Discuss what you would teach a patient receiving treatment for hypertension and the importance of continuing to take prescribed drugs.

Discussion 1.1 – Case
Study One
A 39 year-old woman is brought to the emergency department
by her husband. She is conscious but
confused and keeps repeating that her head hurts so much she feels it might
explode. The husband tells you that
she has no health problems and takes no medications other than aspirin for
occasional pain. He also tells you that
she entered a contest earlier today to try and drink the most water in 1 hour.
She drank 10 glasses but did not win the contest and came home. Her confusion and headache started about an
hour later.
What type of fluid or electrolyte imbalance is she likely to
have and from what cause? Explain your answer.
What physical assessment data are the priority to
obtain? Explain.
What laboratory data would you expect to be ordered?
Is this patient at risk for heart failure or pulmonary
edema? Why or why not?
For details regarding grading criteria and posting
requirements, please see the grading rubric. Contact your instructor if you
have issues or concerns.
Discussion 1.2 – Case
Study Two
The patient is a 29 year old woman admitted 20 hours ago for
an acute exacerbation of Crohns disease with intense abdominal pain. She is NPO and receiving normal saline
intravenously at 175 mL per minute. She
was last given hydromorphone (Dilaudid) 4 mg IV 30 minutes ago. Because she did have an episode of
hypotension earlier after Dilaudid, you now take her vital signs. On inflating
the blood pressure cuff, she develops palmar flexion. The flexion remains after the cuff is
deflated.
What is most likely the cause of this problem?
What electrolytes are most likely to be out of balance and
why?
What is your best first action?Should the Rapid Response
Team be called? Why or why not?
What additional assessment data are most important to collect? Explain your answer.
For details regarding grading criteria and posting
requirements, please see the grading rubric. Contact your instructor if you
have issues or concerns.

Discussion 2.1 – Case
Study One
The patient is a 21 year old college student brought to the
emergency department by his friends when he was found unconscious during a
fraternity party. He was seen drinking
heavily at the party and had not eaten for 2 days before the event. He takes no prescription drugs, and his
current vital signs are T = 97.8, P = 48, slightly irregular and thread; R =
28, deep and regular; B/P = 88/50; His arterial blood gas results are pH =
7.31, HCO 3 = 25 mEq/L; PaCo2= 28 mm Hg; PaO2 = 99 mm Hg.
What specific type of acid-base problem does this patient
have? Explain.
What is the most probable origin of the acid-base imbalance?
Should oxygen be applied?
Why or why not?
What nursing interventions for safety are most appropriate
for this patient?
What additional laboratory and assessment data should be
performed? Provide a rationale for your
answer.
For details regarding grading criteria and posting
requirements, please see the grading rubric. Contact your instructor if you
have issues or concerns.

Discussion 3.1 – Case
Study One Options Menu: Forum
At the start of the shift, you are assessing an 86 year old
patient who is awaiting surgery for a hip repair after a fall 12 hours ago at
home. You are collecting a clean-catch
urine specimen, using a bedpan, as part of the preoperative preparation. You observe that when she voids, the urine
odor is foul and the urine is cloudy and full of sediment. She reports some urgency but notes that she
had urgency before her fall.
What assessment information will you document in the chart?
What additional information should you ask the patient and
what else should you consider?
Organize your thoughts into a SBAR communication.
Who should you notify and why?
For details regarding grading criteria and posting requirements,
please see the grading rubric. Contact your instructor if you have issues or
concerns.
Discussion 3.2 – Case
Study Two
The patient is a 52-year old perimenopausal woman who
reports a small loss of urine with coughing, laughing, and occasionally bending
over. Recently she has started to leak
urine just as she arrives in the bathroom but before she sits on the
toilet. She stated her mother has had a
continuing problem with incontinence for years and seldom leaves her home. The patient wants to continue to lead an
active lifestyle and wants to discuss options for preventing progression of
this embarrassing condition.
What other information should you obtain from this patient?
What type or types of incontinence is she most likely to
have from the information she has provided thus far?
Is this problem likely to be genetic? Why or why not?
What will you tell her regarding options for care?
She asks if there is anything she can do now to help reduce
her urine leakage. How do you respond?
For details regarding grading criteria and posting
requirements, please see the grading rubric. Contact your instructor if you
have issues or concerns.

Discussion 4.1 – Case
Study One
The 56 year old African-American woman is admitted for
treatment of newly diagnosed renal cell carcinoma. You find her daughter in the hallway
crying. She has heard that her mother
has undergone genetic testing related to her cancer diagnosis and wonders if
she is at increased risk for the same condition. She was with her mother during the renal scan
before admission and is also worried that this exposure to a radioactive
isotope will cause cancer in her.
Is renal cell carcinoma commonly inherited, and why is
genetic testing done?
Do renal scan radioisotopes require radiation
precautions? Why or why not?
What risk factors are associated with renal cell carcinoma?
How can you evaluate whether your information was understood
by the daughter and if follow-up is needed?

Discussion 4.2 – Case
Study Two
At the start of the shift, you are assessing an 86 year old
patient who is awaiting surgery for a hip repair after a fall 12 hours ago at
home. You are collecting a clean catch
urine specimen, using a bedpan, as part of the preoperative preparation. You
observe that when she voids, the urine odor is foul and the urine is cloudy and
full of sediment. She reports some
urgency but notes that she had urgency before her fall.
What assessment information will you document in the chart?
What additional information should you ask the patient and
what else should you consider?
Organize your thoughts into SBAR communication
Who should you notify and why?

Discussion 5.1 – Case
Study One
The patient just completed a vascular mapping procedure
with an angiogram to plan the site of an AV fistula for hemodialysis. You are
considering the care priorities for the patients return when the AV fistula is
formed.
What are important teaching points for the period
immediately following AV fistula formation?
The patient asks if there is anything she can do to make
this AV fistula last a long time. How should you respond to promote best
practices in AV fistula self-management?
What else should this patient know about AV fistula care?

Discussion 6.1 – Case
Study One
The patient is a 68 year old man who has had shortness of
breath for the past 2 to 3 days. His past medical history includes a 40 years
of smoking a pack as day history, COPD, and heart failure. He reports that he
became concerned when he woke from sleep because he could not breathe. Your
physical assessment reveals crackles in the lower lobes bilaterally. His oxygen
saturation is 84% without supplement oxygen.
What are some areas of focus to assess as part of this
patients current history?
Whom should you contact and why?
What are some factors that may affect gas exchange for this
patient?
What additional referrals might be appropriate for this
patient?
Discussion 6.2 – Case
Study Two
Your patient is the 68 year old man from the previous
challenge who had shortness of breath for the past 2 to 3 days. His clinical
condition deteriorated further, requiring intubation. The health care provider
orders a CT scan of the chest.
What are responsivities when preparing the patient for the
CT scan?
Why is it important to monitor your patient using
capnography?
A large fluid collection on the left side is found during
the CT scan and a thoracentesis is planned. What are your responsibilities in
preparing for and assisting with this procedure?
Your patient was extubated after the left thoracentesis.
Withing 12 hours he again develops respiratory distress, decreased breath
sounds and a trachea that appears deviated to the right. What is your
assessment?
Discussion 6.3 – Case
Study Three
Your patient is a 41 year old woman with a significant closed
head injury CHI from a motor vehicle crash MVC. She is not anticipated to be
able to be weaned from the ventilator, and the physicians have asked the
patients family for permission to create a tracheostomy. The family is
concerned that the patient will not be able to speak again.
What is your response?
What are some possible concerns for patient care in the
immediate postoperative period?
What can you do to minimize tracheal damage?
The patients family is concerned that the tracheostomy will
be permanent and they are worried about her image. How do you respond?

Discussion 7.1 – Case
Study One
A patient who had a supraglottic partial laryngectomy with a
right sided radical neck dissection 4 weeks ago is now receiving radiation
therapy. He has lost 24 pounds since his surgery, which makes him 15 pounds
less than his ideal weight. He tells you that he has no appetite and that what
food he does eat has no taste. In addition although he expresses that he is
glad to be alive he does not want friends to visit because it takes so much
energy to interact with them. He also says that he can no longer play the piano
because of difficulty moving his right arm and shoulder.
What factors are contributing to his fatigue?
Is the weight loss a concern? If so, what should you do
about it?
Should you further press the issue of not wanting to visit
with friends? Why or why not?
What other health care professionals or resources would be
appropriate at this time?
Discussion 7.2 – Case
Study Two
The patient is a 64 year old man with COPD who lives with
his wife of 35 years. He retired 2 years ago when his disease interfered with
his job as a carpenter. He also quit smoking about a year ago. Since then, his
disease has remained stable; however, he now reports that he thinks his wife is
preparing for widowhood by taking over all the home chores that he always
performed including driving and bill paying. Limiting his interaction with
friends, and making all decisions. He is angry and depressed. Routine
assessment with pulmonary function testing show his FEV to be 40% of his
predicted value, which is an improvement over the 32% value of FEV last year.
What severity classification is his COPD? Provide a
rationale for your choice.
How should you respond to his statement about the wife probably
preparing for widowhood?
Should he continue to drive and pay bills? Why or why not?
What psychosocial assessment of this patient and his
situation should you make?
Should you include the wife in any part of this discussion?
Why or why not?
Discussion 7.3 – Case
Study Three
The patient is a 60 year old man who has just been diagnosed
with non-small cell lung cancer. He smoked cigarettes for about 25 years
starting when he was 16 years old and quit when he was 41 years old. His lung
cancer is at stage I in the left lower lobe. He is distraught, saying that he
cant die now because he has one child in college and two in high school. He
also fears chemotherapy and seems bitter that he quit smoking and got lung
cancer anyway. His next statement is; Why couldnt I get prostate cancer like
most men? At least they survive. No one beats lung cancer.
What can you tell him about lung cancer survival?
What can you tell him about the benefits of having quit
smoking?
For this cancer stage and type, what is/are the most likely
therapy/therapies?
What resources could you recommend to help him at this time?

Discussion 8.1 – Case
Study One
The nurse is caring for a frail, older patient in the
hospital after surgery to repair a bowel obstruction. The patient has a
nasogastric NG tube, through which all her scheduled drugs are given, oxygen at
1 liter/nasal cannula at night, an indwelling urinary caterer, and a saline
lock. The patient is weak and fatigued, has pain not relieved by IV opioids,
and is reluctant to participate in any activities.
What risk factors does this patient have for developing
pneumonia?
What actions does the nurse take to decrease the patients
risk for pneumonia?
Two days later, the NG tube is removed and the patient is
started on ice chips and other clear liquids. The patient swallows repeatedly
when given sips of water. What action does the nurse perform?
The nurse does hourly rounds on the patient, and the
patients daughter states, Something is just not right with mom What action
should the nurse take first? What other actions should the nurse perform?
The physician orders a chest x-ray, and the results show
pneumonia. What actions by the nurse are most important?
Discussion 8.2 – Case
Study Two
A 50 year old patient is admitted to the medical-surgical
floor from the emergency department with severe abdominal pain thought to be
from acute pancreatitis. He case a history of drinking at least a case of beer
a day. He also smokes and appears cachectic. His old chart indicates a history
of COPD, but he does not take drugs for this. He does have a new productive
cough. At chage of shift, the nurse finds the patient dyspneic and slight
confused. Lung sounds have wheezes, and he is mildly febrile. Pulse is 120
beats per minute, respirations are 32 breaths per minute, and blood pressure is
118/64. Oximetry shows a SpO2 of 91%.
What risk factors for ARDS does this patient have?
Explain the relationship between the lung sounds and the
oximetry reading
What diagnostic testing should you be prepared to obtain?
Two hours after applying oxygen at 3 liters/nasal cannula, the patients Spo2
is now 89%4. What additional measures do you anticipate for this patient?

Discussion 9.1 – Case
Study One
A 72 year old woman is transported to the ED with a
diagnosis of chest pain to rule out myocardial infarction MI. During the
initial assessment the nurse notes the cardiac rhythm changes from sinus
tachycardia to ventricular tachycardia VT with a pulse. Her vital signs are 84/40,
pulse 154 and respirations 30.
What is the initial treatment for this patient at this time?
What drugs should you anticipate administering to this
patient? Why are they indicated?
What evidence-based precautions must be taken to promote
safety for both the patient and the ACLS team?
If this rhythm deteriorates to ventricular fibrillation or
VT without a pulse, what steps should you take? Why?
Discussion 9.2 – Case
Study Two
At a recent staff meeting, the medical-surgical nurse
manager reports that the rate of repeated hospitalizations for patients with
chronic heart failure has increased 50% in the past 3 months. As a staff nurse
you agree to be part of the unit quality improvement team to examine the causes
of the increase and make evidence-based recommendations for improving the
outcomes for this patient population. Specific patient data and summaries are
available for the team to review as needed.
Where will your team begin with this process during the
first meeting of the team?
What internet sites will your team use to determine best
practices for decreasing repeated hospital stays and why?
How will you know if the plan of action to improve care was
effective?
See Chapter 5 for assistance for answering above questions.

Discussion 10.1 –
Case Study One
Discuss what you would teach a patient receiving treatment
for hypertension and the importance of continuing to take prescribed drugs.
What signs and symptoms do promptly need to report to the health care provider?
Discussion 10.2 –
Case Study Two
Your patient is a 40 year old woman who is returned to your
ambulatory care unit after having a cholecystectomy performed as minimally
invasive surgery by laparoscopy. After moving her from the stretcher to her
bed, you take her VS pulse is 118 and therady, blood pressure is 88/72
respiratory rate is 28 and pulse oximetry is 88%. When you call her name she
opens her eyes but does not answer any questions.
What should you do first?
What manifestations of shock are present based on the
information you currently have?3. How would you classify this stage of shock?
Provide a rationale for your evaluation.
What other assessment data should you obtain?
Given the type of surgery she has undergone, where would you
expect bleeding to occur and what manifestations would indicate possible
bleeding?
Discussion 10.3 –
Case Study Three
An 82 year old man living alone at home had a sudden onset
of chest pain. He called 911 and was taken to the emergency department.
As his ED nurse what is your first action in response to his
report of chest pain?
The physician prescribes IV nitroglycerin for the pain. What
assessment will you perform prior to administering this drug and why?
The physician prescribed oxygen at 3L via nasal cannula.
What is the purpose of this intervention for managing chest pain?
Discussion 1.1 – Case
Study OneA 39 year-old woman is brought to the emergency department
by her husband. She is conscious but
confused and keeps repeating that her head hurts so much she feels it might
explode. The husband tells you that
she has no health problems and takes no medications other than aspirin for
occasional pain. He also tells you that
she entered a contest earlier today to try and drink the most water in 1 hour.
She drank 10 glasses but did not win the contest and came home. Her confusion and headache started about an
hour later.What type of fluid or electrolyte imbalance is she likely to
have and from what cause? Explain your answer. What physical assessment data are the priority to
obtain? Explain.What laboratory data would you expect to be ordered?Is this patient at risk for heart failure or pulmonary
edema? Why or why not?For details regarding grading criteria and posting
requirements, please see the grading rubric. Contact your instructor if you
have issues or concerns.Discussion 1.2 – Case
Study TwoThe patient is a 29 year old woman admitted 20 hours ago for
an acute exacerbation of Crohns disease with intense abdominal pain. She is NPO and receiving normal saline
intravenously at 175 mL per minute. She
was last given hydromorphone (Dilaudid) 4 mg IV 30 minutes ago. Because she did have an episode of
hypotension earlier after Dilaudid, you now take her vital signs. On inflating
the blood pressure cuff, she develops palmar flexion. The flexion remains after the cuff is
deflated.What is most likely the cause of this problem?What electrolytes are most likely to be out of balance and
why?What is your best first action?Should the Rapid Response
Team be called? Why or why not?What additional assessment data are most important to collect? Explain your answer.For details regarding grading criteria and posting
requirements, please see the grading rubric. Contact your instructor if you
have issues or concerns.Discussion 2.1 – Case
Study OneThe patient is a 21 year old college student brought to the
emergency department by his friends when he was found unconscious during a
fraternity party. He was seen drinking
heavily at the party and had not eaten for 2 days before the event. He takes no prescription drugs, and his
current vital signs are T = 97.8, P = 48, slightly irregular and thread; R =
28, deep and regular; B/P = 88/50; His arterial blood gas results are pH =
7.31, HCO 3 = 25 mEq/L; PaCo2= 28 mm Hg; PaO2 = 99 mm Hg.What specific type of acid-base problem does this patient
have? Explain.What is the most probable origin of the acid-base imbalance?Should oxygen be applied?
Why or why not?What nursing interventions for safety are most appropriate
for this patient?What additional laboratory and assessment data should be
performed? Provide a rationale for your
answer.For details regarding grading criteria and posting
requirements, please see the grading rubric. Contact your instructor if you
have issues or concerns.Discussion 3.1 – Case
Study One Options Menu: Forum At the start of the shift, you are assessing an 86 year old
patient who is awaiting surgery for a hip repair after a fall 12 hours ago at
home. You are collecting a clean-catch
urine specimen, using a bedpan, as part of the preoperative preparation. You observe that when she voids, the urine
odor is foul and the urine is cloudy and full of sediment. She reports some urgency but notes that she
had urgency before her fall.What assessment information will you document in the chart?What additional information should you ask the patient and
what else should you consider?Organize your thoughts into a SBAR communication.Who should you notify and why?For details regarding grading criteria and posting requirements,
please see the grading rubric. Contact your instructor if you have issues or
concerns.Discussion 3.2 – Case
Study TwoThe patient is a 52-year old perimenopausal woman who
reports a small loss of urine with coughing, laughing, and occasionally bending
over. Recently she has started to leak
urine just as she arrives in the bathroom but before she sits on the
toilet. She stated her mother has had a
continuing problem with incontinence for years and seldom leaves her home. The patient wants to continue to lead an
active lifestyle and wants to discuss options for preventing progression of
this embarrassing condition.What other information should you obtain from this patient?What type or types of incontinence is she most likely to
have from the information she has provided thus far?Is this problem likely to be genetic? Why or why not?What will you tell her regarding options for care?She asks if there is anything she can do now to help reduce
her urine leakage. How do you respond?For details regarding grading criteria and posting
requirements, please see the grading rubric. Contact your instructor if you
have issues or concerns.Discussion 4.1 – Case
Study OneThe 56 year old African-American woman is admitted for
treatment of newly diagnosed renal cell carcinoma. You find her daughter in the hallway
crying. She has heard that her mother
has undergone genetic testing related to her cancer diagnosis and wonders if
she is at increased risk for the same condition. She was with her mother during the renal scan
before admission and is also worried that this exposure to a radioactive
isotope will cause cancer in her.Is renal cell carcinoma commonly inherited, and why is
genetic testing done?Do renal scan radioisotopes require radiation
precautions? Why or why not?What risk factors are associated with renal cell carcinoma?How can you evaluate whether your information was understood
by the daughter and if follow-up is needed?Discussion 4.2 – Case
Study TwoAt the start of the shift, you are assessing an 86 year old
patient who is awaiting surgery for a hip repair after a fall 12 hours ago at
home. You are collecting a clean catch
urine specimen, using a bedpan, as part of the preoperative preparation. You
observe that when she voids, the urine odor is foul and the urine is cloudy and
full of sediment. She reports some
urgency but notes that she had urgency before her fall.What assessment information will you document in the chart?What additional information should you ask the patient and
what else should you consider?Organize your thoughts into SBAR communicationWho should you notify and why?Discussion 5.1 – Case
Study OneThe patient just completed a vascular mapping procedure
with an angiogram to plan the site of an AV fistula for hemodialysis. You are
considering the care priorities for the patients return when the AV fistula is
formed.What are important teaching points for the period
immediately following AV fistula formation?The patient asks if there is anything she can do to make
this AV fistula last a long time. How should you respond to promote best
practices in AV fistula self-management?What else should this patient know about AV fistula care?Discussion 6.1 – Case
Study OneThe patient is a 68 year old man who has had shortness of
breath for the past 2 to 3 days. His past medical history includes a 40 years
of smoking a pack as day history, COPD, and heart failure. He reports that he
became concerned when he woke from sleep because he could not breathe. Your
physical assessment reveals crackles in the lower lobes bilaterally. His oxygen
saturation is 84% without supplement oxygen.What are some areas of focus to assess as part of this
patients current history?Whom should you contact and why?What are some factors that may affect gas exchange for this
patient?What additional referrals might be appropriate for this
patient?Discussion 6.2 – Case
Study TwoYour patient is the 68 year old man from the previous
challenge who had shortness of breath for the past 2 to 3 days. His clinical
condition deteriorated further, requiring intubation. The health care provider
orders a CT scan of the chest.What are responsivities when preparing the patient for the
CT scan?Why is it important to monitor your patient using
capnography?A large fluid collection on the left side is found during
the CT scan and a thoracentesis is planned. What are your responsibilities in
preparing for and assisting with this procedure?Your patient was extubated after the left thoracentesis.
Withing 12 hours he again develops respiratory distress, decreased breath
sounds and a trachea that appears deviated to the right. What is your
assessment?Discussion 6.3 – Case
Study ThreeYour patient is a 41 year old woman with a significant closed
head injury CHI from a motor vehicle crash MVC. She is not anticipated to be
able to be weaned from the ventilator, and the physicians have asked the
patients family for permission to create a tracheostomy. The family is
concerned that the patient will not be able to speak again.What is your response?What are some possible concerns for patient care in the
immediate postoperative period?What can you do to minimize tracheal damage?The patients family is concerned that the tracheostomy will
be permanent and they are worried about her image. How do you respond?Discussion 7.1 – Case
Study OneA patient who had a supraglottic partial laryngectomy with a
right sided radical neck dissection 4 weeks ago is now receiving radiation
therapy. He has lost 24 pounds since his surgery, which makes him 15 pounds
less than his ideal weight. He tells you that he has no appetite and that what
food he does eat has no taste. In addition although he expresses that he is
glad to be alive he does not want friends to visit because it takes so much
energy to interact with them. He also says that he can no longer play the piano
because of difficulty moving his right arm and shoulder.What factors are contributing to his fatigue?Is the weight loss a concern? If so, what should you do
about it?Should you further press the issue of not wanting to visit
with friends? Why or why not?What other health care professionals or resources would be
appropriate at this time?Discussion 7.2 – Case
Study TwoThe patient is a 64 year old man with COPD who lives with
his wife of 35 years. He retired 2 years ago when his disease interfered with
his job as a carpenter. He also quit smoking about a year ago. Since then, his
disease has remained stable; however, he now reports that he thinks his wife is
preparing for widowhood by taking over all the home chores that he always
performed including driving and bill paying. Limiting his interaction with
friends, and making all decisions. He is angry and depressed. Routine
assessment with pulmonary function testing show his FEV to be 40% of his
predicted value, which is an improvement over the 32% value of FEV last year.What severity classification is his COPD? Provide a
rationale for your choice.How should you respond to his statement about the wife probably
preparing for widowhood?Should he continue to drive and pay bills? Why or why not?What psychosocial assessment of this patient and his
situation should you make?Should you include the wife in any part of this discussion?
Why or why not?Discussion 7.3 – Case
Study ThreeThe patient is a 60 year old man who has just been diagnosed
with non-small cell lung cancer. He smoked cigarettes for about 25 years
starting when he was 16 years old and quit when he was 41 years old. His lung
cancer is at stage I in the left lower lobe. He is distraught, saying that he
cant die now because he has one child in college and two in high school. He
also fears chemotherapy and seems bitter that he quit smoking and got lung
cancer anyway. His next statement is; Why couldnt I get prostate cancer like
most men? At least they survive. No one beats lung cancer.What can you tell him about lung cancer survival?What can you tell him about the benefits of having quit
smoking?For this cancer stage and type, what is/are the most likely
therapy/therapies?What resources could you recommend to help him at this time?Discussion 8.1 – Case
Study OneThe nurse is caring for a frail, older patient in the
hospital after surgery to repair a bowel obstruction. The patient has a
nasogastric NG tube, through which all her scheduled drugs are given, oxygen at
1 liter/nasal cannula at night, an indwelling urinary caterer, and a saline
lock. The patient is weak and fatigued, has pain not relieved by IV opioids,
and is reluctant to participate in any activities.What risk factors does this patient have for developing
pneumonia?What actions does the nurse take to decrease the patients
risk for pneumonia?Two days later, the NG tube is removed and the patient is
started on ice chips and other clear liquids. The patient swallows repeatedly
when given sips of water. What action does the nurse perform?The nurse does hourly rounds on the patient, and the
patients daughter states, Something is just not right with mom What action
should the nurse take first? What other actions should the nurse perform?The physician orders a chest x-ray, and the results show
pneumonia. What actions by the nurse are most important?Discussion 8.2 – Case
Study TwoA 50 year old patient is admitted to the medical-surgical
floor from the emergency department with severe abdominal pain thought to be
from acute pancreatitis. He case a history of drinking at least a case of beer
a day. He also smokes and appears cachectic. His old chart indicates a history
of COPD, but he does not take drugs for this. He does have a new productive
cough. At chage of shift, the nurse finds the patient dyspneic and slight
confused. Lung sounds have wheezes, and he is mildly febrile. Pulse is 120
beats per minute, respirations are 32 breaths per minute, and blood pressure is
118/64. Oximetry shows a SpO2 of 91%.What risk factors for ARDS does this patient have?Explain the relationship between the lung sounds and the
oximetry readingWhat diagnostic testing should you be prepared to obtain?
Two hours after applying oxygen at 3 liters/nasal cannula, the patients Spo2
is now 89%4. What additional measures do you anticipate for this patient?Discussion 9.1 – Case
Study OneA 72 year old woman is transported to the ED with a
diagnosis of chest pain to rule out myocardial infarction MI. During the
initial assessment the nurse notes the cardiac rhythm changes from sinus
tachycardia to ventricular tachycardia VT with a pulse. Her vital signs are 84/40,
pulse 154 and respirations 30.What is the initial treatment for this patient at this time?What drugs should you anticipate administering to this
patient? Why are they indicated?What evidence-based precautions must be taken to promote
safety for both the patient and the ACLS team?If this rhythm deteriorates to ventricular fibrillation or
VT without a pulse, what steps should you take? Why?Discussion 9.2 – Case
Study TwoAt a recent staff meeting, the medical-surgical nurse
manager reports that the rate of repeated hospitalizations for patients with
chronic heart failure has increased 50% in the past 3 months. As a staff nurse
you agree to be part of the unit quality improvement team to examine the causes
of the increase and make evidence-based recommendations for improving the
outcomes for this patient population. Specific patient data and summaries are
available for the team to review as needed.Where will your team begin with this process during the
first meeting of the team?What internet sites will your team use to determine best
practices for decreasing repeated hospital stays and why?How will you know if the plan of action to improve care was
effective?See Chapter 5 for assistance for answering above questions.Discussion 10.1 –
Case Study One Discuss what you would teach a patient receiving treatment
for hypertension and the importance of continuing to take prescribed drugs.
What signs and symptoms do promptly need to report to the health care provider?Discussion 10.2 –
Case Study TwoYour patient is a 40 year old woman who is returned to your
ambulatory care unit after having a cholecystectomy performed as minimally
invasive surgery by laparoscopy. After moving her from the stretcher to her
bed, you take her VS pulse is 118 and therady, blood pressure is 88/72
respiratory rate is 28 and pulse oximetry is 88%. When you call her name she
opens her eyes but does not answer any questions.What should you do first?What manifestations of shock are present based on the
information you currently have?3. How would you classify this stage of shock?
Provide a rationale for your evaluation.What other assessment data should you obtain?Given the type of surgery she has undergone, where would you
expect bleeding to occur and what manifestations would indicate possible
bleeding?Discussion 10.3 –
Case Study ThreeAn 82 year old man living alone at home had a sudden onset
of chest pain. He called 911 and was taken to the emergency department.As his ED nurse what is your first action in response to his
report of chest pain?The physician prescribes IV nitroglycerin for the pain. What
assessment will you perform prior to administering this drug and why?The physician prescribed oxygen at 3L via nasal cannula.
What is the purpose of this intervention for managing chest pain?

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