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Scenario: Upon completing a medical history and physical assessment the nurse learns that the client has an eight-year history of chronic obstructive pulmonary disease (COPD) and continues to smoke ½ pack of cigarettes daily. The client is febrile (101.20 F) and reports experiencing periods of chilling. The client has a productive cough resulting in large amounts of purulent sputum and reports, "All this coughing and difficulty breathing makes my chest hurt." The client's spouse shares that the client hasn't been eating or drinking as well as usual and constipation has been a problem for the last 3 days. Both covid-19 infection and pneumonia are being ruled out as the possible diagnosis.
The nurse will identify which assessment and/or history data as supporting a diagnosis of pneumonia? Select all that apply.
- Cough
- Anorexia
- Chest pain
- Constipation
- Fever and Chills
- Purulent sputum
- History of COPD
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- What is the nursing care plan of the following scenario? Mr. Bryan L. was assessed and found to have the following signs and symptoms: awake, confused and agitated. He responds to your questions but sometimes he does not use appropriate terminology. He knows his name, but does not know he is in the hospital. He has productive cough, which he spits in the emesis basin. The sputum is thick and yellow, with streaks of blood. Mr. L. states, “I smoke 3 packs of cigarettes a day for many years and I’m going to keep on smoking!” Laboratory values reflect an elevated level of carbon dioxide in his blood. On minimal exertion, he is experiencing shortness of breath (dyspnea); respiratory rate is 29 breaths/min and uses his abdominal accessory muscles to breathe. Capillary refill is sluggish, greater than 3 seconds. Both of his hands and feet are pale and cold to touch. Assessment Diagnosis Goal/expected outcome Planning Intervention Rationale Evaluation Objective data: Subjective…what the nursing process of following scenario? Mr. Bryan L. was assessed and found to have the following signs and symptoms: awake, confused and agitated. He responds to your questions but sometimes he does not use appropriate terminology. He knows his name, but does not know he is in the hospital. He has productive cough, which he spits in the emesis basin. The sputum is thick and yellow, with streaks of blood. Mr. L. states, “I smoke 3 packs of cigarettes a day for many years and I’m going to keep on smoking!” Laboratory values reflect an elevated level of carbon dioxide in his blood. On minimal exertion, he is experiencing shortness of breath (dyspnea); respiratory rate is 29 breaths/min and uses his abdominal accessory muscles to breathe. Capillary refill is sluggish, greater than 3 seconds. Both of his hands and feet are pale and cold to touch.Bradley Buchanan presents to the neighborhood nurse-run clinic with shortness of breath, a persistent cough with blood-tinged sputum, recent weight loss, and night sweats. On initial assessment, the client has a fever of 101.4°F and pain in his chest. His other vital signs are as follows: pulse 98 beats per minute; respirations 26 per minute; blood pressure 110/76 mm Hg; height 68 inches; and weight 140 pounds. Mr. Buchanan is 45 years old. He is employed as a dishwasher at a local restaurant and lives at the local shelter with his wife, who is 8 months pregnant, and his 13-year-old son. Mr. Buchanan is concerned that if he cannot go to work, he will lose the family’s only income. At this point, although Mr. Buchanan’s signs and symptoms and his purified protein derivative test results seem to indicate that he may have tuberculosis, the nurse must pursue further confirmation of the diagnosis. Questions for students: What would be the nurse’s next action? Should the nurse do any…
- The client’s laboratory report today indicates severe hypokalemia, and the nurse has notified the provider. Nursing assessment indicates that heart rhythm is regular when looking at the telemetry monitor. What is the priority nursing intervention? Would it be initiating fall precautions due to potential postural hypotension and weak leg muscles, establish seizure precautions due to potential muscle twitching, cramps, and seizures, or examine sacral area and patient’s heels for skin breakdown due to potential edema. Which one is the priority of these three optionsDiscuss the symptoms the nurse should assess while completing a head-to-toe assessment of a client in potential sickle cell (vaso-occulsive) crisis.Scenario: Emily Campbell is a 48 year old female, she came to the Emergency Department with chest pain and some shortness of breath. She was conscious and ambulatory, and was accompanied by her 19 year old daugter. Presenting complaint: "Nurse, I just don't feel quite right. I've had pain on my chest and I've been feeling breathless." Question(s): 1.) What type of health history should the nurse be taking for Ms. Campbell? Elaborate why. 2.) What three vital questions do you need to ask in order to explore Ms. Campbell's symptoms? Explain the significance of each. 3.) Which part of the history assesment tool should you give focus on with regards to Ms. Campbell's case? Give at least 3 and explain.
- Discuss nursing interventions aimed at preventing/treating respiratory problems for postoperative patients Intervention Description Rationale Deep Breathing and Coughing Oxygen Therapy Incentive Spirometry Repositioning/SplintingScenario Description: Juan Ferguson 50-year-old man with long-term emphysema who has become dyspneic and has been brought to the Emergency Department by paramedics and now is admitted to your floor for admission. He arrives alert and anxious, wheezing and still dyspneic. An IV has been started. Oxygen is started. What is my client’s primary and possible secondary diagnosis? What signs and symptoms would I expect to see with primary and secondary diagnosis? What do I need to assess? What is my top three priority assessments for this client? (Airway, breathing, circulation) What is my focused assessment for this patient and any nursing interventions I may need? What are the signs/symptoms that my client may exhibit if their condition is worsening? Give one or two reasons you would want to contact the healthcare provider?Which of the following would the nurse expect to see in client experiencing hypoventilation? increased oxygenation in the alveoli increased carbon dioxide in the bloodstream decreased hemoglobin in the bloodstream decreased carbon dioxide in the alveoli