Question

A 66-year-old female client with a diagnosis of chronic obstructive pulmonary disease (COPD) is admitted to the health care facility for suspected pneumonia. The client gives a history of working in a factory for 35 years and that she thinks the COPD was caused by inhaling the fumes from the machines she worked with. Her home is near a major highway that is always congested. The client appears well nourished, does not smoke, and only drinks a glass of wine on social occasions. She has recently retired and is hoping to spend time with her grandchildren. Her concern is that, for the past few days, she has been having difficulty breathing and that she has been coughing but it is nonproductive. She has also felt more tired than usual. At first, she thought it was a cold or the flu but became worried when her chest started to hurt each time she took a deep breath. Vital Signs: BP 126/82, HR 90, RR 26, Temp. 98°F (36.7°C), Pulse Ox 93%.

Questions:

a.The nurse is precepting a nursing student. The nurse asks the student to describe changes that are frequently seen when assessing the thorax and lungs of an older client.

b.  Using the nursing process, how will you proceed? What will your priority assessment area include?

d. After your assessment is complete, what would you want to document or share with the primary care doctor regarding the patient condition?

e. Is there anything else that hasn’t been assessed on this paitent that may help you understand the patient condition better?

Answer 1

a.The nurse is precepting a nursing student. The nurse asks the student to describe changes that are frequently seen when assessing the thorax and lungs of an older client.

There are many respiratory changes associated with older adults. There may be deformity in the thoracic cavity that leads to increased work of breathing. The weakening of the respiratory muscles and the limitation of lung volumes. The muscular function of the respiratory cell is less efficient that leads to hypercapnia and hypoxia. Muscle atrophy leads to the reduction of cough strength. The ciliary function becomes weak that leads to the accumulation of particles in the respiratory tract. Reduction of immunity associated with age leads to many chronic infections in elders.

b. Using the nursing process, how will you proceed? What will your priority assessment area include?

By using the nursing process, the nurse has to examine the patient based on a detailed history. The nurse begins with the assessment of Inspection. The nurse has to look for any deformities such as barrel chest. The nurse has to assess for the breathing pattern of the lungs and the use of any accessory muscles for respiration. During palpitations, the nurse has to palpate for the thorax and lungs, intercostal spaces, midclavicular line and palpate for any pain. On percussion, assess of hypersonance sound and lastly, auscultate the breath sounds for the presence of any rhonchi or wheeze.

d. After your assessment is complete, what would you want to document or share with the primary care doctor regarding the patient condition?

A 65-year-old female patient with a history of working in a factory for 35years and habit of drinking a glass of wine on special occasions shows that

• The patient feels difficulty in breathing.
• Patient has non productive purulent cough.
• Use of accessory muscles for pain.
• Rhonchi and wheezing are heard on auscultating the lung sounds.

e.Is there anything else that hasn’t been assessed on this paitent that may help you understand the patient condition better?

The additional information that required for better diagnosing of the patient

• Past history of any respiratory problems and associated symptoms.
• Any experience with nocturnal dyspnea.
• Her daily diet habits.
• Dyspnea while at rest
• Lab values and other diagnostic tests such as chest X-ray, spirometry findings.