23 Jun According to the change-of-shift report at 0645 today, the n
According to the change-of-shift report at 0645 today, the night nurse stated that he was told that late yesterday afternoon Mr. Edwards had a productive cough and he seemed ‘forgetful and slightly ‘confused. (You recall that last week he was not noticeably forgetful.) The daily vital signs recorded at 0500 today included: respirations of 20/minute, blood pressure of 138/86, pulse of 90, and oral temperature of 99.1°F.
You go to his room, planning to walk with him to breakfast. You first notice he is still in bed, lying on his side in bed with disheveled bed covers. When you ask him how he is, his response is slightly delayed, stating ‘not as good as yesterday and ‘been better. His notable pause between the short phrases made you wonder if he was having difficulty breathing.
1. List 3 things that place Mr. Edwards at increased risk for poor or impaired oxygenation.
2. In order of priority list five things you will do within the next 20 minutes and state a relevant, brief rationale for each.
3. Why is the onset of Mr. Edwards forgetfulness or confusion that was noticed yesterday especially relevant for Mr. Edwards? (Limit response to 1 – 2 sentences)
4. Because you noticed that Mr. Edwards was experiencing some shortness of breath while lying in his bed while it was elevated less than 15 degrees, your documentation would include that he was experiencing ______________. (use one word)
CASE goes on . . . . Mr. Edwards decided to stay in his room to eat breakfast. He breathing seems “OK” to you after he sits up and he tells you ‘thats better. His wife has arrived and is helping him get his tray ready to eat, so you leave them alone. A little later you return to his room and find him still seated at the side of his bed. His wife has been unsuccessful in her attempts to encourage him to eat more than two bites of food. She tells you that he cant get up to brush his teeth or eat because it makes him too short of breath.
5. Write the most appropriate oxygenation-related nursing diagnosis related for Mr. Edwards based only on the information you have at this time. (Carefully consider what you know at this point)
6. List one nursing intervention/activity you would initiate to address this diagnosis and one related, desired outcome.
CASE goes on . . . You decide to go look at the nursing notes to learn more about the “productive cough” you heard about in report, but find nothing documented about it. As you walked back in his room you heard him coughing from the bathroom. You notice there are multiple used tissues in the trash can.
7. In follow-up to what you heard and saw when you came into the room and the ‘productive cough you heard about in report, describe 2 specific inquiries you would make at this time.
CASE goes on . . . The client makes his way back to his bed with your assistance. You notice he is having more difficulty breathing and that his skin was noticeably warm. You take his vital signs and obtain a pulse oximetry reading. His respirations are 28 breaths per minute, blood pressure is 146/92, temperature is 102.1 °F, pulse is 104, and SpO2 is 88%. The staff nurse comes in the room, asks you to place Mr. Edwards on 2 L of oxygen per minute, listens to his lungs with you, and assesses the peripheral pulses. There are abnormal lung sounds in upper lungs as well in the left base. The nurse tells you that this is a change from earlier today. Earlier there were a few abnormal sounds in only the upper lobes. Peripheral pulses remain strong and capillary refill is brisk.
8. Write one 3-part nursing diagnosis related to Mr. Edwards oxygenation problem. Make sure that you base this diagnosis only on the information you have been provided from the case description up to now. Do NOT record the same diagnosis recorded in # 5.
9. List three nursing interventions/activities you would initiate to address this diagnosis and the related, desired outcome(s).
10. What does the new finding of abnormal lung sounds in left base indicate? (Do not over-think this; limit your response to one sentence).
11. Does this finding affect Mr. Edwards oxygenation, tissue perfusion, or both oxygenation and tissue perfusion? State which and explain how/why.
CASE goes on . . . The nurse contacted the on-call doctor, Dr. Smith, because Mr. Edwards regular physician was not on duty today. The nurse shared the changes in vital signs and a summary of all the assessments performed this morning with Dr. Smith, including the fact that Mr. Edwards has a productive cough with thick, yellowish-green sputum. Before Dr. Smith gave any orders, he asked whether Mr. Edwards had a history of emphysema. Then, Dr. Smith ordered several tests including a sputum specimen, chest x-ray, CBC, and serum chemistry and electrolytes. Additionally, orders were given concerning starting several medications, parameters concerning how to administer the oxygen, and cancellation of the earlier plans for todays discharge.
After hanging up the phone, the nurse tells you, “Dr. Smith ordered that we obtain the most accurate information about Mr. Edwards blood oxygen levels. Well do that first, and then we need to help Mr. Edwards get rid of these secretions”.
12. Having just read the chapter about oxygenation, you know that the test Dr. Smith ordered to identify Mr. Edwards blood oxygen levels was: _______________________ (name of test).
13. Why did Dr. Smith want to know whether Mr. Edwards had a history of emphysema? (be brief)
14. List 3 nursing interventions that would be most helpful in removing Mr. Edwards pulmonary secretions and briefly describe the rationale for each.
CASE goes on . . . Your shift has finished and you leave. The next week, however, you are assigned Mr. Edwards again. You spend the first part of this clinical day reviewing his records to understand what has occurred in the last week, after you left.
The chest x-ray and sputum specimen confirmed pneumonia with infiltrates in upper lobes and left lower lobe. He was cared for on another unit for a few days while he was acutely ill. During that time, his respirations increased to 48 breaths per minute. He had intermittent high fevers (up to 104 orally) for several days and the antibiotic that was prescribed caused intermittent diarrhea. Although he was thirsty during this time, he was so fatigued that he rarely took ice or water except when physically provided to him. You notice that nursing notes included several assessments that indicated that Mr. Edwards had a fluid imbalance.
15. List 3 physical assessments and related findings that the student nurse may have identified in the record that indicated Mr. Edwards most likely had an imbalance of fluids. (Note, they are not described in the above paragraph).
CASE goes on . . . Next, you noted select laboratory values recorded during that time, including some of the serum electrolytes (sodium = 146, potassium = 4.0; chloride = 96, magnesium = 1.9), components of the CBC (WBC = 21.1, Hgb = 16.9, and Hct = 58%), and urinalysis (no WBCs, urine pH = 4.9, and urine specific gravity = 1.030).
16. Identify the laboratory value(s) most indicative of this imbalance in fluid and briefly explain how the imbalance causes the change in the value(s).
Our website has a team of professional writers who can help you write any of your homework. They will write your papers from scratch. We also have a team of editors just to make sure all papers are of HIGH QUALITY & PLAGIARISM FREE. To make an Order you only need to click Ask A Question and we will direct you to our Order Page at WriteDemy. Then fill Our Order Form with all your assignment instructions. Select your deadline and pay for your paper. You will get it few hours before your set deadline.
Fill in all the assignment paper details that are required in the order form with the standard information being the page count, deadline, academic level and type of paper. It is advisable to have this information at hand so that you can quickly fill in the necessary information needed in the form for the essay writer to be immediately assigned to your writing project. Make payment for the custom essay order to enable us to assign a suitable writer to your order. Payments are made through Paypal on a secured billing page. Finally, sit back and relax.
About Writedemy
We are a professional paper writing website. If you have searched a question and bumped into our website just know you are in the right place to get help in your coursework. We offer HIGH QUALITY & PLAGIARISM FREE Papers.
How It Works
To make an Order you only need to click on “Order Now” and we will direct you to our Order Page. Fill Our Order Form with all your assignment instructions. Select your deadline and pay for your paper. You will get it few hours before your set deadline.
Are there Discounts?
All new clients are eligible for 20% off in their first Order. Our payment method is safe and secure.