Question

You are a nurse admitting a patient to the hospital from the emergency

department (ED) with shortness of breath and recent weight loss. After receiving

a report from the ED nurse, you ready the patient’s room according to unit

specifications and collect the necessary equipment and forms. When the patient

arrives, she is using oxygen via a nasal cannula and seems to be comfortable.

As you begin your admission activities and paperwork, you note that her

shortness of breath slightly increases as she answers your questions.

Accompanying the patient is her daughter, who comments, “This is the fourth

time she’s been admitted to this hospital in the past year.” The patient and her

daughter demonstrate a close, loving relationship. The daughter not only

encourages her mother, but also sets boundaries regarding her mother’s

anxiety.

a. What general priorities would you expect to establish from this

information?

b. How could you facilitate the best implementation of the plan of care?

c. How would you select evidence-based nursing interventions?

d. Which interventions would you expect to implement in this case?

e. How would you determine the success of your interventions?

2. You are a nurse preparing to receive a new patient, fresh from surgery, to your

unit. The patient is a 71-year-old man who underwent a surgical repair of a

fractured femur. As you receive a report from the postanesthesia recovery unit,

you learn that his medical history includes hypertension, 40 pack-years of

smoking, and COPD. His surgical repair was successful but complicated by

excessive bleeding, and he is receiving IV fluids to compensate. He is widowed,

and his three children are scattered throughout the United States. He lives

alone, receives Meals on Wheels, and pays a cleaning service to keep his home

clean.

a. What general priorities would you expect to establish from this

information?

b. What might you identify as expected patient outcomes in this case?

c. How would you identify evidence-based nursing interventions?

d. Describe activities that need to occur continually during the

implementation step to ensure that the most appropriate nursing care is

Answer 1

a. What general priorities would you expect to establish from this information?

• Reports patient frequent hospital visists with same complaint
• O2 administration and suction equipments bedside
• Close monitoring of Vital signs
• need to rule out cause of weight loss
• need radiological studies of chest and blood investigations.

b. How could you facilitate the best implementation of the plan of care?

• Positioning is important.

• Pursed lip breathing helps slow down the rate of breathing

• Have the patient sit near a window, or have a fan blow gently across his/her cheek so

  they feel like they are getting “more air.”

• Teach relaxation techniques to help patients calm down.

• If the patient is blue (gray or dusky) in the face, cannot speak more than 2 words

  between breaths, gets confused, dizzy, weak, or starts wheezing, contact the physician.

c. How would you select evidence-based nursing interventions?

Nurses are in a unique position to support patients suffering from dyspnea by using evidence-based interventions,administration of corticosteroids ,broncho dialotors and opiods.

d. Which interventions would you expect to implement in this case?

• Proper positioning of the patient
• Administer prescribed medications
• Close monitoring of excerberation
• Oxygen Administration

e. How would you determine the success of your interventions?

When patient symptoms reduces and comfortable with his normal breath rate.

2.

a. What general priorities would you expect to establish from this information?

• Patient is known case of COPD and Hypertension
• he is single and wheel chair bound
• Risk of pulmonary Embolism is High
• Prepartion of the unit with oxygen,suction and monitors.

b. What might you identify as expected patient outcomes in this case?

Patient overcome post surgery phase with minimal complications and reduced respiratory and cardiac distress.

c. How would you identify evidence-based nursing interventions?

Patient require preventive measures of respiratory failure,hypertensive crisis,post surgical complications,fall preventive measures and personal aid for his ADL.

d. Describe activities that need to occur continually during the implementation step to ensure that the most appropriate nursing care is.

• Proper positioning of the patient
• Proper diet and nutrition
• Fall prevention
• Personal Aid for his ADL