Question

Scenario

John Doe has entered the ED complaining of:

• Dizziness
• Weakness
• SOB on exertion
• Loss of appetite

1.Complete a head to toe assessment

2.What questions would you ask John Doe

3.From the lab results what treatments would the physician order?

4.What education would you provide to John Doe?

5.Explain what these tests are and what the abnormal values mean and what would be your nursing management?

• WBC
• RBC
• HGB
• HCT
• Platelet Count

Answer 1

The signs and symbols of Mr. John Doe show he is having COPD.

1. Head to toe examination( physical examination):-

• Height
• Weight
• BMI
• Temperature
• Pulse
• Respiratory rate
• SpO2
• Bp
• Assess the finger and hand for cyanosis and clubbing
• Assess the leg and feet for edema.

These are the main thing to be assessed.

2. The questions to be asked to Mr. John Doe.

√ History related to disease condition

*Shortness of breaths:-

• How often you gets shortness of breath
• How long it lasts for
• Distance you can walk the maximum

* Cough

• How often
• When
• How long
• Is it getting worst
• Present of sputum while coughing
• Colour of sputum if
• Have you ever feel the presence of blood which coughing

√Family history

• An of your family members had suffered or is suffering from any lung diseases.

√ Social history

• Is there any history of usage of tobacco or its products been in your family ( specially cigarette)

3. The physician will order of a iron tables or any other iron supplements. COPD patients may suffer from anemia. Thus it is mandatory to have iron tables.

4. Educating the patient is very important.

• General measure

~ It is very important to quit smoking as smoking can create more complication associated with COPD

~ There are many inhaler techniques. One of them is nebulization.

~ Pulmonary rehabilitation is a program conducted to control or reduce the signs and symptoms.

~ Prevention and treatment information.

Every patient have right to know about the treatment plan. So the nurse should explain it and how to prevent it.

~ Nutrition.

Nutrition is necessary as COPD can cause anemia. By taking nutrition rich diet can reduce the effect of anemia.

~ Regular check ups or follow up to be done.

• Assess the diseases severity.

It is mandatory to have a follow up care even if it is cured.

• Medicine

~ bronchodilators

Are used to treat shortness of breath. It helps in dilating our bronchiolis.

~ glucocorticoid

It is used to treat the inflammation of lung tissue. This is a steroid.

~ No cough syrup are used to treat this condition.

• Supplemental therapy

~ administration of oxygen and surgery are the 2 supplemental therapy.

5. The test recommended are

• WBC

WBC is tested to find white blood cell count. This is done because when Hb is low there are chances to reduce WBC. WBC acts as a protector for the body to fight from infection. In COPD WBC can also be on the lower side. Encourage the patient to stay away from infection.

WBC above 11000 and below 4000.

• RBC

Red blood cell count is an investigation performaned to find out whether he is suffering from anemia. RBC contain hemoglobin.

For men 4.5 to 5.9 × microlitre

For women 4.5 to 5.9 × liter

More or less than these values are abnormal.

Encourage the patient to have more leafy vegetables.

• HGB

Hemoglobin is a specific thing that is inside RBC. It helps to carry oxygen to each part of the body. Hemoglobin level indicates the level of anemia. If HGB is low can cause continues bleeding and it high can cause heart attack.

Men 13.5 to 17.5 and women 12 to 15.5 are the normal value

Encourage the patient to take diet rich in iron.

• Platelets count.

It is analysed to find the level of platelet. More than 450000 is called as thrombocytosis and less than 150000 is called thrombocytopenia.