DM is a 20-month-old female brought into the ED by her parents because of increasing shortness of breath and a cough that has worsened over the past several hours. Upon arrival, the following is noted: pulse 136, respiratory rate 40 (labored with intercostal retractions), temperature 102°F, and oxygen saturation 93% on room air. An occasional 'bark-like' cough is noted. The parents state that DM has had what appears to be an upper respiratory infection for the past two days.

1. Which of the following is the most likely diagnosis?
a. Bacterial pneumonia
b. Bronchiolitis
c. Epiglottitis
d. Croup

2. Name another symptom or diagnostic finding that, combined with stridor, may indicate the need for emergent intubation. Which disease would this be indicative of and why?

3. Which of the following is a test that would help to confirm the diagnosis?
a. Lateral neck radiograph
b. Chest radiograph
c. CT of the chest
d. Pulmonary function testing

4. Would this patient benefit from being placed on a high-flow nasal cannula? Why or why not (be specific)?

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Case 4: JV is a 65-year-old male on the surgical floor following a bowel resection 18 hours ago. The nurse notes that he has been complaining of abdominal pain even though he has been using his PCA pump. Currently, he is alert and oriented but complaining of pain. Respiratory rate is 24 and shallow, temperature is 99.8°F. His SpO2 is 95% while receiving oxygen via nasal cannula at 2 lpm.

1. Which of the following is his most likely pulmonary condition at this time?
a. Bilateral bacterial pneumonia
b. Flash pulmonary edema
c. Bibasilar post-op atelectasis
d. Exacerbation of COPD

2. Why is end-tidal capnography indicated for this patient?

3. What treatment would you recommend to improve this patient's condition?

In the first case, the most likely diagnosis is croup, and in the second case, the patient likely has bibasilar post-op atelectasis, requiring interventions such as deep breathing exercises and pain management.

For the first case:

1. The most likely diagnosis is d. croup.

2. Another symptom or diagnostic finding that may indicate the need for emergent intubation in the presence of stridor is severe respiratory distress with signs of impending respiratory failure. This would be indicative of epiglottitis, which is a medical emergency.

3. The test that would help confirm the diagnosis is a. lateral neck radiograph.

4. This patient would benefit from being placed on a high-flow nasal cannula. High-flow nasal cannula delivers humidified and heated oxygen at a high flow rate, which can help improve oxygenation and reduce work of breathing in patients with respiratory distress.

For the second case:

1. The most likely pulmonary condition at this time is c. bibasilar post-op atelectasis.

2. End-tidal capnography is indicated for this patient to monitor their respiratory status and detect any signs of hypoventilation or respiratory compromise.

3. The treatment to improve this patient's condition would include deep breathing exercises, incentive spirometry, frequent turning and ambulation, pain management, and respiratory therapies such as nebulization or chest physiotherapy to promote lung expansion and prevent complications associated with atelectasis.

To learn more about spirometry: https://brainly.com/question/32373634

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