Question

Pt-1 Jennifer Hoffman is a 33-year-old female brought to the Emergency Department by her neighbor. She has a history of asthma since childhood with multiple emergency visits within the last year. She appears to be in respiratory distress, struggling to breathe. She is unable to speak other than simple one-word statements. An infusion of normal saline has been started at a keep-open rate.

PT-2 A 52-year-old patient has just arrived in the Emergency Department with complaints of severe abdominal pain, nausea, and vomiting over the last few days. His abdomen is distended. He has poor skin turgor and dry mucous membranes. He has not urinated since yesterday. He has felt "dizzy" and "weak" all evening. He thought it might be the flu, but decided to come in because the stomach pains were getting worse. He has signed informed consent for treatment and labs have been drawn.

PT 3-Situation: Mrs. Morrow is an obese, 80-year-old white female who developed a venous stasis ulcer on her right medial malleolus while still living at home. She moved into our skilled nursing home care facility 3 days ago. The current plan of care is focused on promoting wound healing, improving venous return, and preventing skin breakdown.

Background: Mrs. Morrow has a past medical history of chronic obstructive pulmonary disease (COPD), chronic venous insufficiency, and deep vein thrombosis (DVT). Peripheral arterial disease is ruled out by duplex ultrasound. Her daughter had her admitted to this skilled nursing home care facility due to concern for her safety with impaired mobility, an unhealthy diet, and inability to adequately care for herself at home.

Assessment: Mrs. Morrow is alert and oriented, but sometimes forgetful of recent events. Vital signs have been within normal limits and are performed weekly. Results from yesterday's labs are in the chart. She is on a regular diet with nutritional supplement and has been eating the majority of her meals since admission. She requires assistance with positioning in bed and assistance times 1 to get out of bed to the chair or ambulate. Her gait is unsteady, and she is easily fatigued. Her Braden Scale score is 16, and her skin is intact except for the venous stasis ulcer on the right medial malleolus. She has brown hyperpigmentation on both lower legs with +2 edema. The venous stasis ulcer is covered with a hydrocolloid dressing, which is due to be changed. In preparation for her dressing change, she was medicated for pain half an hour ago.

1.Create a plan of care for each patient ranking at lease 2 problems in order of priorty(include goals, interventions and evaluation methods),

2. List 5 (or more) education topics related to each patient’s current status.

Include how the topics shall be taught (I.e. give patient literature or demonstration by nurse).

Include statements about how each of the education topics should be evaluated for patient comprehension?

Answer 1

PT-1

1.

Assessment	Nursing Diagnosis	Goal	Intervention	Evaluation
1.objective data Difficulty to breathing	Ineffective breathing pattern related to bronchial constriction as evidenced by struggling to breathe	the patient will be able to breathe easily	Monitor vital signs , baseline data to plan for care Administer bronchodilator as per order to relieve bronchial constriction Provide propped up or Fowler's position,this will increase the lung capacity Teach breathing exercises,to improve lung function Avoid triggers ,in order avoid exacerbation	The patient is able to breathe at ease with normal respiratory pattern
2. Objective data Inability to speak in sentence	Activity intolerance related to decreased oxygenation as evidenced by difficulty to speak in a flow	The patient will have improved oxygenation and speak comfortably	Administer oxygen to improve oxygen saturation Administer medication to ease breath Avoid excessive conversation with the patient Provide calm and quiet environment Encourage patient to use gestures ,writing ,texting method to express needs Reduce panic	The patient is able to speak in sentence with no breathing difficulty

2.Education topic

• Medication: Evaluate by assessing the progress and no symptoms
• Exercises/Activity:can be know what activity the patient performs on daily basis without causing breathing difficulty
• Relaxation techniques:Tye patient should be practicing relaxation techniques like yoga, meditation which can improve lung function
• Environmental exposure: The patient should avoid triggers from external environment from home to open place
• Protective devices: Encourage to use and evaluate by assessing patient for using face mask when going out or where triggers are possible