Question: Henry Parks is a 68-year-old male who presented to the emergency department with the following signs and symptoms

Case Study 1

Henry Parks is a 68-year-old male who presented to the emergency department with the following signs and symptoms

• extreme fatigue
• dyspnoea which worsens when lying down
• persistent cough
• pulmonary crackles evident upon auscultation
• bilateral pitting odema to lower limbs.

Medical history:

• Hypertension
• Heart failure
• Chronic back pain
• Constipation

Henry states that he takes oxycodone 10mg bd for his chronic back pain however it does not completely relieve the pain and he has difficulty sleeping and mobilising.   He is also on medication to manage his heart failure and hypertension which he forgets to take sometimes.

Social History;

Henry lives with his wife, Joan in a rental property which has stairs to the front door which Henry is finding extremely difficulty to navigate.  He spends most of his day watching TV and feels frustrated he is unable to enjoy his past interests of gardening and going to the community centre with his wife. They both receive the aged care pension however find that after paying rent, bills and food there is not much money left for any extra expenses.  Currently   Joan does all the cooking and cleaning as Henry simply cannot help due to his chronic pain, fatigue and limited mobility. Joan states that she doesn’t know how long she can keep going and is finding it difficult to keep up with the housework and cooking.  She said that sometimes Henry goes for days without showering.  Besides their son who visits them about once a month they don’t really see anyone as it is too difficult to go out.

On arrival to ED Henry’s observations were:

• RR 28 breaths per minute
• Sp02 88% on room air
• HR 120bpm
• BP 160/100
• Temp: 36.9 degrees celcius
• GCS 14

Mr. Parks was diagnosed with pulmonary oedema due to an exacerbation of his heart failure. He was treated with oxygen therapy 8L Hi Flow humidified oxygen and 80mg IV frusemide. Investigations ordered were Chest X-ray and pathology which did not show any infection. Mr. Parks responded to treatment and his observations improved.

Case Study 2

Voula Papadopoulos, 75 years of age has been admitted with exacerbation of Chronic Obstructive Pulmonary Disease (COPD).  She came to emergency department with increased work of breathing, shortness of breath and productive cough. 

On assessment: 

• Restless and agitated
• Temp 36.1
• HR 113
• RR 32 with audible wheeze
• SpO2 80% on room air
• Weight 40kg
• Height 1.52m

Medical Management:

• Oxygen 2L per nasal prongs
• Salbutamol 5mg 4hourly
• Ipratropium bromide 500mcg QID

Past medical history

• Osteoarthritis in the knees (uses a walking frame)
• Stroke (resulting in slight left arm hemiparesis and slurred speech)
• Urinary incontinence

Social history:

She lives in a low care aged care facility, and has a daughter who lives nearby. She is a smoker for 40 years a packet a day.