hormone that cause pain and inflammation in the body. PCA (patient controlled analgesic) is also a useful way of management of pain in patient as it gives patient a sense of control over their pain (Jung et al. 2016). Good pain relief also helps patient to breath and cough properly. This is because rib injuries leads to difficulty in taking breath or coughing and pain relievers enable patients to breath properly (Olsén et al. 2016). It also prevents risk of chest infection (Galvagno et al. 2016). Oxycodone is also helpful for round the clock treatment of pain in patients. Metronidazole is useful in treating bacterial infections in the respiratory tract. As chest tube is inserted in Richard’s pleural space, he is susceptible to respiratory infection and this medication provides necessary relief to him. Cephalothin also has the same purpose of treating bacterial infection (Ypsilantis et al. 2016). These drugs are effective in reducing chest infection because they act to covalently bind to microbial DNA and inhibit the nucleic acid synthesis of bacteria finally resulting in bacterial cell death. Metronidazolee is selective for anaerobic bacteria (Metronidazole – DrugBank 2017).  

When patient like Richard is taking so many medications, it is necessary to educate them about the contraindications and purpose of each medication. The medication should be given with precaution to patients who have bronchial asthma, head injury and Bradycardia. During observation of Richard, his blood pressure was low. This may indicate the affect of opioid which resulted in hypotension. Similarly the adverse effect and correct dosage of other medications prescribes to Richard should be explicitly explained to him. Before inserting the chest tube too, he should be informed about the procedure and precautions needed. 

Explanation of two symptoms present in patient:

When Leigh Richard was admitted to the hospital, he was found to be short of breath and had difficulty in sleeping. The initial observation of patient also revealed low blood pressure, high pulse rate. Chest pain and shortness of breath (dyspnea) is common clinical manifestation of the pneumothorax. Shortness of breath is seen in pneumothorax patient due to interruptions of the blood flow to the heart muscle.  This results in shortness of breath and pain in the chest (Porpodis et al. 2014). It may also be caused by anaphylaxis, asthma, blockage in the respiratory tract or blood clot in the artery of the lungs. Dyspnea may also occur because pressure in the lung increases and it prevents the lungs from expanding properly while breathing. Reduced lung function is seen because low oxygen level leading to to tachycardia. In order to circulate oxygen, the body seeks balance by increasing the pulse. This results in chest pain and shortness of breath, the most common presentation of pneumothorax patients (Porpodis et al. 2014).

Another symptoms observed in Leigh Richard included rapid heart rate which was indicated from the pulse rate value of Richard. This is some of the severe symptoms of patient with larger pneumothorax. It is also called tachycardia which might occur due to anxiety in patients. It might also occur due to damage to heart tissues (Wilson et al. 2016).

Link between pathophysiology/ pharmacology context and theory:

While diagnosing disease and planning intervention for patients, it is necessary to create link between pathophysiology/ pharmacological context of disease and their theory. This helps in understanding the disease process and evaluating the correct intervention for patients (Galvagno 2013). In the case analysis of Leigh Richard, it was possible to understand the rationale for intervention because of the pathophysiological theory behind pneumothorax. This revealed the reason for reversal in pleural pressure which occured as result of injury or lung complications. As Richard had suffered traumatic pneumothorax, the first preferred treatment for him was to insert chest drainage tube in patients. This helps to extract out fluid or air that result in the diagnosis of the disease.

The pathophysiological theory behind pleural effusion states that it occurs because of the imbalance between fluid production and fluid removal in the pleural space. This may result due to increased pressure in the pleural space. Under normal condition, pleural space has lubricating fluid that allows lung surface to glide within the thorax (Walter et al. 2016). However, systemic derangements during pneumothorax may be caused disruptions in the fluid balance of the pleural space. In such condition, chest drainage is an appropriate intervention for patients (Porcel et al. 2014). Secondly, this form of intervention exposes patients to acute pain and risk of infection. Hence, different range of analgesics is appropriate for patients like Richard to prevent infection and provide relief to patients.

Conclusion:

The essay summarized the pathophysiology and pharmacology behind the occurrence of pneumothorax through the case analysis of Leigh Richard. The clinical manifestations of Richard’s condition were compared and contrasted the pathophysiological process behind the disease. This helped in the understanding of the impairment that occurs in the lung due to pneumothorax. As Richard suffered traumatic pneumothorax due to motor vehicle accident, the rationale for providing chest drainage was accurately explained.  Secondly, linking the pharmacological interventions with clinical complications helped in identifying the therapeutic efficacy of each drug for patients. The clinical manifestation of pneumothorax in comparison with patient’s observation supported identifying disease process. Secondly, explanation regarding link between pharmacology and pathophysiology clarified the purpose of treatment for recovery of patients. 

Reference 

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