30 Apr LIST 3 PHYSICAL ASSESSMENTS AND RELATED FINDINGS THAT INDICATE AN IMBALANCE OF FLUIDS.
List 3 things that place Mr. Edwards at increased risk for poor or impaired oxygenation.
2. In order of priority (First through fifth), list the five things you will do within the next 15 – 20 minutes and state a brief, but accurate rationale for each. Priority is important, so take time to think about this. 1 point for each correct rationale and 1 point for correct prioritization
1 First
1 Second
1 Third
1 Fourth
1 Fifth
1 Correct Prioritization
1 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)
1 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)
1 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)
1 6. List one nursing intervention/activity you would initiate to address this diagnosis and one related, desired outcome.
1 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.
1 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. Also, you may not record the same diagnosis recorded in # 5.
3 9. List three nursing interventions/activities you would initiate to address this diagnosis and the related, desired outcome(s).
1 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)
1 11. Does this finding affect Mr. Edwards oxygenation, tissue perfusion, or both oxygenation and tissue perfusion? State which and explain how/why.
1 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).
1 13. Why did Dr. Smith want to know whether Mr. Edwards had a history of emphysema? (limit to 1 – 2 sentences)
3 14. List 3 nursing interventions that would be most helpful in removing Mr. Edwards pulmonary secretions and briefly describe the rationale for each.
3 15. List 3 physical assessments and related findings that indicate an imbalance of fluids.
1.5 16. Identify the laboratory value(s) most indicative of imbalance in fluid and briefly explain
1 17. State one nursing diagnosis associated with these laboratory findings discussed in # 16.
2 18. List four independent nursing interventions/actions that are most appropriate for the nursing diagnosis in # 17.
1 19. Review the arterial blood gas results. Which values are low, which are high, and what does this ‘picture indicate overall?
2.5 20. For sodium, potassium, calcium, magnesium, and chloride, briefly describe the major functions of these 5 ions using your own words.
2 List 2 nursing assessments, however, that would have alerted you to a worsening of his oxygenation status?
1 22. In what way is this potassium value abnormal?
1 23. List three foods that you will include in his diet to address this issue.
1 24. List two of the most relevant risk factors that place Mr. Edwards at increased risk for formation of a DVT and explain why.
3 25. Identify 3 nursing strategies that you would want to use to help prevent Mr. Edwards development of a clot. Explain the rationale for use of these strategies in your own words.
3 26. Describe three things that need to be included in teaching related to use of home oxygen.
1.5 27. List 3 things you know about Mr. Edwards that may negatively his cardiovascular function.
3 28. List 3 strategies that you included in your discussion that nurses may use to help prevent fluid and electrolyte imbalances in your clients.
50 points
Oxygenation, Circulation, and Fluids, Electrolytes, and Acid-Base Balance
CASE STUDY
Objective: To apply the concepts of oxygenation, circulation, and fluids, electrolytes, and acid-Base balance and nursing process to a patient experiencing problems in these areas.
Instructions: Go through the case and answer the questions in the order in which they are asked. Formulate each response based only on the information you have available up to that point in the case. Use your own words to formulate responses. Record your typed responses using your own words directly on the ANSWER SHEET. It is due at the start of next weeks class.
Grading: The point values are shown on the ANSWER SHEET. Credit will be reduced for words that are not spelled accurately or for responses that are not in your own words.
Start of the CASE . . . Mr. Edwards is an obese 71 year old who quit smoking 20 years ago. He has a history of hypertension that has been under good control with diet and use of a single antihypertensive drug. Since he retired from fire-fighting over 15 years ago, he maintains a sedentary lifestyle. He is a client in a skilled care rehabilitation unit while he is recuperating from recent knee surgery. He has been making good progress and preparing for discharge, which is planned for today.
You are a student nurse who cared for him last week; at that time you noticed that he was a neatly groomed gentleman (in spite of his recent surgery at that time), remained actively engaged in conversation with you throughout that day, and was known to the nursing staff as being an early riser and taking pride in keeping his room in order. You are assigned to care for him again today.
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