Question

You are admitting a 73-year-old patient to your med/surg unit. Her son brought her to the Emergency Department for worsening shortness of breath and a productive cough over the past two days. When getting report from the ED nurse, this is what they tell you:

Vitals: 128/79, HR 67, RR 26, SpO2 90% on 2L NC (her baseline), 99.9°F orally.

Chest Imaging: Infiltrates in the left mid & lower lobes, no cardiomegaly.

Exam: Patient’s son reports his mom seems a bit more confused than normal. She is pretty lethargic but arouses when asked questions. Respirations are labored with use of accessory muscles. Crackles auscultated in left lung fields. Cough is producing thick, yellow/green sputum. Normal heart tones.

Answer the following questions regarding the case study:

1. What admission orders from the physician would you anticipate?

2. What would be most important to obtain before starting any medications?

3. Why do you think she is lethargic?

4. At this point in her illness, do you think oxygenation with a nasal cannula will help her respiratory status?

5. What changes in her vital signs would you watch for that would indicate she is becoming septic?

Answer 1

The above statement shows that a 73 year old patient is sufering with accute bronchitis and the answers as follos

1. I pridict - Physician may presribe these orders

a). Antibiotics: These are effective for bacterial infection but not for viral infections. They may also prevent secondary infection

b). Cough medicine: One nust be carefull not to completely suppress the cough for it is an important way to bringh up mucus and remove irritantss from the lungs

c). Bronchodilators: These open the bronchial tubes and clear out mucus

d). Mucolytics : These helps in thin or loosen the mucus in the airways making it easier to cough up sputum

e). Anti inflamatory medicines and glucocorticoid steroids: These are for more persistent symptoms

f). Pulmonary rehabilation program: this includes work with a respiratory therapist to help breathing

2. Before starting medication we must know regarding

- name of the medicine, uses, dosage, route of administration and side effects

- We must know about alternatives of medicines if it is not suitable for the client

- We must know about the complications of drugs and nurses responsibilties

3. Accute bronchitis can make her very tired for two reasons

Firstly the persistant cough disturb her sleep making her feel tired and exausted this problem can effect those with accute and chronic bronchitis

and secondly accute brochitis is caused by an infection as opposec to an irritant she can feel more tired as her body uses its energy to fight of the infection and recover

lethargy only usually lasts while her body recovers which can be from a few days to several weeks at the most

If lethargy continues after all symptoms have cleaed it is important to consult doctor as it may be a sign of another medical consition or a secondary infection.

4. If she feels difficulty in breating along with decreased O2 saturation, must administer oxygen by canula according to the O2 saturation

5. Vital changes are most frequently related to hypoxemia for which the body tries to compansate by increasing cardiac output thus heart rate and blood pressure are usualy increased. Respiraratory rate, when stable show a rate with a prolonged expiratory phase or will increase as a result of hypoxemia and hypercpnia when in accute failure.

all these these changes may results infection and inflamation og bronchi.