Nursing careplan of Pneumothorax

Hemodynamic Vent (Question 6)

Patient Profile

R.B. is a 55-year-old woman who presented to the emergency department (ED) via ambulance for acute shortness of breath. Her daughter called an ambulance after finding her mother with an increased respiratory rate and shortness of breath. Upon arrival to the ED, R.B.’s respirations were 40 and shallow with wheezing in the lower lobes and rhonchi in the upper lobes bilaterally. She had positive jugular vein distention and a heart rate of 128. After treatment with albuterol nebulizer via mask, her vital signs were temperature 96.8˚F, pulse 98, respirations 28, blood pressure 148/84, and O₂ saturation 94% with 15 LPM via mask. Arterial blood gasses showed her pH 7.19, pCO₂ 90, PO₂ 92%, HCO₃ 38. R.B. was intubated for hypercapnia. After an echocardiogram showed an ejection fraction less than 50%, she had an emergency left heart catheterization done with two stent placements into the left anterior descending artery. A pulmonary artery catheter was placed, and the initial hemodynamic readings show elevated left ventricular preload. R.B. is now being transferred to the intensive care unit (ICU).

Subjective Data

• Lives with her single daughter, who cares for D.B. full time
• Daughter is not present at bedside
• Smokes 1 pack of cigarettes per day
• No longer active outside of the home because of her chronic illness
• Does not drink alcohol

Objective Data

Physical Examination

• Orally intubated #8 endotracheal (ET) tube taped at 26 cm to lip
• Ventilator settings: FIO₂ 60%, tidal volume 700, assist control (A/C), rate 16, PEEP of 5
• Height 5’5”,weight 117 kg
• Alert and oriented to person, place, and time
• Fine crackles and wheezes bilateral lower lobes
• 2+ pitting edema bilateral lower extremities

Diagnostic Studies

• Chest x-ray postintubation: ET tube 4 cm from carina. Infiltrates in both bases; left base is worse than right
• 12-lead ECG: ST elevation
• Troponin: 41.94
• Lung V/Q scan negative for pulmonary embolism
• Urinalysis: dark yellow and cloudy, protein 28 mg/dL, positive for casts, positive for red blood cells and white blood cells, positive for glucose and ketones

Discussion Questions

6) Describe each of R.B.'s ventilator settings and the rationale for the selection of each.

• Ventilator settings: FIO₂ 60%, tidal volume 700, assist control (A/C), rate 16, PEEP of 5

Acute Kidney Injury (Questions: 2,8)

Patient Profile

A.S. is a 70-year-old female who presented to the emergency department because of a 4-day history of increased shortness of breath and generalized weakness. A.S. stated that she has been able to do her daily chores at home independently, but for the past few days, it was getting difficult for her to get around and that she needed to take frequent breaks because she was short of breath and had no energy. She has a long history of heart failure, type 2 diabetes, and hypertension. She is admitted with a tentative diagnosis of acute kidney injury (AKI).

Subjective Data

• Has been having headaches on and off, with nausea and dizziness
• Reported that she had not been taking her medications regularly at home because of “forgetfulness”
• Has not been urinating a lot
• Feels “puffy” in her legs and hands

Objective Data

Physical Examination

• Blood pressure 178/96, pulse 110, temperature 98.9°F, respirations 24, and an oxygenation of 93% on room air
• Alert and oriented to person, place, and time
• Mild jugular venous distention
• Fine crackles in bilateral lower lobes
• Heart rate regular, no murmurs
• Bowel sounds normoactive and present in all four quadrants
• 2+ edema bilateral lower extremities and hands

Diagnostic Studies

• Echocardiogram shows decreased left ventricular function
• Urinalysis: Urine dark yellow and cloudy, protein 28 mg/dL, negative for glucose and ketones, positive for casts, red blood cells and white blood cells
• 24-hour urine output = 380 mL
• Laboratory Tests:
  • Hemoglobin 8 g/dL
  • Hematocrit 23.8%
  • RBC 2.57 million/mm³
  • WBC 4.7 mm³
  • Sodium 132 mEq/L
  • Potassium 5.2 mEq/L
  • Calcium 9 mg/dL
  • BUN 36 mg/dL
  • Creatinine 4.9 mg/dL
  • BNP 182 pg/mL

Discussion Questions

2) What is the most likely cause of A.S.’s AKI?

8) What are the goals of conservative therapy for a patient with AKI?

Cross- sectional studies are sometimes done with one respondent answering for the whole household. What problems do you anticipate in such a survey? Use terms presented in the course materials to name, explain, and provide an example of at least 2 specific kinds of bias that may be present.

What is angina and how does it relate to coronary artery disease?

8.) A new graduate nurse working on a medsurg floor needs to start an IV on an older patient with no visible veins. The new nurse asks a more seasoned nurse if he would start the IV for her, as she regconizes the lack of experience may require more than one stick. This would be an example of?

a.) veracity

b.) fidelity

c.) nonmaleficence

Which conflict does Wilson use most to drive (bring forth, move forward) all the other elements of the story? Choose ONE that you feel is more apparent and easier to defend than the others. o Troy vs Society o Troy vs Himself o Troy vs Family o Troy vs Death Instructions (how to get it done): • You have completed research on August Wilson, his life, and his plays. • You have completed reading/viewing Fences by August Wilson. • You have read the resources on Conflict in this unit. • Choose the conflict area that you think will have the strongest text support. • Create a thesis statement that clearly states your stance on why this conflict is the driving force of the play and how you’re going to prove it (see “Helpful Hints” section below). • Research needed sources so that you have at least 3 outside sources that are valid and reliable. • Be sure also to include text examples from the Fences, the play. • Defend your thesis in an introduction, at least three supporting sections, and a conclusion.

Is about the story fences

1. What is vaccination coverage and why is it important?
2. How does the CDC track vaccination coverage?
3. What vaccinations are available for parents to get for their children?
4. What are possible outcomes when parents do not vaccinate children?

The code of ethics is divided into sections. Which sections of provision reflect nursing fundamentals values and commitments?

a.) Provisions 10,11&12

b.) Provisions 1,2&3

c.) Provisions 7,8&9

22.) The nurse tells the patient he/she will be “right back” with pain medicine. The nurse gets distracted with another patient issue and doesn't return with the pain medicine for 45 minutes. Which of the following ethical principles have been violated.

a.) autonomy

b.) fidelity

c.) non-maleficence

The nurse calls the physician using the SBAR communication approach. The nurse states, I am calling about the patient Mrs. Smith, on Two east, University Hospital. I am concerned because her blood pressure is 210/98 and she is complaining of a headache. She was admitted yesterday and was alert, but becoming lethargic, will follow commands and respond appropriately. She is pale, extremities are cool. O2 saturations is 92% room air. She had atenolol one hour ago with no change in BP. I am not sure what the problem is, but know that the patient seems to be less stable. I would suggest that you consider a transfer to the unit for closer monitoring. Is there anything that I need to be doing right now for Mrs. Smith? The bold/italic portion of the quote reflects which component of SBAR?

a.) S

b.) B

c.) A

1. Describe dietary sources of cholesterol

2. Explain( compare and contrast) the different types of lipoproteins tested in a lipid panel

10.) The unit manager is reviewing potential HIPPA confidentiality breaches with a new nurse. Which of the following are examples of potentially breaching confidentiality of a patient's health information? Select all that apply

a.) providing family member with code word for phone information access.

b.) sharing a password with a colleague

c.) failing to log off a computer on the nursing unit

d.) discussing patient information in a public area.

e.) sending a fax with an appropriate cover page stating confidential information.

1.) The nurse recognizes the standard of care is a legal term. The Standard of Care describes?

a.) the philosophy of care

b.) the minimum requirement of acceptable care

c.) a specific procedure for how to perform a nursing task.