Question

#1: (Patient Case): T.C. is an 85 yr-old female admitted for COPD Exacerbation. The patient presented with worsening dyspnea and wheezing over the last 2 weeks, and a productive cough. The patient regularly uses oxygen at home. The patient lives alone in an apartment on the 4th floor (no elevator in the building). Patients’ neighbor brought her into the ED when she noticed the patient having trouble getting up the stairs to her apartment after going down to the first floor to do laundry. The patient has not really been able to get out of her house in the past 4 weeks to purchase goods including food, or to renew her prescriptions. Daily weights have been ordered. (Medical/Surgical History): COPD, Emphysema, Smoker x 50 years (still currently smoking ½ pack per day), Hypertension, Hyperlipidemia, Morbid Obesity, and Bilateral Knee Replacement.(Admission Vital Signs): T-38.4 C/101.2 F, HR-110, RR-25, SpO2-89% on 4L oxygen with a nasal cannula, BP-185/92, weight 113.4 kg/250 lb, height-5’2”(Physical Assessment): (Neuro) A/O x 4, (Respiratory) Crackles/Rhonchi in lung fields bilaterally with thick green sputum, (Cardiovascular) Irregular, S1 & S2 heard, (Integumentary) Stage II sacral ulcer & +3 pitting edema of lower extremities bilaterally, (GI) Active bowel sounds in all 4 quadrants/diarrhea x 4 days, (GU) new finding of urinary retention/it’s been 4 hours since she urinated, (Musculoskeletal) Generalized weakness/uses a cane to ambulate to the toilet with 2-person assistance(Radiology): Chest x-ray shows diffuse opacities bilaterally (abnormal)(Labs): WBC 14.18, Hgb 8.5, Hct 29, Glucose 287, CO2 10(Current Medications): Prednisone 20 mg daily, Montelukast 10 mg daily, Aspirin 81 mg daily, Hydrochlorothiazide 25 mg twice daily, Symbicort 160 mcg 2 puffs twice daily, ProAir 1 puff every 6 hours PRN, Breo Ellipta 200/25 mcg 2 puffs daily

Use the Patient care concept map template to answer the components of the following question of the concept map i. Individual's information

1. Age

2. Medical diagnosis

3. A brief review of underlying pathophysiology *List what functional changes are happening *List process that initiated and maintained disorder or disease

ii. Assessment Data

1. Include all assessment data, not simply information that supports the selected nursing diagnoses Inspect Palpation Percussion Auscultate Neurologica iii. Nursing Diagnoses

1. Select three nursing diagnoses to addresses

a. One must be an actual problem

b. One must address a psychosocial need

c. The final must be a high priority for the individual

iv. Linkages Within and Between Diagnoses 1. The concept map demonstrates relationship within and between the nursing diagnoses.

v. Planning 1. Prioritize diagnoses to reflect the needs of the individual 2. Set realistic outcome measurement 3. At least two (2) scholarly, primary sources from the last 5 years, excluding the textbook, are provided

vi. Implementation1. Interventions are individualized for patient-provider rationale 2. Interventions support the achievement of selected outcome measurements-provide rationale 2 NR226 Fundamentals – Patient Care RUA: Concept Map _RUA_Concept_Map

vii. Evaluation of Outcomes (5 points/15%) 1. Determine if outcomes were met. 2. Provide evidence that supports that determination. 3. Describe what changes, if any, are needed to promote expected outcomes in the future.

viii. Safety-Communication-Infection Control a. specific elements of communication used when providing care, b. safety concerns related to the individual for whom you cared, and c. infection control practices followed while caring for this patient.

ix. APA Citations and Writing a. References are submitted with assignment. b. Uses appropriate APA format (6th ed.) and is free of errors. c. Grammar is free of errors. d. Spelling is free of errors. e. The mechanics of writing are free of errors. For writing assistance (APA, form

Answer 1

Answer:

1. Age – 85 years

2. Medical diagnosis – The patient is having heart and lungs disease.

3. The heart disease is causing a problem in proper blood flow in the body. Lack of sufficient blood flow in the body leads to a decrease in the oxygen in the body. To compensate for a low oxygen level in the body, the breathing is increased in the patient. The normal heart rate (HR) of a person ranges from 60 to 100 beats per minute. The HR in the patient is 110, which is a higher rate. The normal respiratory rate (RR) of at rest is 12 to 20 breaths per minute. In this case, the patient is having a RR of 25. Hypertension, hyperlipidemia, and morbid obesity cause the heart to function abnormally.

The three nursing diagnosis to address the problem is as follows:

a. An actual problem: The problem in majorly with the heart and lungs. For this problem, lung function tests are necessary. Other important confirmatory tests are chest X-ray, CT scan, arterial blood gas analysis and blood tests.

b. Addressing psychosocial need: The patient should be asked for the daily rate of smoking. The patient should provide honest information about the habits.

c. Diagnoses of high priority for the individual: The disease should be diagnosed early before the disease is advanced. The patient’s health should be regularly checked. Early diagnosis would minimize the exacerbation.