Mr. W Emergency Medical Services Case Study
Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages to Order 5-10 Pages
Mr. W Emergency Medical Services Case Study
Mr. W is an 83-year-old man who was brought to the hospital from a long-term care facility by emergency medical services after reporting severe dyspnea and shortness of breath. He has been experiencing cold like symptoms for the past 2 days. He has a productive cough with thick yellowish sputum.
When Mr. W awoke in the nursing home, it was found that he was having difficulty breathing even after using his albuterol metered-dose inhaler (MDI). He appears very anxious and is in respiratory distress. His history includes chronic obstructive pulmonary disease (COPD) related to smoking 2 packs of cigarettes per day since he was 15 years old; he quit smoking 2 years ago when he was admitted to the long-term facility. Mr. W has been in continent of urine and stool for the past 2 years.
In the emergency department, Mr. W undergoes chest radiography, and admission laboratory tests are performed, including serum electrolyte levels and a complete blood count. A sputum sample is sent to the laboratory for culture and sensitivity testing and Gram staining.
Mr. W’s vital sign values are as follows:
Blood pressure Heart rate O2 saturation Respiratory rate Temperature
154/92 mm Hg 118 beats/min 88% on 1 L/min oxygen by nasal cannula 38 breaths/min 100.9°F (38.3°C) (oral)
Mr. W’s ABG results include the following: pH, 7.37; arterial partial pressure of carbon dioxide (PaCO2), 55.4 mm Hg; arterial partial pressure of oxygen (PaO2), 51.2 mm Hg; bicarbonate (HCO3␣) level, 38 mEq/L (38 mmol/L).
Which priority actions will the nurse take when the patient is initially admitted to the emergency department (ED)? Select all that apply. 1. Place the patient on a cardiac monitor.
- Get a baseline set of vital signs. 3. Draw admission labs and place a saline lock. 4. Change the patient’s adult pad. 5. Send the patient for a chest x-ray. 6. Order the patient a lunch tray.
What is the priority nursing concern for this patient? 1. Skin care due to incontinence 2. Clearance of thick secretions 3. Rapid heart rate
- Elevated temperature Copyright © 2019, Elsevier Inc. All rights reserved.
The RN assesses Mr. W in the emergency department. Which assessment findings are consistent with a diag- nosis of COPD? Select all that apply. 1. Enlarged neck muscles
- Forward bent posture 3. Respiratory rate 15 to 25 breaths/min 4. Inspiratory and expiratory wheezes 5. Blue-tinged dusky appearance 6. Symmetrical lung expansion
The health care provider’s (HCP’s) prescribed actions for this patient include all of the following. Which inter- vention should the nurse complete first? 1. Send an arterial blood gas (ABG) sample to the
laboratory. 2. Schedule pulmonary function tests. 3. Repeat chest radiography each morning. 4. Administer albuterol via MDI 2 puffs every 4 hours.
What is the nurse’s interpretation of these results? 1. Compensated metabolic acidosis with hypoxemia 2. Compensated metabolic alkalosis with hypoxemia 3. Compensated respiratory acidosis with hypoxemia 4. Compensated respiratory alkalosis with hypoxemia
Based on the patient’s ABG results, what are the nurse’s priority actions at this time? Select all that apply. 1. Administer oxygen at 2 L/min via nasal cannula. 2. Initiate a rapid response.
- Teach the patient how to cough and deep breathe. 4. Begin IV normal saline at 100 mL/hr. 5. Arrange a transfer to the intensive care unit (ICU). 6. Remind the patient to practice incentive spirometry
every hour while awake
Which intervention would the RN assign to an experienced LPN/LVN? 1. Drawing a sample for ABG determination 2. Administering albuterol by hand-held nebulizer 3. Measuring vital signs every 2 hours
- Increasing oxygen delivery to 2 L/min via nasal cannula
Which interventions would the acute care RN dele- gate to an experienced unlicensed assistive personnel (UAP)? Select all that apply. 1. Changing the patient’s in continence padas needed 2. Performing pulse oximetry every shift
- Teaching the patient to cough and deep breathe 4. Reminding the patient to use incentives pirometry
every hour while awake 5. Assessing the patient’s breath sounds every shift 6. Encouraging the patient to drink adequate oral
Mr. W’s emergency department lab values include a serum potassium of 2.8 mg/dL (2.8 mmol/L). What is the priority nursing action at this time? 1. Teach the patient about potassium-rich foods.
- Provide the patient with oxygen at 2 L per nasal cannula.
- Contact and notify the HCP immediately. 4. Initiate 0.9% saline at 20 mL/hr.
Mr. WisreceivinganIVdoseofpotassium10mEq/ 100 mL (10 mmol/100 mL) normal saline to run over 1 hour. The UAP asks the nurse why it takes so long to infuse such a small amount of fluid. What should the nurse explain to the UAP? Select all that apply.
“IV potassium is very irritating to the veins and can cause phlebitis.”
- “Tissue damaged by potassium can become necrotic.”
- “Oral potassium can cause nausea, so IV potassium is preferred.”
- “The maximum recommended infusion rate for IV potassium is 5 to 10mEq/hr (5 to 10 mmol/hr).”
- “That’s a good question, and I will ask the HC Pif I can give the drug IV push.”
- “The goal is to prevent infiltration in to the tissue.”
During morning rounds, the nurse notes all of these assessment findings for Mr. W. Which finding indi- cates a worsening of the patient’s condition? 1. Barrel-shaped chest
- Clubbed fingers on both hands 3. Crackles bilaterally 4. Frequent productive cough
The nurse reports the morning assessment findings (see question 11) to the HCP. Which prescribed intervention is most directly related to the nurse’s assessment findings?
- Administer furosemide 20 mg IV push now. 2. Keep accurate records of intake and output. 3. Administer potassium 20 mEq (20 mmol) orally
every morning. 4. Weigh the patient every morning.
Which assessment finding would the nurse instruct the UAP to report immediately? 1. Incontinence of urine and stool 2. 1-lb (0.45-kg) weight loss since admission
- Patient cough productive of greenish-yellow sputum
- Eating only half of breakfast and lunch
The UAP checks morning vital signs and immediately reports the following values to the nurse. Which takes priority when notifying the HCP? 1. Heart rate of 96 beats/min
- Blood pressure of 160/90 mm Hg 3. Respiratory rate of 34 breaths/min 4. Oral temperature of 103.5°F (39.7°C)
An LPN/LVN tells the RN that the patient is now receiving oxygen at 2 L/min via nasal cannula and his pulse oximetry reading is now 91%, but he still has crackles in the bases of his lungs. What intervention should the RN assign to the LPN/LVN?
- Begin creating a plan for discharging the patient. 2. Administerfurosemide20mgorallyeachmorning. 3. Get a baseline weight for the patient now. 4. AdministercefotaximeIVpiggybackevery6hours.
The RN administers the patient’s first dose of IV cefotaxime. Within 15 minutes, Mr. W develops a rash with fever and chills. What is the nurse’s first action at this time?
- Discontinue the IV infusion. 2. Administer 2 tablets of acetaminophen. 3. Measure the area of the rash. 4. Check for numbness and tingling
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