The Nursing situation is designed to help you to improve

 

The Nursing situation is designed to help you to improve critical thinking and clinical judgement for safe patient outcomes.

You will document answers to the discussion questions and upload them via the link below. Please use the rubric as a guide as you answer the questions.

NURSING SITUATION

TISSUE PERFUSION

History of Present Illness

 Joan Walker is a 77 year old female that has a productive cough of green phlegm which started 5 days ago. Three days ago, her primary care physician prescribed prednisone 40 mg/QD and azithromycin 250mg x 5 days.

            Joan started the medication supervised by the nurse at her assisted living facility and on the 3rd day she developed intermittent chills and a fever of 102.0F. She has been having difficulty breathing causing her to use her albuterol inhaler every 1-2 hours with no improvement. Her caregiver calls 911 and she is taken to the ED.

            Joan recently loss her husband of 45 years 8 months ago. They had no children. Joan depends on her church family and pastor for comfort and emotional support. She asks her caregiver before leaving for the ED to contact them on her behalf. Joan later told the nurse in the ED, “I think this maybe the end therefore when my church family arrive, please allow them to pray with me”. The nurse assured her she would be encouraged Joan to relax and focus on getting better. “I don’t understand why this continues to happen! My husband and I stopped smoking 10 years ago!”

Past Medical History COPD/Hypertension/Hyperlipidemia/Anxiety Disorder/1ppd smoker for 40 years. Quit 10 years ago.

Joan Walker’s Clinical Data upon Admission

Temp (102.0F) Pulse (110/Regular) RR(30/Labored/Use of Accessory Muscles) BP     (178/96) O2 Sat (86%/Pt. placed on 6L via N/C). Pain (2/Dull ache over chest).

Lab Results                                                                                                    ABGs

WBC               14.5                                                                             pH                   7.25

Hgb                 13.3                                                                             pCO2               68      

Neutropils      92                                                                                p02                    52     

Bands              5                                                                                  HC03                36

Potassium       3.9                                                                               02                      84%                                     

CO2                35

Glucose          112 (Patient is not Diabetic)                                     

Lactate Acid 3.2

BUN                32

Creatinine      1.2

Discussion Questions

Based on Ms. Walker’s presentation to the ED, conduct a general head to toe assessment and document your findings. (Remember to consider her PMH, age and psychosocial findings).

Discuss the pathophysiology of COPD. Utilizing the nursing process, what would your nursing care include? What are some of the “Red Flags” related to COPD and this scenario?

Discuss Ms. Walker’s lab values. What do they tell you about your patient’s current condition?

Discuss Ms. Walker’s ABGs and Lactic Acid Levels. Prepare a brief SBAR you would give to the attending physician in the ED along with your recommendations/orders.

Based on Ms. Walker’s PMH, what are some of the home medications you would expect her to be on?

Discuss her current oxygen therapy? Would you change or maintain it?

What nursing priorities will guide your plan of care for Ms. Walker?

What can you do to engage yourself with this patient’s experience and show that she matters to you as a person?

What educational/discharge priorities will be needed to assist Ms. Walker’s healing process? Who would you like to collaborate with along with the patient?

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