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...
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NURSING SITUATIONTISSUE 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. Provide 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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