BRONCHITIS AND LUNG CANCER CASE STUDY Scenario The intensive care…

Question Answered step-by-step BRONCHITIS AND LUNG CANCER CASE STUDY Scenario The intensive care… BRONCHITIS AND LUNG CANCER CASE STUDY Scenario The intensive care unit (ICU) nurse calls to give you the following report: “D.S. is a 56 year old man with a past medical history of chronic bronchitis. He quit smoking 12 years ago and exercises regularly. He went to see his physician with complaints of increasing exertional dyspnea; a large mass was found in his right lung. Three days ago he underwent a right middle lobe (RML) and right lower lobe (RLL) lobectomy; the pathology report showed adenocarcinoma. He has no neurological deficit, and hiss VS run 120/70, pulse 110, Respirations 30, and he has been running a fever of 100.2 F. His heart tones are clear, all peripheral pulses are palpable, and he has an IV of D 5 ½ NS at 50 mL/hr in his right forearm. He has a midaxillary chest tube to Pleur-evac drain; there’s no air leak, and it’s draining small amounts of serosanguineous fluid. He has C/O pain at the insertion site, but the site looks good, and the dressing is dry and intact. He’s on 5 L oxygen by nasal canula. He refuses pain medication. He is a real nervous guy and hasn’t slept since surgery. He’ll be there in about 20 minutes.” 1. What additional information would you ask the nurse to provide at this time? CASE STUDY PROGRESS D.S. is transported by wheelchair past the nurse’s station to a room at the far end of the hall. You enter his room for the first time to find him sitting on the edge of the bed with his left leg in bed and his right foot on the floor. You introduce yourself and tell him that you are going to be his nurse for the rest of the shift. You note that he keeps rubbing his left hand over the right side of his chest. 2. What issues or problems can you already identify? 3 What would you assess at this time? CASE STUDY PROGRESS D.S. states “I have a nephew who rolled his jeep and busted himself up real bad. He got hooked on those drugs, and I don’t want any part of them.” 4. How would you respond to D.S.’s statement? 5. Why is D.S. experiencing difficulty using his right arm? Given the type of surgery he underwent, is this expected? 6. You administer morphine sulfate 4 mg IV and tell D.S. that you will return in 30 minutes; 15 minutes later he turns on his call light. When you enter the room D.S. says “I think I’m going to throw up.” What are the next three things you would do? 7. D.S. states “I started to feel sick a couple of minutes ago. It just kept getting worse until I knew I was going to throw up.” Given this information, What do you think is responsible for the sudden onset of nausea? 8. Would it be appropriate to give D.S. a second dose of morphine before reporting his reaction to the provider? State your rationale. Describe your next steps. 9. D.S.’s pain and nausea are under control an hour later. You remove the chest tube dressing and note that the area around the insertion site looks slightly inflamed, the tissue immediately around the tube looks white and moist, and there is scant amount of brown drainage. What action would you take next? CASE STUDY PROGRESS The next day, the nurse giving you D.S.’s report says that he has been driving her crazy all day long. She tells you that he is fine but has been paranoid and demanding. You enter D.S.’s room to see how he is doing and to tell him you are going to be his nurse again today. You nte that his head bobs up and his mouth opens. Like a fish taking in water, every time he inhales. He says, “I just can’t [breath] seem to [breath]get enough [breath]air.” 10. Identify six possible problems that D.S. could have that would account for his behavior. 11. What actions will you take next? Give your rationale. CASE STUDY PROGRESS D.S.’s respiratory rate is 46 breaths/min; you auscultate slight air movement over the large airways and no breath sounds distal to the third intercostal space. He’s sitting on the side of the bed with his arms hunched up on the overhead table. His gown is in his lap. He is diaphoretic, you note intercostal retractions with inspiration, and all muscles of the upper torso are engaged in respiration. 12. What would you do next? 13. After D.S. is successfully resuscitated, you accompany him during transfer to the ICU. Why would you do this, and what information would you provide to the ICU nurse? CASE STUDY PROGRESS After stabilizing D.S. in the ICU, the provider returns to your floor and compliments you on your clear thinking and fast action. The nurse who gave his report comes up to you to apologize. She is relative new and asks you to explain how you know when a patient is in the early and late stages of respiratory distress. 14. How would you distinguish between early and late stages of respiratory failure? Health Science Science Nursing NUR 3191 Share QuestionEmailCopy link Comments (0)