Question

Bill, a licensed practical nurse (LPN) is collecting admission data on Mr. Howell, who has been admitted for dyspnea and weight loss. While questioning Mr. Howell, Bill learns that he has had progressive weight loss during the past several months and that he has had a productive cough. He also reports waking up at night “wringing wet” and his wife has to help him change the bed sheets.

1. What additional questions should Bill ask about Mr. Howell’s cough?
2. What disorder is suggested by Mr. Howell’s symptoms?
3. What diagnostic tests would you expect to be ordered?
4. Mr. Howell is scheduled for a bronchoscopy. What pre-procedure care should Bill provide? Post-operative care should Bill provide?

Answer 1

Answer q -1

-Ask to the patient about the color , odour and quantity of the sputum produced.

-ask for any chest pain -chest pain may be associated with respiratory and cardiac problems.Determine the location ,severity,onset duration and precipitating factors.

-assess for any cynosis

-clubbing of fingers is a sign of lung disease, it is mainly seen in patient with chronic hypoxic condition

- ask the patient if there is any presence of blood in the sputum

Answer-2

-From his signs and symptoms he may suffering with viral pneumonia

Answer q 3

laboratory test like -

-complete blood count(RBC and WBC count)reduced red blood cell count may cause dyspnea and elevated white blood cell count indicate infection

-arterial blood gass analysis are measured to determine the effectiveness of gas exchange

- sputum culture and sensitivity

-Throat culture

- nasal samples

oxygen saturation test-it help to measure the arterial oxygenation

-

Answer q 4

Bronchoscopy is a procedure in which a flexible tube(bronchoscope) is inserted in to the airway through the nose or mouth to provide a view of the tracheobronchial tree.This procedure is also done to collect bronchial or lung secretion and to perform tissue biopsy.

Pre-procedure care

-Explain the procedure to the patient ,this will prepare him for any possible unpleasant experiences and will help to gain his cooperation and confidence.

-Take an informed consent from the patient

-The patient must be refrain from eating and drinking for 4-6hours before the procedure ,this reduce the risk of aspiration of gastric contents during procedure.

-Take the vital signs (blood pressure, Temperature, pulse rate ,respiration rate,oxygen saturation )are recorded during the assesssment.

-collect the medical history(any concurrent medical problem,drug therapy,and any history of allergies)-

-Post operative care

-Monitor thepatient vital signs regularly according to their general condition,

-check for any changes in the breathing pattern , chest pain or oxygen saturation level.

-observe the patient for any post operative complications like nose bleeding,vocal cord injury ,irregular heart beat , lack of oxygen to the body tissue.

-observe the patient for bleeding , bleeding can occur when biopsies particularly of tumors are taken, When bleeding occur the patient should be nursed on the affected side to prevent blood entering the opposite lungs.

-when the patient is no longer experiencing the effect of the intravenous sedation , he can be allowed to sit up

-The patient may be offered fluids when the effect of local anesthesia on the airway have worn off and an adequate swallowing reflex has returned.