PLEASE I NEED HELP WITH MY A&E HOMEWORK
Stewart Jackson is a 76 year old male admitted yesterday with
complaints of shortness of breath and fever for the past four days and productive cough for the past week. He has been diagnosed with COPD exacerbation. Mr. Jackson has a history of asthma and COPD for the past 15 years, Hypertension and venous stasis for the past 11 years, and was recently diagnosed with pneumonia three months ago. He takes an albuterol inhaler at home as needed (two puffs Q4H prn shortness of breath). He is a current smoker and has been smoking ½ packs/day for the past 60 years. Upon entering his room to perform your morning assessment, you notice his breathing is slightly labored and tachypneic with a respiratory rate of 24 breaths per minute and an oxygen saturation of 88% while on 2 L/min via nasal cannula. His HR is 102 and BP is 158/82.
1. What would be your priorities for this patient and why?
2. What would be important to include in your focused assessment of this patient? What abnormalities might you expect to find?
3. This patient has the following orders:
a. Albuterol 2.5mg inhaled via nebulizer q4h prn (last given 5 hours ago)
b. Pneumococcal Vaccine 0.5 ml IM times 1 dose
c. Influenza vaccine 0.5ml IM times 1 dose
d. Inventive Spirometry every hour while awake
Which of the following orders would you implement first and why?
The patient is given Albuterol inhaled via nebulizer. His vital signs are rechecked and are now: HR 120, BP 160/80, RR 22, O2 sat 90%.
4. Besides checking his vital signs, how would you evaluate the effectiveness of this medication?
5. The patient complains, "I feel like my heart is racing." Why might the patient be experiencing this change?
6. Based on his vital signs and assessment post nebulizer, you feel the patient remains uncomfortable and has not improved significantly enough. What would be your next course of action?
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