Question

ne of your assigned patients is Mrs. R, an 80 year old woman, who is 3 days post-op hom a low bowel resection and ventral hernia repair. Her past medical history includes hypertension, chronic obstructive pulmonary disease (COPD), high cholesterol and Type 2 diabetes. Her home medications include: Ramipril 5 mg daily; metoprolol 50 mg bid; metformin 500 mg ac; and Crestor 10 mg daily. She has an IV of D51/2NS with 20 meq potassium running at 125 mL/hr, a urinary catheter, a Morphine epidural infusing per pain management protocol. You note her respiratory rate has increased to 30 breaths/minute with shallow breaths. Her urine output is 60 mL for the past 4 hours and she has had several fluid boluses for her low blood pressure. BP currently is 98/54, P 116. You believe she is beginning to experience early stages of hypovolemic shock and respiratory distress. What is your PRIORITY nursing diagnosis? Ineffective Breathing pattern What might be the cause of this patient's symptoms? A person suffering from severe in What diagnostic tests and labs will most likely be ordered? 10 or injury develops breathing problema - What labs/diagnostic tests would you expect to be abnormal and why? What labs/diagnostic tests would you expect to be normal and why? lm, What teaching would be beneficial for this patient?

Answer 1

1. Nursing diagnosis-

a. Decrease cardiac output related to altration in heart rate and atrial pressure as evidence by low BP, less urine output i.e 60 ml/4 hr.

b. ineffective breathing pattern related to chronic airflow contraints as evidence by increase respiration rate.

2. causes of patients symptoms

• no proper use of hypertensive medication
• COPD
• stress
• family history of hypertension and DM

3.test should be advised-

1. Renal function test
2. ABG ANALYSIS
3. sodium , potasium electrolyte ,
4. blood glucose level
5. X-ray

4. expected abnormal value-

a. renal function test - because of 60 ml /4hr urine output.

b. blood sugar level- because patient is on diabetic medicine (i.e- metformin).sometime diabetic ketoacidosis ocurs in chronic DM.

C. Abnormal ABG- patient is having respiratory problems. may be pco2 will increase.

d. abnormal sodium & pottassium- thses are the important electrolyte for normal heart functioning.alteration of these electrolyte can be aggrevate the symptom.

e. x-ray- to check bronchospasm.

5.expected normal value- liver function test will be normal because symptoms are showing no altration in liver function.

6. health teaching-

1. maintain adequate fluid volume
2. do the procedure in aseptic technique to reduce the infection or maintain adequate cleanliness.
3. maintain intake and output chart.
4. take the medicine on proper time and proper dose.
5. avoid the situation which agrevate the COPD symptoms.