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Joe Ritter, a 74-year-old retired bricklayer, has a 40-pack-year tobacco history and a history of chronic obstructive pulmonary disease (COPD). Today, he presents to the emergency department with reports of shortness of breath and difficulty breathing. He in respiratory distress with retracting respirations of 26 breaths/min, BP is 154/76 mm Hg, pulse is 120 beats/min, and temperature is 37°C.
His skin color is pale gray, his chest is barrel-shaped, and he uses accessory muscles to breathe; he appears anxious and is sitting in a tripod position. His nail beds are bluish in color; his oxygen saturation by pulse oximetry is 72%.
Chest auscultation reveals wheezes and decreased-to-absent breath sounds in bilateral bases. Hyperresonance is noted upon chest wall percussion. Chest x-ray showed atelectasis bilaterally in the bases. Mr. Ritter coughs with minimal amounts of clear sputum. (Learning Objectives 5 and 8)
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Nursing Diagnosis 1: |
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Goals: (Expected Outcome, long and short term)
Outcome: |
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Nursing Interventions: (How am I going to fix this problem?) 1. 2. 3.
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Rationales: (Why did I choose these interventions? Why will they work?) 1. 2. 3.
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Evaluation: (How do I know my interventions were effective?)
Goal # 1.
Goal # 2. *REPEAT THIS CHART FOR EACH NURSING DIAGNOSIS, TOTAL OF 3* |
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- The term meaning the surgical creation of a stoma into the trachea to insert a breathing tube is __________ bronchiectasis thoractomy tracheostomy tracheotomyJoe Ritter, a 74-year-old retired bricklayer, has a 40-pack-year tobacco history and a history of chronic obstructive pulmonary disease (COPD). Today, he presents to the emergency department with reports of shortness of breath and difficulty breathing. He in respiratory distress with retracting respirations of 26 breaths/min, BP is 154/76 mm Hg, pulse is 120 beats/min, and temperature is 37°C. His skin color is pale gray, his chest is barrel-shaped, and he uses accessory muscles to breathe; he appears anxious and is sitting in a tripod position. His nail beds are bluish in color; his oxygen saturation by pulse oximetry is 72%. Chest auscultation reveals wheezes and decreased-to-absent breath sounds in bilateral bases. Hyperresonance is noted upon chest wall percussion. Chest x-ray showed atelectasis bilaterally in the bases. Mr. Ritter coughs with minimal amounts of clear sputum. (Learning Objectives 5 and 8) What is the pathophysiology related to this disease process in the aging…LF, a 34 year old white male, presented to the emergency room complaining of acute and severe shortnessof breath and intense chest tightness. LF’s speech was choppy and breathing was very rapid and erratic,punctuated by noticeable wheezing. LF’s medical records included the results of pulmonary functiontesting he had undergone six months beforeHis medical records also indicated prior admission for respiratory symptoms and a history of poorly-controlled asthma.LF received high-dose bronchodilator medication through use of a valved holding chamber. This wasfollowed by intravenous glucocorticoids and nebulized bronchodilators every two hours for a twelve-hourperiod, followed by nebulized bronchodilators every four hours for a forty-eight hour period.After discharge from the hospital, LF was provided a take-home flow meter to monitor his lung function.Table 4 shows LF’s PEFR results during a 30-day period.Table 4. Peak flow monitoring from day 1-30 post-discharge. All PEFR values are given…
- Your patient is on the respiratory unit at the general hospital. He has been there now for 2 weeks, and his condition is worsening. His main complications are pneumonia, breathlessness, and anorexia. His condition is complicated further as he is diabetic, and his blood glucose levels are fluctuating. He is very weak and he most likely be admitted into the ICU after the change of shift. The doctors are monitoring his input and output, as well as daily electrolytes and blood counts. This morning the potassium level came back very low and potassium chloride (KCl) has been added to his IV. His right lung collapsed this afternoon, and he had a chest tube inserted which is connected to a suction machine. In preparing for the end of shift you need to calculate his 12-hour fluid balance. Here is the information that you will need to complete your task: My Vlad has a continuous IV of NS with 20 meq KCl infusing at 100mL/hr He took in a total of 4 x (6oz) glasses of water 4 oz jello at breakfast…Mary Smith is a 67-year-old, newly widowed, individual who has recently been diagnosed with congestive heart failure and advanced chronic pulmonary obstructive disease. After the early death of her husband, she was employed for several years as a secretary for a corporate lawyer. Though she was a "heavy" smoker for several years, she had not smoked in the past three years. She has two adult children, both very concerned about their mother's health. Both children are married, have teenage children, and live within 100 miles of Mrs. Smith. Mrs. Smith expresses concern about her future health care needs, primarily when she is not able to make decisions for herself. She tells you that she does not want to be kept alive on machines and desires to die as "naturally and painlessly" as possible. When asked, she tells you that she has discussed none of her desires or wishes with her family members and wonders how to best open such discussions. She is afraid that her family will not abide by her…It’s Day One in the St. Mary’s ER for nursing student, Toni Santos, as he embarks on clinical rounds with his preceptor, Nurse Martinez. His bond with a patient presenting suspicious lung-related symptoms takes him by surprise, as does his family’s. He is 56 symptoms are coughing and having trouble breathing, wheezing for about two weeks. He was a heavy smoker, dranks alcohol, and use heroin four year prior. Mr. Jones was severely overweight. The clinical manifestations for Mr. Jones were: the chronic cough, wheezing, hoarseness in the voice, and the lesion in the right upper lobe the x-ray revealed. Possible treatment/management is to stop smoking, lifestyle changes, chemotherapy, immunotherapies, radiation and eventually going in for surgery for either a wedge resection or lobectomy on the right lung,A risk factor... Increases the chance of a disease or condition developing. Yup! It increases the chances of developing a disease or condition. Mr. Jones’ risk factors are... Alcohol…
- Mr. Abgenyegah is a 49-year-old man, married man with only one child, a male. He is in the hospital with fever, a three months old cough, which is productive with brownish phlegm, this according to him has resulted in some challenge in breathing. He initially tries some antibiotics and some cough syrup but does not remember its names, he experiences night sweats and has recently realize that he has to increase his belt hole one step tighter to fit. He said he has once had a bad itch when he took Augmentin 4 years ago (i) Which organ system(s) could be involved in this presenting complain and why? (ii) What other questions would you ask to help you have a working diagnosis (iii) What investigations can you think of as a helpful tool in helping you arrive at a diagnosis (iv) Re- write the above history in a structured manner (v) What is your likely diagnosis? (vi) What will be your holistic advice to the patient?Mr. JKL is a 69 yr old white male complaining of shortness of breath during activities and sometimes at rest. He does not report any myocardial ischemia symptoms and is treated for hypertension and prostate cancer (diagnosed 5 years prior). The patient quit smoking 3 years ago and smoked on average 2 packs per day for 51 years. He was admitted to the hospital 4 months ago due to respiratory symptoms. The patient is not on supplemental oxygen, his oxygen saturation is 95%, and he reports some shortness of breath with a dyspnea rating of 5 (1-7 scale). The patient is sedentary, rarely walks outside of his home, and does not engage in sports or recreational activities. Mr. JKL's preexercise medical exam results: BMI = 31.8 Resting heart rate = 85 Blood pressure = 144/98 Enlarged anteroposterior chest diameter and decreased breath sounds and prolonged exhalation Current medications: Atrovent inhaler 8 puffs twice per day Doxapram HCL, 50 mg 3 times daily Furosemide, 40 mg 4 times daily…A 67yo male is admitted to the unit with a dx of CHF. Pt states, “I get short of breath before I’m able to make it up one flight of stairs to my room.” He also reports having to take frequent breaks while doing everyday activities. During your assessment you observe his skin to be pale pink, with swelling in his hand and feet. You also notice pt leaning forward in the bed to breathe with labored breath sounds.
- The patient states, "I have gas after I eat spicy foods." The patient complains of what ? after eating spicy foodsKenneth Bronson is a 27-year-old male who was just admitted to the Medical Unit from the Emergency Department. He presented to the Emergency Department two hours ago with chest tightness, difficulty breathing, a productive cough for a week, and fever. Chest x-ray revealed right lower lobe pneumonia. IV was started of normal saline at 75 mL per hour. He is receiving oxygen at 2 L/min per nasal cannula. SpO2on room air was 90%, which increased to 95% with supplemental oxygen. He had a temp of 102.6°F and was given acetaminophen 1,000 mg in the Emergency Department. The pharmacy just delivered the antibiotics to be given. Would you do anything different for a patient experiencing respiratory distress? Would you do anything differently if Kenneth had told you he had been using e-cigarettes? How would the RN collaborate with the hospital pharmacist to prevent anaphylaxis? What evidence-based interventions would you perform on Kenneth?A nurse is caring for a client who presented to the emergency department with an acute asthma exacerbation. The respiratory rate is 36 breaths/min, and a pulse oximeter is 85% on room air with accessory muscle use to breathe. The nurse placed the client on oxygen 4 liters nasal cannula. The arterial blood gas (ABG) is as follows: pH: 7.28, PaCO2: 50 mm Hg, PaO2: 75 mm Hg, and HCO3: 26 mEq/L. Which of the following treatments is the nurse's highest priority? A) Administer bronchodilators B) Administer sodium bicarbonate Administer methylprednisolone (D) Perform a chest x-ray
