Question

In: Nursing

Case: Tuberculosis I.P. is a 50-year-old female who presents to the emergency room with productive cough...

Case: Tuberculosis

I.P. is a 50-year-old female who presents to the emergency room with productive cough and fever. Sputum results are positive for tuberculosis.

Subjective data

Patient states cough started 10 days ago, getting worse
Reports feeling tired and no appetite for days
Smokes 1 pack a day for 33 years
Married with two children, ages 12, 14
Takes a “sugar” pill to help with diabetes
Works as home health aide

Objective data

Vital signs: T 38 C, P 64, R 12, BP 120/64
Weight: 145 lb (Last ED visit 6 months ago documented weight at 155 lb.)
Height: 5'4"
Sputum positive for tuberculosis
Chest x-ray shows infiltrates right and left lower lobe

Medications: ASA 81 mg per day, metoprolol 25 mg per day, Simvastatin 20 mg per day, Metformin 500 mg BID, multivitamin 1 per day

Questions

Are vital signs within normal limits? Why or why not?
What other equipment is necessary to assess this patient?
Create a problem list from data.
How should you measure the patient’s oxygen levels?
What teaching and nursing interventions should you consider for this patient?

Expert Solution

Q1

ANSWER: In the vital signs, the patient is having an abnormal temperature that is 38 ^o C which is more than the normal ( 37 ^o C) that indicate fever. Pulse is 64 beats per minute that is under normal range, respiration is 12 and blood pressure is 120 /64 are also normal. The normal range of pulse is 60-100, respiration is 12-18, and blood pressure 120/80.

Q2

Answer: the other equipment that is necessary to assess the patient is glucometer to check the blood glucose level because the patient is also having history of diabetes. This will helps to identify the patient's blood glucose level is under control or not after taking the sugar pills.

Q3

Answer: the problem list from the data are

the patient complaint of

-cough for 10 days and now getting worse

- feeling tired

-lack of appetite

- diabetes

- From the objective data patient have a fever, sputum positive for tuberculosis and chest x ray shows infiltrate right and lower left lobe.

Q4

Answer: The oxygen level can be measure by using pulse oximeter or by doing ABG analysis. Pulse oximeter in non invasive technique in which the pulse oxymeter is attach to the finger and reading will come automatically in the screen. ABG analysis is an invasive procedure, in this the arterial blood is collected and the SPO₂ level is monitored by sending the blood in the laboratory.

Q5

The teaching and the nursing intervention to be considered includes

- Assess the vital signs, oxygen level, blood glucose level

- Provide the patient in fowler position to maintain more comfortable position and make proper breathing pattern.

- Administer medication as per advice by the physician.

- use of PPE should be done to prevent spreading of tuberculosis

- Isolate the patient seperately.

- Educate the patient to stop smoking

- Explain the details about the new diagnosis that is tuberculosis.

- Educate regarding the treatment of the tuberculosis and advice not to skip the tuberculosis medication because once if it is skip need to start again the medication course from the begining.

- Advice to prevent contact with other people as much as possible and advice to use mask if going outside to prevent spreading to other.

- Advice to maintain high nutritious diet to maintain the health.

Nightingale answered 1 year ago

A 50-year-old man, who is a chronic alcoholic, presents to the emergency room with a sudden...

A 50-year-old man, who is a chronic alcoholic, presents to the emergency room with a sudden onset of abdominal pain that radiates to the back. A blood test reveals elevated serum pancreatic lipase levels and a CT abdomen suggests inflamed pancreas. Both of these findings together confirm the diagnosis of acute pancreatitis. The patient was admitted and appropriately managed. The pain reduces over the next two days. On day 3, the patient reports worsening of pain, nausea, and vomiting. An...

A 54-year-old woman who has a history of COPD presents with a productive cough for the...

A 54-year-old woman who has a history of COPD presents with a productive cough for the last 3 months and shortness of breath with little exertion. Her blood pressure is 130/90 mm Hg and pulse rate 126 bpm. Arterial blood gas results are as follows: pH 7.29; PaCO2 72 mm Hg; HCO3– 34 mEq/L; PaO2 50 mm Hg. How do you interpret the patient’s blood gas values? What treatment would you anticipate? Outline the nursing plan of care to address...

Neuro Case Study Mrs. Greene is a 92-year-old woman who presents to the emergency room with...

Neuro Case Study Mrs. Greene is a 92-year-old woman who presents to the emergency room with an acute change in mental status and generalized weakness. Her past medical history is unremarkable. She has not had episodes of confusion in the past. Case Study It is determined that Mrs. Greene has a urinary tract infection (UTI) for which she is started on intravenous (IV) levofloxacin (Levaquin). Mrs. Greene’s confusion escalates to visual hallucinations, the pulling out of two IV sites, and...

Case Study: 52-Year-Old Female Presents with Chronic SOB, and Cough History of Present Illness: Casey, who...

Case Study: 52-Year-Old Female Presents with Chronic SOB, and Cough History of Present Illness: Casey, who is 52-year-old female presents after admission to the San Francisco General 7E Medical/Surgical Hospital. Her chief complaint of shortness of breath on exertion. She reports that she was seen for similar symptoms previously at her primary care physician’s office three months ago. At that time, she was diagnosed with acute bronchitis and treated with bronchodilators, empiric antibiotics, and a short course oral steroid taper....

A 67-year-old female patient presents to the emergency room you work at complaining of shortness of...

A 67-year-old female patient presents to the emergency room you work at complaining of shortness of breath and pain on the right side of her chest. Upon auscultation of the lung field during the physical exam, you note flatness and diminished breath sounds over the right lung. Her temperature is 101.3°F. What are the possible causes of her symptoms? (What is your differential diagnosis?) What tests might order to determine the specific cause of this patient’s symptoms? Why? This patient’s...

Case: Left-Sided Weakness M.R. is a 67-year-old African-American female who presents to the emergency department with...

Case: Left-Sided Weakness M.R. is a 67-year-old African-American female who presents to the emergency department with left-sided weakness. Subjective data: PMH: HTN, hypothyroid, sickle cell anemia Sudden onset of headache Current smoker, 1 pack a day for 45 years Having trouble speaking Left-sided face droop Reported pain 6/10 Objective data: Height: 5'6"; weight: 192; BMI: 31 Vital signs: T 37 C, P 72, R 18, BP 174/94 Lungs: clear all bases O2 sat: 100% CV: heart rate regular, positive peripheral...

CASE 1: A 45-year-old female, conscious and coherent, presents with cough for 2 weeks, fever and...

CASE 1: A 45-year-old female, conscious and coherent, presents with cough for 2 weeks, fever and malaise. Physical examination reveal rales in the left lung base, respiratory rate of 30 breaths / min. associated with minimal difficulty of breathing. Blood pressure is measured at 90 / 60mmHg. Laboratory results show elevated WBC and Urea levels at 8mmol / L. A. Based on the case presented above, evaluate the severity of the patient's condițion. B. What recommendation or treatment option will...

The client comes in to the Emergency Room with complaints of difficulty breathing, productive cough, malaise,...

The client comes in to the Emergency Room with complaints of difficulty breathing, productive cough, malaise, and night sweats. He is currently living in a 1 bedroom apartment with his wife, brother, sister-in-law and 3 small children. His vital signs are as follows: T 100.5 F, P 88, RR 20, BP 132/65, SpO2 89% on room air, weight is 99 lbs. He complains of chest pain 8/10. He is diagnosed with active tuberculosis (TB). Discuss 3 priorities for nursing care...

MC is a 52-year old African American female who presents to the emergency department with reports...

MC is a 52-year old African American female who presents to the emergency department with reports of shortness of breath, productive cough, and pain to her chest. She reports her cough is worse at night with chronic pain due to coughing. She denies wearing home oxygen and can been seen purse lip breathing. The nurse observed dyspnea on exertion when MC ambulated to the restroom. She states that she must stop halfway up the stairs in her home to catch...

Mood Disorders Scenario Scenario: Ally is a 25 year old female who presents to the emergency...

Mood Disorders Scenario Scenario: Ally is a 25 year old female who presents to the emergency department via an ambulance after an intentional overdose. Ally reports she took #25, 50mg Benadryl & #10, 100mg Lithium tablets. She reports feeling lightheaded, nauseated and having a constant ringing in her ears. She is unaware of how long ago the overdose occurred. She stated she had text a friend prior to taking the pills and the next thing she remembers is waking up...