Question

A 78 year old female with a history of two pack a day smoking is on home oxygen. When you arrive she is unable to speak, is cold and clammy and has her head resting on her chest. Her vital signs are BP 96/78, P 94 and R 24 and shallow. Her SpO2 is 78% on 3 Lpm nasal cannula. You should first

Answer 1

A 78-year-old female with signs of respiratory distress should immediately have her oxygen delivery increased and receive emergency medical care, as she might be suffering from complications like COPD or pneumonia associated with her smoking history.

Step-by-step explanation:

A 78-year-old female with a significant smoking history and on home oxygen presenting with inability to speak, being cold and clammy, and having a low SpO2 of 78% on 3 Lpm nasal cannula, likely requires immediate medical attention. Her clinical presentation suggests possible respiratory distress or failure, which could be attributed to complications such as chronic obstructive pulmonary disease (COPD) - often linked to long-term smoking - or an acute condition like pneumonia, for which smokers are at higher risk.

Given the urgency, the first step should be to increase oxygen delivery, preferably via a high-flow system such as a non-rebreather mask, and call for emergency assistance. This patient's vital signs and symptoms are concerning and indicative of possible hypoxemia. Crackling sounds heard during auscultation, a history of smoking, and symptoms of respiratory distress could suggest pneumonia or COPD exacerbation, both of which require immediate intervention to ensure adequate oxygenation and treatment of the underlying cause.