Question

Case Scenario: Task

A patient rushed to ER Dept. with complaint of severe DOB. As independent nursing intervention,

patient was placed on bed safely in high back rest and hooked to O2 inhalation at 5 Lpm via face

mask. Upon assessment, Mrs. Nicole Reyes, a 42-year-old, the Physician noted that there is

swelling on her right breast, discharge and crusting on nipple, v/s BP: 150/90, RR, 40, SPO2: 88%,

Temp. 36.5 C. On examination, the Physician note that her breasts feel nodular but with discrete masses

T-3 >5 cms, N-3, M-1. Other findings include evidence of inflammation, w/ axillary node enlarged.

Thorax assessment as follows: Decreased chest movement, Stone dullness to percussion,

diminished breath sounds, decreased resonance and fremitus, + pleural friction rub and

egophony, In response to questioning, she relates that she is a “heavy coffee drinker” and is

under a great deal of stress in her job, and the mass was noticed 5 years ago with no consultation was made due financial constraint. She reports that a maternal aunt died of breast cancer. She

wants to know if the mass could be cancerous or what can be done to eliminate this breast problem.

The Doctor order for some laboratory examinations and stat CXR. Initial Dx r/o Breast Cancer Stage III,

Pneumonia, Covid 19 Suspect

1. Apply COLDSPA

Character

Describe the sign or symptom (feeling,

appearance, sound, smell, or taste if applicable).

Onset

When did it begin?

Location

Where is it? Does it radiate? Does it occur

anywhere else?

Duration

How long does it last? Does it recur?

Severity

How bad is it? Or How much does it bother you?

Pattern

What makes it better or worse?

Associated factors/How it Affects the client

What other symptoms occur with it? How does it

affect the client

2. Make a Concept Map

3. Associated Concepts

WHY WAS IT ORDERED? Level 1

Associated Concepts:

Infection

The purpose of this activity is to evaluate client orders and determine the relationship to the

concept of infection.

Related Concept Learning Outcomes

1. Describe diagnostic and laboratory tests to determine the individual’s infection status.

2. Compare and contrast independent and collaborative interventions for clients with

infection.

Client Diagnosis:

Instructions: Search through the orders in the client’s medical record and identify how each

order is related to the concept of infection. Consider medications, diagnostics, and collaborative

considerations. Fill out the following table.

Order How is the order related to infection?

Sputum GS/ CS ( Gram stain/ Culture and -

sensitivity

CBC w/ Platelet count -

Na+, K+ -

Ferritin -

HCRP -

SGPT, SGOT -

Nasopharyngeal swab/Oropharyngeal -

Swab for Covid 19 -   

Blood Culture R and L pheripheral

Answer 1

1) This is illness assessment. If you have the patient with you or a similar patient then you may ask them. It is to be done in front of the patient. Generally the outcomes are, character is modular, onset in this case should be 5yrs ago, Location is breast, Duration is five years, severity you have to know from the patient but knowing from the data, it should be severe, associated factors are Difficulty in breathing and all the associated symptoms of Covid as suspected that is loss of taste,smell, fever, cough maybe present.

2) In concept map you generally have to represent the signs, symptoms, pathophysiology, tests, diagnosis, interventions, medications of the disease in a chart manner. So, look for the abovesaid things for breast cancer. I don't know whether the question asked for the concept map for pneumonia and covid also or not. Please confirm that part.

3) 1) Diagnostic and laboratory tests include nasopharyngeal swab or RT PCR for covid test, chest xray for pneumonia, biopsy for breast cancer.

2) If the person has covid(after test), then order for doxycycline/azithromycin, paracetamol, amoxycilline, vitamin C, zinc. For pneumonia, same antibiotics will work as it is for covid. For breast cancer, Chemotherapy and surgery.