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Assessment of Respiratory Function Nursing and Health Essay

Rubric Use the following rubric to guide your work.Tasks Expert Acceptable Unacceptable Focus Questions (100 points) Answers All questions correctly AND submitted on time. (90-100 points) Answers at least 50% of questions correctly AND submitted on time. (70-90points) Answers less than fifty percent of questions OR not on time. (0-70 points)Case Study, Chapter 20, Assessment of Respiratory Function1. John April, 24 years of age, is a male patient who was admitted to the surgical unit after a successful repair of an inguinal hernia. He is 5 feet 10 inches tall and weighs 120 kg. He has a neck circumference of 21 inches. The patient has a morphine PCA. He has no known drug allergies. vital signs are as follows: blood pressure 122/70 mm Hg, respiratory rate 26 breaths/min, heart rate 88 bpm, and temperature 98.6øF. The patient complains of incision pain and rates it on the pain scale as 7 of 10. family is visiting at the bedside. The nurse administers a bolus dose of morphine.

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Fifteen minutes after administering the pain medication, a family member enters the hallway and yells, We nhelp in here! John is not breathing. The nurse finds John having periods of apnea lasting a few seconds followed by a short snorting gasp and then he begins breathing at a rate of 12 breaths per minute. lips are bluish in coloration and so are nail beds. The patient is lying supine in the bed. He awakens as the nurse enters, but is very lethargic and somnolent.a. Which assessment parameters are appropriate to determine the characteristics and severity of the symptoms that the patient is exhibiting?b. Which nursing interventions should the nurse institute? Which intervention must be provided immediately?c. Explain the possible reasons for the patient?s sudden decline in the respiratory status.Chapter 23 Case study1. Harry Smith, 70 years of age, is a male patient who is admitted to the medical-surgical unit with acute community-acquired pneumonia. He was diagnosed with paraseptal emphysema 3 years ago. The patient smoked cigarettes one pack per day for 55 years and quit 3 years ago. The patient has a history of hypertension, and diabetes controlled with oral diabetic agents. The patient presents with confusion as to time and place. The family stated that tis a new change for the patient. The admission vital signs are as follows: blood pressure 90/50 mm Hg, heart rate 101 bpm, respiratory rate 28 breaths/min, and temperature 101.5øF. The pulse oximeter on room air is 85%. The CBC is as follows: WBC 12,500, platelets 350,000, HCT 30%, and Hgb 10 g/dL. ABGs on room air are pH 7.30, PaO2 55, PaCO2 50, HCO3 25. Chest x-ray results reveal right lower lobe consolidation, presence of apical bullae, flattened diaphragm, and a small pleural effusion in the right lower lobe. Lung auscultation reveals severely diminished breath sounds in the right lower lobe and absence of breath sounds at the base. The breath sounds in the rest of the lungs are slightly decreased. The patient complains of fatigue and shortness of breath and cannot finish a short sentence before the respiratory rate increases above the baseline and nail beds and lips turn a bluish tinge and the pulse oximetry decreases to 82%. The patient is diaphoretic and is using accessory muscles. The patient coughs weakly, but he does not raise any sputum.a. What nursing assessment findings support the diagnosis of pneumonia?b. What diagnostic findings support the diagnosis of pneumonia?c. What nursing diagnoses should the nurse formulate for the patient?d. What goals should the nurse develop for the patient?e. What overall interventions should the nurse provide?Chapter 24 Case Study2. Sallie Thorp, a 21-year-old patient, presents to the physician?s office with an asthma action plan form she acquired from a literature search on the World Wide at http://www.nhlbi.nih.gov/health/public/lung/asthma/asthma_actplan.pdf. She states that she would like to develop the plan with the help of the nurse and physician and review it at each appointment to keep it current. She has had moderate persistent asthma for 5 years, and she has visited the emergency department several times in the past year with severe asthma attacks. She stated that she forgets to take her medications, because the medications are at times that the hospital provided the inhalers (12 noon and midnight), and she gets confused on which inhalers are the long-acting ones and which inhaler is the short-acting rescue inhaler she is supposed to use when she has an exacerbation. She stated that if she could, she would like to take the inhalers at 8 AM and again at 8 PM. The patient stated that she has a flow meter and that a respiratory therapist at the hospital taught her how to use it in the past, and he wrote down her personal best peak flow, which is 400 L/sec. The nurse reviews the patient?s medical chart and discovers that she has been prescribed the following from today?s visit: ? Use albuterol (Proventil): 2 to 4 puffs every 20 minutes for up to 1 hour as rescue inhaler. If symptoms improve, then take the inhaler every 4 hours for 1 to 2 days. If no improvement after 2 days, call the physician. ? Salmeterol (Serevent): 50 mcg every 12 hours ? Fluticasone (Flovent): 88 mcg or 2 puffs every 12 hours ? Cromolyn sodium (Nasalcrom): one spray to each nostril once daily and before being exposed to known asthma triggers. You may use the spray up to every 4 hours. ? Measure peak flow meter every morning before using inhalers and record. Use peak flow meter, as needed, if you develop symptoms, such as cough, shortness of breath, wheezing, chest tightness; use of neck and chest muscles to breathe; problems talking or walking because of extreme shortness of breath. ? Follow-up in 3 months. ? Have the nurse provide education on asthma self-management and fill out the action plan that the patient brought with her today and have the physician review it and sign it.The nurse also notes that the medications have not changed from the last visit. (Learning Objectives 8 and 9)a. Print out the form and complete the form using the information from the case study. Please use the form to help you answer the question below.b. Define the green, yellow and red zone for tpatient.c. List the medications below :Medication Dosage Classification Action Teaching pointsd. Explain ways to evaluate the patient?s mastery of the content?

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