A client has started a new drug for hypertension. Thirty minutes after he takes the drug, he develops chest tightness and becomes short of breath and tachypnea. He has a decreased level of consciousness. These signs indicate which of the following conditions?
A. Asthma attack
B. Pulmonary embolism
C. Respiratory failure
D. Rheumatoid arthritis
Correct Answer: C. Respiratory Failure
The client was reacting to the drug with respiratory signs of impending anaphylaxis, which could lead to eventual respiratory failure. Respiratory failure is a clinical condition that happens when the respiratory system fails to maintain its main function, which is gas exchange, in which PaO2 lower than 60 mmHg and/or PaCO2 higher than 50 mmHg.
Option A: Although the signs are also related to an asthma attack, consider the new drug first. The overall etiology is complex and still not fully understood, especially when it comes to being able to say which children with pediatric asthma will carry on to have asthma as adults (up to 40% of children have a wheeze, only 1% of adults have asthma), but it is agreed that it is a multifactorial pathology, influenced by both genetics and environmental exposure.
Option B: Most pulmonary embolisms originate as lower extremity DVTs. Hence, risk factors for pulmonary embolism (PE) are the same as risk factors for DVT. Virchow’s triad of hypercoagulability, venous stasis, and endothelial injury provides an understanding of these risk factors.
Option D: Rheumatoid arthritis doesn’t manifest these signs. Most common clinical presentation of RA is polyarthritis of small joints of hands: proximal interphalangeal (PIP), metacarpophalangeal (MCP) joints, and wrist. Some patients may present with monoarticular joint involvement.
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