Question

Part 1

M.C. 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

What other questions should the nurse ask about the cough?

Develop a problems list from the objective and subjective data.

What nursing diagnoses can be derived from the problems list?

What should be included in the plan of care?

What risk factors are associated with this age group?

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

Part 2

S.P. 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

What other questions should the nurse ask about the fatigue?

What other assessments are necessary for this patient?

What are some causes of fatigue?

Develop a problems list from the objective and subjective data.

What should be included in the plan of care?

Based on the readings, what is the most likely cause of fatigue for this patient?

Part 3

S.R. 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.

What subjective information should the nurse obtain?

The nurse is assessing the patient’s pulses. Which locations should the nurse check?

The nurse needs to evaluate the adequacy of the collateral circulation before obtaining an arterial blood gas (ABG) sample. How should the nurse proceed?

What is the most likely cause of this patient’s shortness of breath, productive cough, and swelling in both legs

Answer 1

ANSWERS

PART 1

1.What type of cough is it ? Dry or wet ?

when did the cough started ?

Any mucus present in it ?

Are there any medical condition present with it ?

Whether patient on any medication ?

2. Problems list :

- Heart attack - hearing impairement

- aneurysm - Alzheimers disease

- Heart failure - fluid aspiration

- Dementia - infection

3. Nursing diagnosis:

- Imbalanced nutrition less than body requirement related to poor intake .

- Risk for infection related to high glucose level.

- Knowledge deficit related to lack of information.

4. Plan of care

- it includes detail analysis of patient status

- maintaining input output ratio

- maintaining oxygen level.

5. Hypertension , DM , Coronary artery disease , obesity

6.The patient is treated for the hypertension and is on the ACE inhibitor . This may be the cause of disease.

PART 2

1.Question related to fatigue

• How much sleep do you get?
• Do you sleep well?
• What are your sleep habits?
• What is your day-to-day lifestyle like ?

2.

• Asses for nausea
• asses for decreased urinary output
• Asses the history of illnes

3. Cause of FATIGUE

• Lack of Physical activity
• Over weight
• lack of sleep
• medications like antidepressants

4. Problems

- bed sores

- cardiogenic shock

- Stiffness

- increased risk of infection

5. CARE PLAN :

- Monitor weight

- Monitor input and output

- Monitor vital signs

- Asses for IV sites

6.It may be cause of congestive heart failure

PART 3

1.Dyspnea

2.Check the cartoid pulse

3. She can go for the Allen test . It is simple procedure used to occlude the radial and ulnar arteries for 20sec over the wrist to check the circulation

4. Lung inflammation may be the cause .