Nancy Gilbert is a 65-year-old Caucasian female with a 5-year history of laryngeal cancer requiring a
permanent tracheostomy and continuous supplemental oxygen. She has an 80-pack-year history of
cigarette smoking (2 packs per day for 40 years) and lives with her husband who continues to smoke in
their home. On Tuesday afternoon she was admitted to the medical unit with pneumonia and placed
in isolation for Methicillin-Resistant Staphylococcus Aureus (MRSA). The scenario takes place on
Wednesday at 1400.
Sterile trach suctioning
Respiratory distress
Dr J cooper
Admitted yesterday
NKA
Full code
Cough, SOB, fatigue
With husband, nonverbal, writes responses
Chief informant – husband
Father COPD
Pt complaint of wet cough for 1 week, feels very tired from coughing all the time. Complains of
difficulty catching breath.
Pt may benefit from suction
Recent decrease in appetite
Stage 4 laryngeal cancer
Married 42 years
140/72 hr 86 rr 18 temp 99.7 sat 90% on 50% trach collar
Droplet/contact isolation precautions
Recent change in vision
Lips dry and cracked
Total laryngectomy
Exposed to 2nd hand smoke from husband
Dyspnea on exertion
Reports pain with deep breath
Respirations slightly labored
Chest ex reduced
Diminished bs in lower lobes
Rhonchi in upper lobes
Weak cough
Tolerating regular soft diet
No alcohol, spicy foods, use of milk of mag occasionally
No last BM information
Walks 20 min day X 4 days week
Orders:
Vs every 4 hours
Cont pulse ox
I&O
permanent tracheostomy and continuous supplemental oxygen. She has an 80-pack-year history of
cigarette smoking (2 packs per day for 40 years) and lives with her husband who continues to smoke in
their home. On Tuesday afternoon she was admitted to the medical unit with pneumonia and placed
in isolation for Methicillin-Resistant Staphylococcus Aureus (MRSA). The scenario takes place on
Wednesday at 1400.
Sterile trach suctioning
Respiratory distress
Dr J cooper
Admitted yesterday
NKA
Full code
Cough, SOB, fatigue
With husband, nonverbal, writes responses
Chief informant – husband
Father COPD
Pt complaint of wet cough for 1 week, feels very tired from coughing all the time. Complains of
difficulty catching breath.
Pt may benefit from suction
Recent decrease in appetite
Stage 4 laryngeal cancer
Married 42 years
140/72 hr 86 rr 18 temp 99.7 sat 90% on 50% trach collar
Droplet/contact isolation precautions
Recent change in vision
Lips dry and cracked
Total laryngectomy
Exposed to 2nd hand smoke from husband
Dyspnea on exertion
Reports pain with deep breath
Respirations slightly labored
Chest ex reduced
Diminished bs in lower lobes
Rhonchi in upper lobes
Weak cough
Tolerating regular soft diet
No alcohol, spicy foods, use of milk of mag occasionally
No last BM information
Walks 20 min day X 4 days week
Orders:
Vs every 4 hours
Cont pulse ox
I&O
