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Katherine Bowen Part 2

NUR 130 AY 2023-24

Part 2 – Inpatient Care – 5 Points (see points)

Ms. Bowen has been admitted to the Medical Unit with a diagnosis of Acute COPD exacerbation most likely caused by pneumonia. You are about to start your shift.

You receive the following SBAR report.

S

Ms. Katherine Bowen presents to the Emergency Department (ED) complaining of a productive cough of green phlegm that started three days ago being admitted for Acute COPD exacerbation most likely caused by pneumonia.

B

PAST MEDICAL HISTORY:

Ms. Bowen has diagnosed Chronic Obstructive Pulmonary Disease and Anxiety. She has an allergy to sulfa medication.

PERSONAL/SOCIAL HISTORY:

Katherine, or Kate as she likes to be called, lives at home with her husband of 64 years Xander. They live alone independently though their two adult children live less than 30 minutes away. She is a retired elementary school teacher.


A- Assessment:


NEURO & PAIN

Alert & oriented to person, place, time and situation (x4)

Appears anxious and in distress


CARDIO

Pale

hot & dry

no edema

heart sounds regular – S1 S2

pulses strong, equal with palpation at radial/pedal/post-tibial landmarks

P: 113 (regular)

B/P: 154/89

Normal Saline (0.9% NS) running at 75 milliliters and hour


RESPIRATORY

Dyspnea with use of accessory muscles,

breath sounds very diminished bilaterally anterior and posterior with scattered expiratory wheezing

barrel chest present

RR: 28 (labored)

Sats: 89% on 6 liters N/C


GI

Abdomen soft/non-tender,

bowel sounds audible per auscultation in all 4 quadrants

Unknown when last BM or when last ate


GU

Voiding without difficulty, urine clear / yellow


ID

(Infectious Disease)

101.2 F / 38.4 C (oral)

Antibiotics have not been given.

Was on home antibiotics


INTEGUMENTARY & MUSCULOSKELETAL

(Skin/Drains/Mobility)

Skin integrity intact

skin turgor elastic

no tenting

20 ga IV in her left forearm


ENDO

Not diabetic

·


MENTAL HEALTH

· Feelings of hopelessness

· Religious and close to her pastor that has visited

R- Review &

Recommendation

(“What’s the plan?”)
.

· Goals

· Patient Education

· Discharge/Transfer Status

Next Page


Answer the following questions.

1.

Look at the interpretation of both the EKG and the Chest X-ray and answer the questions below. (1 point)


EKG

Interpretation:

Sinus Tachycardia




Chest X-ray =




Interpretation: Left lower lobe infiltrate. Hypoventilation is present in both lung fields.

a)

Why would the HCP order an EKG?

b)

What is a lobe infiltrate?


What does hypoventilation in the Chest X-ray mean?

2.

Using the medication and procedure orders below, fill out the chart regarding each order, rationale for the order and the expected outcome would be. (2 points)

Order

Analyze Cues – Why is it being used?

Evaluated / Expected Outcome:

Albuterol-ipratropium 2.5 mg neb

Establish peripheral IV

Lorazepam 1 mg IV push every 6 hours as needed (PRN) for anxiety

Methylprednisolone 125 mg IV push

Levofloxacin 750 mg IVPB

Acetaminophen 1000 mg oral

Obtain blood cultures

Next Page

3.


Prioritize the medications and orders in descending order. (Use the assumption that you are acting as the nurse alone without additional assistance) (2 points)

· Acetaminophen 1000 mg oral

· Albuterol-ipratropium 2.5 mg neb

· Establish peripheral IV

· Levofloxacin 750 mg IVPB

· Lorazepam 1 mg IV push every 6 hours as needed (PRN) for anxiety

· Methylprednisolone 125 mg IV push

· Obtain blood cultures

Order / Medication

Prioritized Order

Why is this order / medication being given in this order?

Why did you prioritize it this way?

1

2

3

4

5

6

7

1

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