Description
1. Fill in all the questions from the case study 2. create a paper with intro, patho, assessment based on the case study (take a look at the tip sheet)
Scenario
D.Z., a 68-year-old man, is admitted at 1600 to a medical floor with an acute exacerbation of chronic obstructive pulmonary disease (COPD). His other medical history includes hypertension and type 2 diabetes. He has had pneumonia yearly for the past 3 years and has been a two-pack-a-day smoker for 38 years. His current medications include enalapril (Vasotec), hydrochlorothiazide, metformin (Glucophage), and fluticasone/salmeterol (Advair). He appears a cachectic man who is having difficulty breathing at rest. D.Z. seems irritable and anxious; he complains of sleeping poorly and states that lately he feels tired most of the time. He reports cough productive of thick yellow-green sputum. You auscultate decreased breath sounds, expiratory wheezes, and coarse crackles in both lower lobes anteriorly and posteriorly. His vital signs (VS) are 162/84, 124, 36, 102° F (38.9° C), and Spo2 88%.
Admission Orders
Diet as tolerated
Out of bed with one-person assistance
Oxygen (O2) to maintain Spo2 of 90%
IV of D5W at 50 mL/hr
ECG monitoring
ABGs in a.m.
CBC with differential now
Basic metabolic panel now
Chest x-ray daily
Sputum culture
Albuterol 2.5 mg plus ipratropium 250 mcg nebulizer treatment STAT
1. Are D.Z.’s Vital Signs and Spo2 acceptable? If not, explain why.
2. Describe a plan for implementing these orders.
3. What is the primary nursing goal at this time?
4. Based on this priority, name 3 independent nursing actions you would implement and why.
5. Identify 3 expected outcomes for D.Z. as a result of your interventions.
Medication Administration Record
Methylprednisolone (Solu-Medrol) 125 mg IV push every 8 hours
Azithromycin (Zithromax) 500 mg IVPB q24h
Fluticasone/salmeterol (Advair) 100/50 mcg 2 puffs twice daily
Heparin 4000 units subcutaneous every 12 hours
Enalapril (Vasotec) 10 mg PO daily
Albuterol 2.5 mg/ipratropium 250 mcg nebulizer treatment every 6 hours
Metformin (Glucophage) 500 mg PO twice daily
Nicotine patch 24 mg for 24 hours, daily
6. Indicate the expected outcome associated with each medication D.Z. is receiving
7. Because D.Z. is on azithromycin, what interventions need to be included in his plan of care? Select all that apply.
- Place D.Z. on intake and output.
- Administer the medication over 30 minutes.
- Request a hearing test before initiating therapy.
- Monitor IV site for inflammation or extravasation.
- Assess liver function study results and bilirubin levels.
- Carefully dilute the medication in the proper amount of solution.
8. What common side effects of bronchodilator therapy do you need to assess for?
9. You deliver D.Z.’s dietary tray, and he comments on how hungry he is. As you leave the room, he is rapidly consuming the mashed potatoes. When you pick up the tray, you notice that he has not touched anything else. When you question him, he states, “I don’t understand it. I can be so hungry, but when I start to eat, I have trouble breathing and I have to stop.” Describe 4 interventions that might improve his caloric intake.
10. What other interprofessional team members could you involve in D.Z.’s care and how?
11. After speaking with D.Z. about his diet and reviewing his medications, you are now concerned about his glycemic control. Hospital policy allows you to obtain as-needed blood glucose levels for patient with diabetes, so you direct the UAP to obtain D.Z.’s blood glucose level before the next meal. What is your responsibility in delegating this task to the UAP?
12. The UAP reports that D.Z.’s blood glucose level is 366 mg/dL (20.3 mmol/L). What action do you need to take and why?
CASE STUDY PROGRESS
The next morning, D.Z. is sitting in the bedside chair and appears to be experiencing less difficulty breathing. He states his cough remains productive of yellow-green sputum, although it is “easier to cough up” than it was the previous day. You auscultate decreased breath sounds and a few coarse crackles in both lower lobes posteriorly. His VS are 150/78, 94, 24, 99.7° F (37.6° C). His Spo2 is 92% with O2 on at 2 L per nasal cannula.
Chart View
Arterial Blood Gases
| pH | 7.33 |
| Paco2 | 58 mm Hg |
| HCO3 | 32 mEq/L (32 mmol/L) |
| Pao2 | 65 mm Hg |
| Sao2 | 92% |
13. Interpret D.Z.’s ABG values.
14. Has D.Z.’s status improved or not? Defend your response.
15. What interventions would you include in your plan of care for D.Z. today?
CASE STUDY PROGRESS
D.Z.’s wife approaches you in the hallway and says, “I don’t know what to do. My husband used to be so active before he retired 6 months ago. Since then he’s lost 35 pounds (16 kg). He is going downhill so fast that it scares me. He wants me in the room with him all the time, but if I try to talk with him, he snarls and does things to irritate me. I have to keep working. We don’t want to drain all of our savings, and I have to be able to support myself when he’s gone. Sometimes I go to work just to get away from the house and his constant demands. He calls me several times a day asking me to come home, but I can’t go home. I just don’t know what to do.”
16. How would you respond to her statement?
17. What topics do you need to address with D.Z. to reduce his risk for readmission?
CASE STUDY OUTCOME
D.Z. is discharged after 6 days with instructions to follow up with the primary care provider in 1 week. At the appointment, D.Z. reports he has been able to maintain his smoking cessation and is feeling less dyspnea. The provider continues the respiratory medication regimen and arranges for D.Z. to begin pulmonary rehabilitation therapy the next week.
Do you have a similar assignment and would want someone to complete it for you? Click on the ORDER NOW option to get instant services. We assure you of a well written and plagiarism free papers delivered within your specified deadline.