Emerging adulthood, as defined by Jeffrey Arnett, is marked by:…

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Question Emerging adulthood, as defined by Jeffrey Arnett, is marked by:… Emerging adulthood, as defined by Jeffrey Arnett, is marked by:stability and growth.  instability and exploration.  permanence and responsibility.  intimacy and investment.    Biology Science Physiology Share QuestionEmailCopy link Comments (0)

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Question   1. Laboratory and Diagnostic TestingComprehensively presents key/relevant Information accurately and in sufficient detail: description of the ordered/completed diagnostic tests, pertinent results (normal and abnormal ranges), and rationales for each diagnostic test. • Assessment & Reasoning Respiratory SystemJohn Franklin, 35 years oldSuggested Respiratory Nursing Assessment Skills to Be Demonstrated:Inspection: Client positioning - tripod, position of comfort; (face) nasal flaring, pursed lips, color of face, lips; (posterior)level of scapula - rise evenly, use of accessory muscles anterior/posterior, sternal/intercostal retractions. Quality and pattern of respirations.Palpation: (posterior) down the back sequentially checking for tenderness/pain, warmth, crepitus & fremitus (best with ball of hand), chest wall expansion(symmetry) - thumbs over spine and fingers spread like butterfly wings-pneumonia, pneumothorax. Assess for masses, bulges, muscle tonePercussion: Across and down back for resonance vs hyperresonance (pneumothorax), dullness (pneumonia). Avoid percussing over bone.Auscultation: Posterior - down the back sequentially from C7 (lung apex) to T10; anterior - above clavicles to sixth rib (xiphoid); flanks from axillae to 8th rib. Ladder type sequence moving right to left for comparison. Listen for full inspirations and expiration.Palpation, percussion and auscultation follow same pattern and avoids scapula and spine (posterior) and mammary tissue (anteriorly) - assess as close to chest wall as possible. Compare left to right for aeration =Make Learning Active!Role play or go through the interview/body assessment process - student to student or as a group.Review the case study as an application exercise in small groups or together as a class.Depending on your program some of this content in the case study may not have been taught. Do not letthat prevent you from utilizing this case study! Instead use it to promote learning by having students identify what they do not yet know and provide guidance to where they can find the information in the textbook or on the internet to address knowledge gaps. This is educational best practice and another way to scaffold knowledge!© 2019 Keith Rischer/www.KeithRN.comPresent Problem:John Franklin is a 35-year-old African American male who has a history of hypertension and asthma who smokes 1⁄2 ppd since the age of eighteen. He began to feel more short of breath after supper today and began to have a persistent non- productive cough. He ran out of his albuterol inhaler two months ago and has audible expiratory wheezing when he comes to the triage window of the emergency department (ED).John is promptly brought to a room in the ED and you are the nurse responsible for his care.What data from the present problem are RELEVANT and must be interpreted as clinically significant by the nurse?(Reduction of Risk Potential)What is the RELATIONSHIP of your patient's past medical history (PMH) and current meds?(Which medication treats which condition? Draw lines to connect.)RELEVANT Data from Present Problem:Clinical Significance:  PMH:Home Meds:Pharm. Class:Mechanism of Action (own words):Asthma HypertensionAlbuterol inhaler 2 puffs every 4 hours PRN wheezingFurosemide 20 mg PO daily  Patient Care Begins:What vital signs are abnormal? What is the reason (pathophysiology) for these findings?(Reduction of Risk Potential/Health Promotion and Maintenance)Current VS:P-Q-R-S-T Pain Assessment:T: 99.1 F-37.3 C (oral)Provoking/Palliative:Denies painP: 110 (regular)Quality: R: 24 (regular)Region/Radiation: BP: 188/110Severity: O2 sat: 91% RATiming: Abnormal VS:Clinical Significance:  © 2019 Keith Rischer/www.KeithRN.comYou place John on a cardiac monitor, continuous oximetry and quickly collect the following assessment data:Current Assessment:GENERAL:Appears anxious, body tense, brows furrowedRESP:Coarse inspiratory and expiratory wheezing with prolonged expiratory phase, labored breathing, diminished aeration in bases, subcostal retractions presentCARDIAC:Skin warm and dry, no edema, heart sounds strong, regular with no abnormal beats/murmurs, pulses 3+ throughout, brisk cap refillNEURO:Alert & oriented to person, place, time, and situation (x4)GI:Abdomen pink, flat, soft/nontender/symmetrical, bowel sounds audible per auscultation in all four quadrantsGU:Voiding without pain/difficulty, reports urine clear/yellowINTEGUMENTARY:Cool, moist forehead, skin integrity intact, skin turgor elastic, no tenting presentWhat assessment findings are abnormal? What is the reason (pathophysiology) for these findings?(Reduction of Risk Potential/Health Promotion & Maintenance)RELEVANT Assessment Data:Clinical Significance:  Put it All Together and Think Like a Nurse!1. Interpreting relevant clinical data, what is the primary problem? What body system(s) will you assess most thoroughly based on the primary/priority concern?2. Which specific nursing assessments for this body system are most important? Validate successful completion of each nursing assessment on a manikin (if available) identified with peer or faculty initials.What's the problem?What's causing the problem?(explain pathophysiology in OWN words)PRIORITY Body System to Assess:   PRIORITY Nursing Assessments:Rationale:Validate Student Performance:   © 2019 Keith Rischer/www.KeithRN.com3. What is the current nursing priority and plan of care?Nursing PRIORITY: PRIORITY Nursing Interventions:Rationale:Expected Outcome:   4. State the rationale and expected outcomes for the medical plan of care.Medical Management:Rationale:Expected Outcome:   Radiology Reports:What diagnostic results are RELEVANT and must be interpreted as clinically significant by the nurse?(Reduction of Risk Potential/Physiologic Adaptation)Lab Results:Radiology: Chest X-RayResults:Clinical Significance:No infiltrates noted, silhouette of heart is slightly enlarged Complete Blood Count (CBC) WBCHGBPLTs% NeutsBandsCurrent:10.514.5295780RELEVANT Lab(s):Clinical Significance:  © 2019 Keith Rischer/www.KeithRN.comBasic Metabolic Panel (BMP) NaKGluc.Creat. Current:1403.21851.3 RELEVANT Lab(s):Clinical Significance:  Evaluation: Thirty minutes later...John has received two albuterol/ipratropium nebulizers and IV methylprednisolone. You collect the following clinical data to reassess his status.Current VS:Most Recent:Current PQRST: T: 99.1 F-37.3 C (oral)T: 99.1 F-37.3 C (oral)Provoking/Palliative: P: 96 (regular)P: 110 (regular)Quality:DeniesR: 20 (regular)R: 24 (regular)Region/Radiation: BP: 146/90BP: 188/110Severity: O2 sat: 95% RAO2 sat: 91% RATiming: Current Assessment:GENERAL APPEARANCE:Resting comfortably, appears in no acute distressRESP:Breath sounds have mild expiratory wheezing with equal aeration bilaterally, able to speak in full sentences with no SOBCARDIAC:Pink, warm & dry, no edema, heart sounds regular with no abnormal beats, pulses strong, equal with palpation at radial/pedal/post-tibial landmarksNEURO:Alert & oriented to person, place, time, and situation (x4), less anxiousGI:Abdomen pink, flat, soft/nontender/symmetrical, bowel sounds audible per auscultation in all four quadrantsGU:Voiding without difficulty, urine clear/yellowSKIN:Skin integrity intact, skin integrity intact, skin turgor elastic, no tenting present1. What data is RELEVANT and must be interpreted as clinically significant by the nurse?(Reduction of Risk Potential/Health Promotion and Maintenance)RELEVANT VS Data:Clinical Significance:TREND: Improve/Worsening/Stable:   © 2019 Keith Rischer/www.KeithRN.comRELEVANT Assessment Data:Clinical Significance:TREND: Improve/Worsening/Stable:   1. Has the status improved or not as expected to this point? Does your nursing priority or plan of care need to be modified after this evaluation assessment? (Management of Care, Physiological Adaptation)Evaluation of Current Status:Modifications to Current Plan of Care:  2. What did you learn that you can apply to future patients you care for? Reflect on your current strengths and weaknesses this case study identified. What is your plan to make any weakness a future strength?What Did You Learn?What did you do well with this case study?  What could have been done better?What is your plan to make any weakness a future strength?   Health Science Science Nursing NSG 210 Share QuestionEmailCopy link Comments (0)
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