Question

Part 1

M.A. is a 69-year-old man who presents to the outpatient office with a hacking, raspy cough.

Subjective Data
PMH: HTN, DM
Cough is productive, bringing up green phlegm
Runny nose, sore throat
Denies fever
Sore throat pain when swallowing
No history of smoking or seasonal allergies
Complains of fatigue

Objective Data
Vital signs: T 37 P 72 R 14 BP 134/64
Lungs: + Rhonchi bilateral upper lobes, wheeze
O₂ Sat = 98%
Ears = TM bulging
Nose = + erythema, yellow discharge
Throat = + erythema, – pustules
Medications: Metoprolol 12.5 mg per day, Glucophage 500 mg twice a day

Questions

1. What other questions should the nurse ask about the cough?
2. Develop a problem list from objective and subjective data.
3. What nursing diagnoses can be derived from the problems list?
4. What should be included in the plan of care?
5. What risk factors are associated with this age group?
6. Based on the readings, what is the most likely cause of this patient’s cough?

Part 2

M.A. is a 75-year-old female who presents to the provider’s office with fatigue.

Subjective Data
PMH: HTN, hyperlipidemia, MI 3 years ago
Fatigue started about a month ago, getting worse
Relieved with rest, exacerbated with activity
Denies chest pain
Ankles swollen

Objective Data
Vital signs: T 37 P 112 R 18 BP 110/54
Lungs: bilateral lower lobe crackles
O₂ Sat = 94%
Skin = cool to touch
CV = heart rate regular, positive peripheral pulses, ECG = no changes
+2 edema bilateral ankles
Medications: Metoprolol 20 mg per day, 325 mg of aspirin per day

Questions

1. What other questions should the nurse ask about fatigue?
2. What other assessments are necessary for this patient?
3. What are some causes of fatigue?
4. Develop a problem list from objective and subjective data.
5. What should be included in the plan of care?
6. Based on the readings, what is the most likely cause of fatigue for this patient?

Part 3

M.A. is a 65- year-old woman who presents to the emergency department complaining of shortness of breath, productive cough, and swelling in both legs. The patient has a past medical history of congestive heart failure (CHF), hypertension, and diabetes. Vital signs are T 97.5, P 85, R 16, and BP 160/90. Physical exam reveals +2 edema bilateral lower extremities, heart rate and rhythm regular, and lungs with rhonchi in the bases. The patient is started on a nebulizer treatment, and an electrocardiogram has been ordered.

1. What subjective information should the nurse obtain?
2. The nurse is assessing the patient’s pulses. Which locations should the nurse check?
3. The nurse needs to evaluate the adequacy of the collateral circulation before obtaining an arterial blood gas (ABG) sample. How should the nurse proceed?
4. What is the most likely cause of this patient’s shortness of breath, productive cough, and swelling in both legs?

Answer 1

PART 1

Q.N.1 What other questions should the nurse ask about the cough?

• When onwards the cough started?
• What are the other symptoms?
• Do you feel chest pain while coughing?
• What is the colour of sputum?
• Is this cough interfere with your sleep?
• Do Any of your family member have history of TB, asthma etc?
• Do you feeling breathing difficulty while coughing?
• Do you have any allergy?
• Does your cough have any relation with allergy?
• Do you have habbit of smoking? if yes how many cigarattes per day?
• Have you developed any URT infection in the last week?
• Where do you live? in a poluted area or not?

Q.N.2 Develop a problem list from objective and subjective data.

• Productive cough with green colour sputum
• Elevated blood pressure indicates hypertension
• Diabetes Mellitus
• Sorethroat
• Fatigue
• Altered respiratory Rate
• Altered air entry
• Adventious breath sounds wheeze and ronchi

Q.N.3 What nursing diagnoses can be derived from the problems list?

• Ineffective airway clearence related to thick secretions as evidenced by auscultating adventious breath sound such as ronchi.
• Impaired breathing pattern related to excess thick secretions on airway as evidenced by altered respiatory rate.
• Ineffective peripheral tissue oxygenation
• Impaired swallowing related to sore throat as evidenced by verbalization

Q.N.4 What should be included in the plan of care?

• Assess the respiratory rate, depth quality etc.
• Maintain a clear airway.
• Provide a comfortable upright position to improve the oxygenation.
• Administer supplimental oxygenation.
• Provide chest physiotherapy to the dependent lung lobes.
• Provide postural drainage to the patient.
• Send the sputum sample for culture and sensitivity.
• Provide steam ingalation to make the sputum thin.

Q.N.5 What risk factors are associated with this age group?

As age increases, the immunity power of individual may loss.This will make them more susapectable to many of the infections. Age related changes such as loss of ciliary activity in the lungs and respiratory tract may aid in the accumulation of pathogenic organisms in the respiratory tract. Hence, the old age is very prone to develop upper respiratory tract infection and flu like symptoms.Apart from that, the patient is also having history of Diabetes and hypertension. This can also contribute to the development of Respiratory infections.Ageing may lead to low immunity and other associated bodily changes. This can contribute to pneumonia and other infections.

Q.N.6 Based on the readings, what is the most likely cause of this patient’s cough?

The patient is having a serious upper respiratory tract infection. The symptoms are more likely indicating a bacterial infection. Inflammation of the lung tissue is associated with accumulation of sputum this can cause serious productive cough.