Griffith, Sadie STUDENT-Pneumonia-COPD Unfolding Reasoning LATEST 2021 SOLUTION FALL-2021 GUARANTEED GRADE A+

History of Present Problem: Joan Walker is an 84-year-old female who has had a productive cough of green phlegm that started four days ago that persists. She was started three days ago on prednisone 40 mg PO daily and azithromycin (Zithromax) 250 mg PO x5 days by her clinic physician. Though she has had intermittent chills, she had a fever last night of 102.0 F/38.9 C. She has had more difficulty breathing during the night and has been using her albuterol inhaler every 1-2 hours with no improvement so she called 9-1-1 and was brought to the emergency department (ED) where you are the nurse who will be responsible for her care. Personal/Social History: Joan was widowed six months ago after 64 years of marriage and resides in assisted living. She is a retired elementary school teacher. She called her pastor before coming to the ED and he has now arrived and came back with the patient. The nurse walked in the room when the pastor asked Joan if she would like to pray. The patient said to her pastor, “Yes please, I feel that this may the beginning of the end for me!” What data from the histories is RELEVANT and has clinical significance to the nurse? RELEVANT Data from Present Problem: Clinical Significance: RELEVANT Data from Social History: Clinical Significance: What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds? (Which medication treats which condition? Draw lines to connect) PMH: Home Meds: Pharm. Classification: Expected Outcome: • COPD/asthma • Hypertension • Hyperlipidemia • Cor-pulmonale • Anxiety • 1ppd smoker x40 years; quit 10 years ago 1. Fluticasone/salmeterol diskus 1 puff every 12 hours 2. Albuterol MDI 2 puffs every 4 hours prn 3. Lisinopril 10 mg PO daily 4. Gemfribrozil 600 mg PO bid 5. Diazepam 2.5 mg PO every 6 hours as needed 6. Triamterene-HCTZ 1 tab PO daily One disease process often influences the development of other illnesses. Based on your knowledge of pathophysiology, (if applicable), which disease likely developed FIRST that created a “domino effect” in her life? • Circle what PMH problem likely started FIRST • Underline what PMH problem(s) FOLLOWED as domino(s) Patient Care Begins: Current VS: P-Q-R-S-T Pain Assessment (5th VS): T: 103.2 F/39.6 C (oral) Provoking/Palliative: Deep breath/Shallow breathing P: 110 (regular) Quality: Ache R: 30 (labored) Region/Radiation: Generalized over right side of chest with no radiation BP: 178/96 Severity: 3/10 O2 sat: 86% 6 liters n/c Timing: Intermittent–lasting a few seconds What VS data is RELEVANT and must be recognized as clinically significant by the nurse? RELEVANT VS Data: Clinical Significance: Current Assessment: GENERAL APPEARANCE: Appears anxious and in distress, barrel chest present RESP: Dyspnea with use of accessory muscles, breath sounds very diminished bilaterally ant/post with scattered expiratory wheezing CARDIAC: Pale, hot & dry, no edema, heart sounds regular–S1S2, pulses strong, equal with palpation at radial/pedal/post-tibial landmarks NEURO: Alert & oriented to person, place, time, and situation (x4) GI: Abdomen soft/non-tender, bowel sounds audible per auscultation in all 4 quadrants GU: Voiding without difficulty, urine clear/yellow