NURS 4581 ADULTS WITH COMPLEX NEEDS Respiratory Distress Case Study…
Question Answered step-by-step NURS 4581 ADULTS WITH COMPLEX NEEDS Respiratory Distress Case Study… NURS 4581 ADULTS WITH COMPLEX NEEDSRespiratory Distress Case Study AssignmentSTAGE 1: Vincent Brody67 year old White male admit: 01/25/2021Height: 69in Weight: 110 kgAllergies: NKDA Chief Complaint- admitted directly from the provider’s office several hours ago for exacerbation of his chronic obstructive pulmonary disease (COPD). Physical findings include a barrel chest and clubbed fingers.Past Medical History- Patient has a 50-year history of smoking 2 packs a day. During the last year he has had two exacerbations of his COPD. Home Medications: Albuterol-ipratropium bromide 100 mcg-20 mcg1 inhalation orally QID Salmeterol xinafoate 50mcg inhalation BID Aspirin 81mg PO dailyPast Surgical History: None Past Social History: Patient has a 50 year history of smoking 2 packs a day. He has continued to smoke despite health care provider’s recommendation to quit. He denies ETOH or illicit drug use.History of Current Illness- 01/25/2021 On arrival to the ED received bronchodilators and is maintaining O2 saturations at 91% on 2 L/min of oxygen per nasal cannula. IV of 5% dextrose 0.45% normal saline (D5 ½ NS) with 20meq potassium chloride (KCL) is infusing at 100 mL/hr. He has responded well to medications and treatments and appears to be resting. He continues to have a productive cough. Patient has complained of increasing fatigue with activity and inability to sleep well at night. He has also had increased sputum production and cough with a low grade fever for 2-3 days. Assessment:Pain: 4/10 – general achiness all over.Neuro:, Asleep, easily arousable, Ox4, follows simple commands. GCS 14. PERRLA 3mm brisk. Motor strength is equal and strong bilaterally.Cardiac: S1 & S2 auscultated no extra sounds. Continuous ECG monitoring. Rhythm: sinus tachycardia HR 107. Peripheral pulses 2+/3+. Trace non-pitting peripheral edema in bilaterally lower extremities. BP 158/98 (118). Cap Refill < 5 sec. x 20 with clubbing noted in all digits.Respiratory: RR 32 labored, barrel chest that is symmetrical, bilateral crackles noted in the lower bases of the lungs and also diminished on the R base. O2 sat 94% on 2L NC. Cough is weak wet and productive with thick yellowish green sputum. Gastrointestinal (GI): abdomen obese, soft, with NO tenderness, guarding, masses or pulsations noted. BS- active x 4 quads. Diet Regular as tolerated. Last BM 2 days prior to arrival.Genitourinary (GU): has not yet voided. Urinal at bedside.Musculoskeletal (MS):. Moderate Fall Risk; Activity observed- bedrest.Integumentary: Skin is pink, warm, dry and intact. Temp 102 orally. PIV- R FA 20g CDI with D5 ½ NS with 20meq potassium chloride (KCL) is infusing at 100 mL/hr Critical thinking exercises 1. What is the pathophysiology of COPD from smoking?2. For stage 1, from different body systems, what are your 3 primary nursing concerns with supporting evidence for this patient and why?3. What priority medications would you expect to be ordered for this patient and why?4. What priority lab/diagnostic tests would you expect to be ordered for this patient and what results would you anticipate being abnormal and why?5. What patient/family teaching is important? Be specificSTAGE 2: Mr. Brody is admitted to the ICU with the following orders: Continuous ECG, SpO2 monitoring, and vital signs every 5 minActivity: BedrestDiet: Regular as tolerated Labs: ABG, CBC, Chemistry Panel, Sputum for C&SDiagnostics: 12 Lead EKG, Chest x-ray O2 at 2 1iters/min per NC—titrate for SpO2 >90%Albuterol 2.5 mg in 3 mL normal saline via nebulizer every 20 minutes × 3 dosesAzithromycin 500 mg IVPGBK dailyCefotaxime 1.5 g IVPGBK every 8 hoursD5 ½ NS with 20meq potassium chloride (KCL) is infusing at 100 mL/hr Lab & Diagnostic Results:ABG: pH 7.35 PaCO2 49 HCO3 30 PaO2 58CBC: WBC- 20 RBC- 7.5 Hgb- 18 Hct- 56 Plt- 130 Chemistry Panel: Na 140 K 4.0 Cl 100 Ca 9.0 Mg 1.4 Phos 3.8 Glu 138 BUN 22 Creat 1.2 Total Protein 5 Albumin 2 GFR >60 Serum Osmo 310 12 lead ECG- Sinus Tachycardia Chest X-Ray: lung fields appear hyper-inflated with a flattened diaphragm with consolidation noted in the Right Lower Lobe (RLL). Critical thinking exercises 1. What is your rationale for each of the admitting orders? List out each order and explain why you think they are ordered for this patient.2. What is your rationale for EACH of the abnormal physical assessment parameters in stage 1, the abnormal laboratory and diagnostic tests from stage 2? List each abnormal result out by section (physical exam, lab results, diagnostic tests) and provide abnormal result and explain rationale for why you believe they are abnormal.3. What patient and family teaching is important? Be specific STAGE 3: After an intense coughing episode, Mr. Brody starts complaining of sudden shortness of breath. His respiratory rate increases to 38 and is more labored, breath sounds are absent over the R side of the chest. Pulse Oximetry has dropped to 86%, Heart rate is 128. He is extremely anxious. Critical thinking exercises1. When a patient develops a rapid onset of shortness of breath, what are the nurse’s immediate priorities?2. What has most likely occurred? What are the signs & symptoms associated with this condition?3. You have to call the Intensivist. Using the SBAR write out your report.4. What patient and family teaching is important? Be specific The following orders were written by the Intensivist:· Stat orderso Have a consent ready to review and signo Obtain a thoracotomy tray and a chest tube set-up with a 24 French chest tubeo Chest x-ray before and after chest tube insertiono Oxygen to maintain SpO2 greater than 90%o Meds: Morphine 2 mg IV push prior to chest tube insertion Diagnostic Results: Chest X-ray: New visual Right side visceral pleura edge without peripheral lung markings. Critical thinking exercises 1. What is your rationale for each of the above orders? List out each order and explain why you think they are ordered for this patient.2. What is your rationale for the abnormal diagnostic result in Stage 3? Explain rationale for why you believe they are abnormal.3. List all the different reasons for inserting a chest tube?4. For stage 3, from different body systems, what are your 3 priority nursing concerns with supporting evidence for this patient and why?5. What patient and family teaching is important? Be specificSTAGE 4: A chest tube has been placed in the right lateral chest wall and connected to a dry system with 20cm of suction. Two additional doses of Morphine 2mg IVPush had to be given. Post-procedure chest xray has been performed. O2 saturation has increased to 92% on oxygen of 100% partial non-rebreather mask. RR is 10 with GCS of 8. Critical thinking exercises1. From stage 4, what is your priority nursing concern with supporting evidence?2. Your concern needs to be called to the provider who just placed the chest tube. Write the SBAR report you would give.3. What order for what medication would you anticipate receiving and why?4. What items need to be assessed on the chest tube and the drainage system?5. What patient and family teaching is important? Be specificSTAGE 5: Day 1 post chest tube insertion. You are to get Mr. Brody out of bed to the chair. He is AAOx4, GCS 15, extremity strength is still equal but weaker than prior day. He is experience 2/10 pain at chest tube insertion site. He has O2 at 2L NC with O2 sat 94% with a RR 22.Critical thinking exercises1. List the steps you will follow to get Mr. Brody out of bed.2. What are some safety considerations when caring for a patient with a chest tube?3. What will you do if the chest tube becomes disconnected?4. What will you do if the chest tube becomes dislodged?5. What patient and family teaching is important? Be specificThe remainder of Mr. Brody hospital stay was uneventful and he was able to have the chest tube removed on the 4th day and on day 7 he was successfully transferred to a pulmonary rehab center for further management and care.Final critical thinking exercise:1. What priority patient teaching would be important in the patient who smokes and has exacerbation of COPD?2. What discharge teaching would this patient/family require? Be specific3. What additional information would you like to have seen covered in this evolving case study?4. As you watched this case unfold, how did it make you feel? Provide a list of references utilized on the assignment. Health Science Science Nursing NURSING 4581 Share QuestionEmailCopy link Comments (0)
