Case Study – Stress Response and Health Breakdown
Please use Journal articles
Case Study Questions
Assessment 3: Case analysis – Bill
2500 words ± 10%
This analysis will enable you to demonstrate your knowledge and understanding of the impact of unresolved stress on cardio-pulmonary function. You must complete all three parts.
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Part A (approx. 1000 words)
Analyse Bill’s respiratory changes in relation to his current clinical condition. Your analysis should include the mechanics of breathing, intrapulmonary pressure, physical factors and the ramifications for V/Q ratio.
Part B (approx. 750 words)
Discuss Bill’s haemodynamic changes, including the factors contributing to these changes, potential impact on cardiac output, and the particular adrenergic receptors stimulated.
Part C (approx. 750 words)
Analyse and interpret Bill’s arterial blood gases, including buffering systems, regulatory mechanisms, pressure gradients, and solubility of gases. Relate your interpretation to the oxyhaemoglobin dissociation curve.
The case analysis rubric will assist you in meeting the requirements of this assessment.
Case study: Bill
Bill, a 40-year-old, has had asthma since childhood. He has experienced many hospitalisations and required long-term oral steroids.
He presents to the emergency department (ED) with acute exacerbation of his asthma that he believes has been triggered by a known allergen. At home he increased his salbutamol with little effect. He is now anxious and agitated.
On presentation to the ED his clinical assessment reveals:
• Noted use of accessory muscles
• RR 36 breaths/minute
• HR 150 beats/minute
• BP 142/88 mmHg
• Temperature 36.2oC
• SpO2 88%
• Height 170 cm
• Weight 80 kg
Management in the ED includes:
• Oxygen via a non-rebreather mask at 15 L/min
• Salbutamol, ipratropium bromide via nebuliser
First ABG Suggested Normal Values
pH 7.25 7.35-7.45
PaO2 60mmHg 80-100mmHg
PaCO2 55mmHg 35-45mmHg
HCO3 22mmol/L 22-26mmol/L
Base Excess -2 -2 to +2
No improvement so further management of:
• IV hydrocortisone
• Adrenaline via a nebuliser
• Salbutamol as an intravenous infusion
• IV normal saline at 100 mL/hour
• Arterial blood gas analysis
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