Complete case study. Element: Patient Outcomes Management

Complete case study. Element: Patient Outcomes Management of Changing Patient Condition Concept: Impaired Gas Exchange Case Scenario A 44-year-old woman presents to the emergency department with complaints of blood-tinged productive cough, sudden onset of chills, shortness of breath, and intractable back pain. Her symptoms began 5 days ago with a productive cough, nasal congestion, and sore throat after returning from a trip to Great Britain. Two days ago, she visited her primary care physician and was started on prednisone 20 mg once daily and levofloxacin 750 mg once daily for 5 days. Background and Past Medical History Prescribed drugs and over-the-counter medications did nothing to relieve the patient’s symptoms. She does not recall the names of over-the-counter medications but states she was taking a “gel capsule.” She reports worsening of shortness of breath and describes having chest pain with inspiration and back pain. She has cough-associated emesis and chills. Her cough produces rusty sputum. Other details in her history are as follows: Reports history of diet-controlled diabetes and a hysterectomy 4 years ago Denies the use of tobacco, alcohol, and illicit drugs Reports being in a motor vehicle crash 2 years ago with back injury Takes Percocet 10 mg/625 mg every 4 to 6 hours at home Respiratory Assessment Lung sounds Rate Color Capillary refill Oxygen saturation Physical Assessment 1. What should a nurse expect to find when completing a physical assessment? Physical Assessment Anticipated Findings Use this column to describe the link between assessment findings and related pathophysiology. Indicate the pertinent positives and pertinent negatives of the condition using the information presented. Vital signs: T 38.2 °C P 106/regular RR 28 BP 91/57 O2 saturation on room air 88% Height, weight, and waist circumference: 5′4″, 180 lb, 33″ waist General appearance: Pale, dry mucous membranes, uncomfortable Skin Eyes: PERRL Ears and hearing: No complaints Nose and sinuses Mouth: Teeth in good condition Neck Lymph nodes Thorax and lungs: Rhonchi RLL; crackles on inspiration Heart: Tachycardia Peripheral circulation Abdomen: Bowel sounds active × 4 quadrants Musculoskeletal: Back pain 10/10 Neurologic 2. What are the priority assessments and why? What are the safety concerns for the patient? 3. Labs and tests are completed. What lab values are abnormal and what is the explanation for the abnormalities? WBC: 14,080 Hematocrit: 42.7% Platelet count: 174,000 Coagulation studies: Normal Basic metabolic panel: Normal without anion gap Arterial blood gas on 3 L/min by nasal cannula: pH: 7.36 Pco2: 45 mm Hg Hco3: 23 mmol/L Po2: 60 Sao2: 92% ECG: sinus tachycardia without evidence of ischemia CXR: “RLL consolidation consistent with RLL pneumonia” © Science Photo Library / Alamy Stock Photo RLL consolidation Admission The patient is admitted to non-ICU care with the following orders: Start patient on IV 0.9% normal saline Ceftriaxone 1 g IV every 12 hours for 7 days after pan culture and blood work sent to lab Broad-spectrum antibiotic that covers gram-positive and gram-negative bacteria Cephalosporin Azithromycin 500 mg IV daily for 3 days Gram-positive macrolide Blood glucose 152 Regular insulin administered per sliding scale Hydrocodone/acetaminophen 5/325 mg orally every 4 hours as needed for pain 4. What other orders would a nurse anticipate? 5. Develop three nursing diagnoses related to the pathophysiology of this, as informed by the findings of your assessment and the preceding lab values. In other words, link the pathophysiology that a nurse anticipate will happen with the patient. Use the following table to guide the process. Alteration in Condition (Pathophysiology) Critical Thinking and Clinical Decision Making Apply your knowledge of pathophysiology to the clinical decisions you will make as you plan for client care. Using critical thinking to guide the process, link the pathophysiology to the clinical plan of care. Consider, “What do I anticipate will happen with this patient?” Impaired gas exchange Risk for infection Fluid status SCIENCE HEALTH SCIENCE NURSING NURS 498L

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