Question

Mr. Stanley London is a 72 year old retired military sergeant who has a 48 years history of smoking 20 packs of cigarettes a year. He reported having a productive cough, hoarseness, and difficulty breathing. He said all these are happening to him because he is old. He has history of several primary malignancies including, multiple melanomas, and recurrent squamous cell carcinoma of the right lower and left upper lungs. Also, he is insulin dependent Type 2 diabetes Mellitus and hypothyroidism. He said he is bothers by his inability to concentrate which he compares it to “suffering from some sort of brain fog.” He is easily irritated and anxious, and that he does not enjoy his normal activities. He is admitted to the psychiatric mental health hospital in a metropolitan city in Manchester for depression. He has lost weight and become socially isolated, he thinks it is because he isn’t really hungry anymore. However, I drink my ensure shakes for meals because they are easy to prepare and they taste good. He also talks about being unusually tired lately, and state that sometimes he doesn’t really have any energy to get from the living room to the bedroom. His wife died 5 years ago, and he lives alone and does not want to stay with his son David. At the time of his admission assessment accompanied by his son David. David reports that his father has periods of confusion and forgetfulness. David, tells the nurse, “He did very well when mom died, he didn’t cry.” Even when he was at home alone. Moreover, the nurse noticed an open sore on Mr. London’s left arm, and Mr. London stated, “I scraped it the fence two weeks ago. It is smaller than it was.” Also, Mr. London reported that he is deaf in his right ear. Mr. London later told the nurse that he was going take a shower before going to the group therapy. During the morning group exercise Mr. London become tired and short of breath quickly.

Prescribed Interventions:

Elopement precaution

One –on-One precaution

Unit restriction

Fall precaution

Escitalopram (Lexapro) 20 mg one time a day

Levothyroxine (synthroid) 125 mcg time a day

Developing critical and clinical reasoning:

1. What would be primary nursing diagnosis for Mr. Stanley London?
2. Formulate a short term goal for Mr. London
3. Looking at the assessment data, identify the major problem that may be a long term focus of care for Mr. London.
4. What is the appropriate way communicate with an elderly person who is deaf in his right ear?
5. Why is it important for the nurse to check the temperature of the water before an elderly client gets into the shower?
6. What would be another appropriate nursing diagnosis for Mr. London?
7. A suicide assessment is conducted. Why is Mr. London at high risk for suicide?
8. What will be priority nursing intervention for Mr. London?
9. Why is Mr. London, during the morning exercise becomes tired and short of breath quickly?
10. What is Lexapro 20 mg one time a day and synthroid 125 mcg one time a day prescribed for Mr. London? Discuss.

Answer 1

The primary nursing diagnosis should be the focus on the present complain that is breathing difficulty, hoarseness of voice, productive cough. So the primary nursing diagnosis is " Ineffective breathing pattern related to productive cough as evidence by breathing difficulty"

A short term goal for Mr. Landon is to maintain normal breathing patterns.

Base on the assessment the major problem that needs long term care for the patient is regarding the confusion and forgetfulness. It is a common problem in the old age patient or the problem may be because of the complication of diabetic Mellitus. If the patient is having forgetfulness and confusion, after some days or month, he will not able to do daily activities by self. So there is long term care assistance need for the patient in daily activities.

For the communication of the patient who is having deaf of right side ear, the nurse should talk with raise the voice but not shouting to the patient. While talking the speed should be very slow. The nurse can also talk near the left side ear so that he can hear properly. The communication should be done in bright light so that the client can see the lip sign and facial expression.

The nurse need to check the temperature of the elder patient before going to the shower is to prevent the burn. when the person becomes older they lose the sensation and for Mr. Landon, he is having diabetes Mellitus which causes the loss of sensation. So the nurse needs to check the temperature before he goes for the shower.  

Another appropriate nursing diagnosis is "Self-care deficit related to forgetfulness and confusion in doing work as evidence by not taking food properly, presence of open wound"

A suicide assessment is done for Mr. Landon. It is because the client is having depression and social isolation. Depression is the main cause of the suicide in the world.

The priority nursing intervention is to restrict patient excessive exercise to prevent breathing difficulty on exertion. Place the patient in fowler's position to maintain proper breathing patterns. Educate regarding the deep breathing and coughing exercise. Assist the patient in daily activities. Administered the medication on time.

Mr. Landon becomes tired and breathing difficulty in morning exercise quickly is because the patient is a history of damage to the lungs. During exercise, the dry air make the airway in the lung more narrow and blocks the airflow and it make difficult to breathe.

Lexapro is the drug use for the treatment of depression and anxiety. Synthroid is use to treat hypothyroidism.So the patient is having depression and hypothyroidism, Lexopro and synthroid are advice by the doctor.