Question

2-15 THE PATIENT WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE 0700 Handoff Report: Mr. Y, a 66-year-old man, was admitted with exacerbation of his chronic obstructive pulmonary disease (COPD). He has been agitated during the night and is dyspneic this morning. The 0600 vital signs are 1 98.8°F, P 102, R 32, BP 146/98, pain level 0-1. pulse ox was 89% (room air). He has an IV of D5W infusing at 75 ml/hr. Oxygen was started at 2 L/min/nasal cannula and the pulse ox is up to 90%. He receives albuterol inhaler 2 puffs 24h prn and salmeterol (Serevent) inhaler 2 puffs q12h with spacer device and prednisone 20 mg po daily. The patient has a 40-year history of smoking. He has noticed an increase in sputum production and SOB for the last 2 weeks. Rapid and shallow breathing and use of accessory respiratory muscles were present on admission. Respirations short and shallow, pursed-lip breathing noted. Oxygen at 2 L/min/nasal cannula. Skin cool, 1 + pitting edema noted in bilateral lower extremities, pedal pulses present, weak. The following nursing interventions are recommended initially: 2 Priority Setting and Decision Making B A R Prioritize the following five recommended nursing interventions as you would do them to initially take care of Mr. Y. Write a number in the box to identify the order of your interventions (#1 - first intervention, #2 = second intervention, etc.), and state a rationale for cach intervention. INTERVENTIONS PRIORITY # RATIONALE • Auscultate lung sounds • Assess pulse oximeter, oxygen, and nasal cannula • Retake the vital signs OOOOO • Administer salmeterol inhaler using spacer device Y Place in high Fowler's position KEY POINTS TO CONSIDER

Answer 1

1. Place in High fowlers position to promote breathing.

Rationale : This facilitates relaxation of abdominal muscles and allows breathing.

2. Auscultate the lung sounds

Rationale : Obstructions or secretions of large airways can be identified by the low pitched, rattling sounds of the lungs which indicates ineffective breathing.

3.Assess the pulse oximetry, oxygen and nasal cannula.

Rationale : This is an effective way to check for the pulmonary function.Pulse oximetry determines the levels of oxygen saturation and the percentage of haemoglobin.

4. Administer Salmeterol inhaler using spacer device.

Rationale: Salmeterol promotes effective breathing in case of COPD exacerbations.

5. Retake the vital signs

Rationale : Retaking vital signs clearly indicates the patient condition once after performing all the interventions.