Question

In: Nursing

The nurse reviews the History and Physical (H&P) and the care plan of the assigned patient:...

The nurse reviews the History and Physical (H&P) and the care plan of the assigned patient:

Admitting Information: Mr. Wong, a 72-year-old male of Chinese descent, is brought into the office by his son. The son provided most of the information since the patient speaks little English. The patient lives in China but has been in the U. S. for 5 months visiting his son. He was planning to return home in a couple of weeks.

Physical Examination:

VS: T.99.8, P.92, R.28, BP.130/90, Pulse Ox 94%

Neuro: Alert, soft-spoken, smiles and answers questions appropriately via the son, who interprets. PERRLA.

Resp: Rhonchi bilaterally, Productive cough with yellow-colored phlegm. Dyspnea. Indicates that “chest hurts all over”.

CV: Pulse slightly irregular. Murmur-neg

Skin: Dry, Decreased turgor

GI: Abdomen soft, nontender. Son states his father is not eating very well. He misses the traditional cooking but dies like some American soups. Denies constipation.

GU: No complaints. WNL

Psychosocial: Quiet, small frame, thin man.

Medications: No prescription medications. Has been using several herbal teas for “the cold in his chest.”

Day shift Report to Evening shift: Mr. Wong has been in the hospital for 2 days. There is always someone in the room with the patient. His son spent the night with him. The patient is quiet and speaks little English. He seems to respond better to male nurses. Lung sounds are still diminished in the lower bases. He has refused his bath for 2 days now. He has lost another pound since admission. His IV is infusing well at 125mL/hr.

Day Shift Nursing Notes:

0800 Neuro: Awake, quiet, and cooperative. PERRL.

Resp: Diminished in the lower bilateral bases. Productive cough with light yellowish sputum. Pulse ox 94%. SOB noted. O2 at 2L/NC.

CV/Skin: Warm, cap.refill<3 sec. Turgor non-elastic

GI: Active bowel sound x 4 quadrants----------------------------------------------------N. Nurse RN

0900 GI: Ate 50% of breakfast. Family has brought in some food for the patient.

MS: up to bathroom with assistance from the son. SOB noted on exertion. Son states that the father is upset because he believes his urine smells bad because of the IV medication. -------------------------------------------------N. Nurse RN

1300 GI: Ate 10% of lunch. Drinking teas and soups brought from home. --------N. Nurse RN

1400: System unchanged. ---------N. Nurse RN

On the third hospital day, Mr. Wong refuses the 0800 dose of IV Cefizox and refuses to let the nurse listen to his lungs. He tells the family that he is tired and wants to be left alone. His 0800 VS are T. 98.9, P.96, R. 26, BP. 134/90. Pulse ox 84%.

PLEASE PROVIDE 4 NURSING INTERVENTIONS AND THEIR RATIONALE FOR THIS PATIENT.

Identify the nursing interventions that you would plan to implement at this time.

Identify an evidence-based rationale for each intervention that you plan to implement

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Expert Solution

Nursing interventions for Mr. Wong :

1. Interventions for dyspnoea

* Provide a proper position( sitting) and body alignment for maximum breathing pattern

Rationale: Sitting position helps for chest expansion and there by easy breathing.

2. Encourage the patient for deep breathing ( slow inhalation, hold for few seconds and allow passive expiration. )

Rationale : Deep breathing techniques helps in deep inspiration , helps in increase of oxygenation.

* Administer oxygen supplementaion

: to increase the oxygen saturation in the blood

Nursing interventions for impaired verbal communication ( related to cultural, language difference):

* Provide sufficient time for patient to respond , maintaina calm and unhurried way.

: patient need extra time to answer, as he is having the language difference, to find the correct word for his ideas.

* Avoid talking with others infront of the patient

: Talking to others in infront of the patient, excluding the patient from the conversation may increase the frustration and helplessness of the patient.

Nursing interventions for non compliance with the drugs:

* Involve the patient in planning the proper treatment for him

: Participating patient in planning helps to get his interest in treatment and cooperation.

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