Case Study Analysis of Shaun Morely
Patient Assessment
Shaun Morley, a 35-year-old male got admitted to emergency department (ED), by his husband, George, displaying a range of respiratory distress following a recent SARS-CoV-2 infection. Shaun's physical appearance reflects systemic distress: his complexion is pale, and his skin feels cool and clammy and compromised peripheral perfusion is because of hypoxemia and hypotension. Besides, the other symptoms reported are dry and cracked lips, dehydration, fatigue, systemic inflammation, strong desire for sleep, fluid imbalance due to fever and respiratory distress. The respiratory is clearly evident from his positioning and observed behaviour such as increased
eathing, pain and holding his chest upright.
Auscultation of lung sounds reveals bilateral crackles filled fluid indicative of pneumonia which is a clear indication of SARS-CoV-2 disease. Moreover, expiratory wheezes across all lung fields indicates
onchial constriction and inflammation in the airways, characteristic of underlying asthma which is being intensified by the respiratory infection.
The vital signs further highlight the seriousness of Shaun's condition. Tachycardia (124 bpm) and hypotension (95/56 mmHg) indicates systemic stress and insufficient tissue perfusion, exace
ated by fever and dehydration. Tachypnea (respiratory rate 30 bpm) with moderate work of
eathing and hypoxemia (SpO2 91% on room air) feature the seriousness of his respiratory split the difference, with deficient oxygenation regardless of expanded respiratory exertion.
Laboratory results gives additional insights to better understand Shaun's condition. Raised levels of inflammatory markers such as CRP level of 22 mg/L, recommend progressing contamination and i
itation, indicates pneumonia. Raised creatinine levels (115 umol/L) demonstrate expected renal impairments, probable auxiliary to foundational hypo perfusion, highlighting the need for comprehensive nursing intercessions.
Disease Pathophysiology and complications
Pneumonia is the inflammation of lung parenchyma that can be caused because of various infectious agents, including microscopic organisms such as virus, fungi and parasites (Tian et al., 2020). On account of viral pneumonia secondary to Coronavirus, like Shaun's, the pathophysiology is complex and involves various key mechanisms in disease severity.
The SARS-CoV-2 infection basically infects respiratory epithelial cells by binding to angiotensin-changing over chemical 2 (ACE2) receptors, which are exceptionally communicated in the respiratory lot (Manson, 2020). This viral passage leads in direct harm to the respiratory epithelium and impedes the mucociliary clearance mechanism, which regularly assists with eliminating microorganisms from the airways.
Because of this damage to the respiratory epithelium, the epithelium is more susceptible to various microbial contaminations. Some of the microorganisms, for example, Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus, can then colonize the lower respiratory tract causing pneumonia (Tian et al., 2020). These microbes multiply in the alveoli, leading to alveolar blockage causing inflammation.
The inflammatory reaction set off by both the viral and bacterial microorganisms is a central feature of pneumonia pathophysiology. The release of cytokines, like interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α), along with other immune cells are directed to the site of infection to eliminate the pathogens. Besides, dysregulated inflammation can also result in tissue harm and compromise lung capability (Jose and Manuel, 2020).
Besides the local inflammatory response, there are the chances of systemic inflammation that results in the release of inflammatory mediators into the bloodstream. This systemic inflammation results in the development of sepsis complications which is reported in several cases of pneumonia (Channappanavar & Perlman, 2017). The overall pathophysiology is very complex that leads to alveolar constriction, impaired gas exchange, and other associated respiratory symptoms.
Complications
Respiratory Failure
Respiratory failure happens when the respiratory system fails to maintain enough gas exchange that resulting in hypoxemia. For Shaun's situation, from the CT scan reports it was understood that there is a bilateral consolidation that cause significant impact on the gas exchange phenomena, which is because of hypoxemia (Ranieri et al., 2012). As the illness advances, Shaun might encounter demolishing respiratory pain, proved by expanded work of
eathing and hypoxemia, if not managed promptly results in the respiratory failure.
Respiratory failure can be grouped into two primary types: hypoxemic...