Question

7. G.S., a 77-year-old man, comes to the hospital complaining of shortness of breath, morning cough, and swelling in his lower extremities. He has difficulty breathing when he walks short distances, such as to the bathroom. What questions do you need to ask him related to risk factors? (3-4 main questions)

8. G.S. states that he sleeps in a recliner to make it easier to breathe. He feels his shoes are tight at the end of the day. He is placed on oxygen at 2 liters/minute via nasal cannula. What are your priorities regarding assessment? What assessment findings can you expect? (Clinical manifestation)

  

9. G.S. shares that he has experienced “attacks” like this in the past year, but this one was a bit worse. He states that he and his wife had visited their daughter and her 3 kids who were sick with colds. What is the likely cause of this exacerbation? _____________________ What would you anticipate in regard to treatment? ( 3 items) ______________________________________________________ What is G.S. at risk for with exacerbation?

10. G.S.’s arterial blood gases show a slight ↓ PaO2 and ↑ PaCO2, and his chest x-ray shows flattening of his diaphragm. O2 saturation is 88%. His FEV1/FVC is 65%, and he states he is having difficulty completing ADLs without frequent rest periods. What interventions would be of benefit to G.S. at this time?

11. G.S. is given a short-acting bronchodilator via nebulizer. He will also be given a SABA inhaler and an ICS for home use. He is started on azithromycin (Zithromax).

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12. Why was a nebulizer used in the hospital?

13. What is the rationale for the SABA?

14. How should he use his ICS

15. Will G.S. need oxygen for home use? (Why?)

16. G.S. is going to be discharged to home. He is given an Acapella device to assist him with expulsion of mucus. His wife is present, and you begin to teach them about home care. (What will you teach?)

17. G.S. appears fatigued and has difficulty answering the many questions he is asked. His wife expresses concern that he has not been sleeping well. (Based on subjective and objective assessment findings thus far develop a list of 4 appropriate full nursing diagnoses for G.S.) (Patho, physical, nurtrition, coping, & knowledge)

18. What areas could be addressed with G.S. in regard to health promotion? How can his wife and family

19. G.S. comes into the clinic in one week for follow-up. He is breathing much easier and states that he is able to perform ADLs with less distress. He and his wife ask about how to prevent further breathing difficulties. (identify additional areas for teaching – hint: 5 points to teach on)

Answer 1

Answer to question number 7:

• usually, shortness of breath, cough, swelling of lower extremities can be caused by either heart failure,kidney failure, decompensated liver disease, COPD or Asthma like conditions.
• so one should ask him( Mr.G.S) the following questions:
• Do you have paroxymal nocturnal dyspnoea ( shortness of breath at night) -usually linked to cardiac diseases.
• Do you have a medical history of Asthma. if he does, then it could be an exaceberation.
• Do you smoke or take alcohol (how often) .if he is a chronic smoker or chronic alcoholic then it can also indicate that he might have COPD and liver cirrhosis.
• How much do you urinate in a day (approximately). if he urinates less (500ml or less) then he must have a compromised kidney function.