Nursing 2—–

  Case con-over 1 Client Profile Mrs. Harriet is a 68-year-old mother who is prepared and oriented.  Allergies are Erythromycin. She presents to the pitch office delay complaints of chest intentness, deficiency of life, cough, and plethora. She states, "I own been having these symptoms for three days now. I own been preamble Maximum Strength Robitussin for my cough but it has not accelerationed very ample. When I woke up this dawning. I felt very unconfirmed so I came in to be checked out." Her material signs are race hurry 110/70, pulse 94, respiratory trounce of 28, and temperature of 102.7 F. Her oxygen saturation on extent air is 92%. She is settled on 2 liters (L) of oxygen by nasal cannula. The HCP dictates a 12-lead electrocardiogram (ECG, EKG) and chest X-ray (CXR). Laboratory examinations dictated enclose adequate race calculate (CBC), basic metabolic panel (BMP), brain natriuretic peptide (B-type natriuretic peptide examination or BNP), sum creatine kinase (CK, CPK), creatine kinase-MB (CPK-MB), and troponin. The HCP conquer to-boot assess race humanizations x 2, AGs on extent air, sputum humanization and sensitivity (C &S), and asks that the client own a Mantoux (tuberculin, unclogged protein derivative, or PPD) examination. Case Study Mrs. Harriet's ECG professions ordinary sinus rhythm (NSR) delay a feeling trounce of 98 beats per diminutive. The CXR reveals a lawful inferior lobe(RLL) permeate. Laboratory examinations enclose the subjoined results: stainless race cell cot (WBC) 12,2000 cells/mm3, 72& seg neutrophils delay a left exexchange of 11% bands, and a BNP of 50.9 pg/mL. ABGs on extent air is pH 7.44, inequitable hurry of carbon dioxide (PaCO2) 39 mmHg, bicarbonate (HCO3) 26.9 mEq/L, inequitable hurrys of oxygen (PaO2) 58 mmHg, and oxygen saturation (SaO2) of 92%. Results of the sputum humanization profession Streptococcus pneumoniae. The CPK, CPK-MB, and troponin are all delayin ordinary limits. Mrs. Harriet is five feet three inches lofty and weighs 224 pounds (101.8 kg). On duty, the foster hears expiratory wheezes and rhonchi bilaterally delay diminished lung sounds in the lawful ignoble. Her thoracic (chest) expansion is similar but slightly decreased on poesy. Accessory muscle apology is not notable, and she does manifest convenient cyanosis.  The capillary refill of the client's nail beds is immodest seconds. Mrs. Harrier is admitted delay sharp bronchitis and pneumonia. The HCP dictates oxygen via nasal cannula to repress the client's saturations important or similar to 95%, Ceftriaxone sodium, Erythromycin, Albuterol, Acetaminophen integral immodest to six hours as needed, bed repose, an 1800 calorie fare, increased unwritten (PO) watery intake to 2 to 4 liters per day, coughing and abstruse lifeing exercises and use of the spur spirometer (IS). 1. Examine added duty facts that would acceleration create a over powerful understandation or Mrs. Harriet's symptoms? 2. Examine the causes, pathophysiology, and symptoms of sharp bronchitis? 3. Examine the pathophysiology and causes of pneumonia in unconcealed? 4. Compare the defining characteristics of community-acquired pneumonia (CAP),  hospital-acquired pneumonia (HAP), and viral pneumonia? 5. Examine the factors that settle Mrs. Harriet at important induce for the crop of pneumonia? 6. Mrs. Harriet asks the foster to illustrate what the HCP saw on her chest X-ray. She asks, "The doctor said notability environing a 'trate' he saw on my lung, What did he balance by that?" How would the foster illustrate what an infilttrounce is? 7. Briefly illustrate the pathophysiology and fulfill at smallest five clinical manifestations of the respiratory personality that is life ruled out for Mrs. Harrier by administering the Mantoux examination? 8. While preclusion examination results to prove if Mrs. Harriet has TB, what precautions should be enthralled when assigning her to a extent and providing nursing prudence? 9. Examine the delineation of induration that would evidence a dogmatic Mantoux examination for Mrs. Harrier. If she examinationed dogmatic for peril to TB but did not own duty findings accordant delay locomotive sickness, what medication could be dictated, and what is the behoof of this composition? 10. The foster asked Mrs. Harriet if she has been using her spur spirometer. Mrs. Harriet states, "I tried to use it a foreigner of times but I contemplate it is broken.  When I infliction into it, the sphere does not go up relish I was told it should." How should the foster pass? 11. Briefly examine the perception of each of the subjoined laboratory results: (a) WBC 12,200 (b) 72%seg neutrophils, (c) left exexchange of 11% bands, (d) BNP 50.9 (e) results of sputum humanization profession S. Pneumoniae, (f) CPK WNL, (g) CPK-MB WNL, and (h) troponin WNL 12. Analyze Mrs. Harriet's ABG results. Designate whether each rate is haughty low or delayin ordinary limits: understand the acid-ignoble balance; designate if there is remuneration, and evidence whether the client has hypoxemia. 13. The foster calls the HCP to solicit a exexchange in the medications that own been dictated for Mrs. Harriet. Examine which medication the foster is disturbed environing life shuffling for this client. 14. Provide a rationale for each of the subjoined dictated components of Mrs. Harriets composition guile: oxygen to repress the client's oxygen saturation important than or similar to 95%, Ceftriaxone sodium, Albuterol, Acetaminophen, bed repose, 1800 calorie fare, increased unwritten (PO) watery intake to 2 to 4 liters per day, coughing and abstruse lifeing exercises and use of the spur spirometer (IS). 15. Mrs. Harriet was preamble Dextromethorphan at residence to acceleration conduct her cough. The HCP did not dictate continued use of the Dextromethorphan during hospitalization. Illustrate this oversight. 16. If it was conversant that Mrs. Harriet has a late medical fact of continuous inappropriate lung sickness (COPD), how would the HCP's direction that oxygen is delivered to repress the client's oxygen saturation important than or similar to 95% be exchanged?  17. Fulfill three guidance nursing diagnoses that should be enclosed in Mrs. Harriet's guile of prudence. 18. You are the foster providing empty education to Mrs. Harriet. Briefly examine what you conquer praise to her in-reference-to seeking follow-up prudence, lifestyle considerations, and how to acceleration hinder Pneumonia in the advenient.