Question

76, DNR/DNI, NKDA PMH Smoker, ½ RRRx 50 years COPD HTN MI with stenting 10 years ago HPI Syncopal episode with fall resulting in head laceration and knee pain. X-ray negative for fracture. Admitted to telemetry

As a nurse what are your concerns (plan of care, diagnostic test to be ordered, etc.) for this patient?

Answer 1

COPD

• It is also known aschronic obstructive lung disease and chronic airflow limitation.it is a disase state characterized by airflow obstruction caused by emphysema or chronic bronchitis.it is characterized by cough,exertional dyspnea,wheezing and crackles,sputum production,weight loss ,barrel chest ,congestion and hyperinflation seen on chest x-ray and ABG levels that indicate respiratory acidosis and hypoxaemia.
• Nursing care

Monitor vital signs

Administration of low concentration of oxygen.

Monitor pulse oximetry.

Provide respiratory treatments and CPT.

Record the colour,amount and consstency of sputum.

Monitor weight.

Assessment and Diagnostic findings

Pulmonary function studies are used to help confirm the diagnosis of COPD.Spirometry is used to evaluate airflow obstruction .Bronchodilator reversibility testing maybe performed to rule out the diagnosis of asthma and to guide initial treatment.Arterial blood gas measurement is also done.

Hypertension

Hypertension is a major risk factor for coronary,cerebral,renal,and peripheral vascular disease.The goals of treatment include reduction of the BP and preventing or lessening the extent of organ damage.Signs and symptoms include headachevisual disturbances,dizziness,chest pain and tinnitus.

Routine laboratory tests include urinalysis,blood chemistry ie analysis of sodium,potassium,creatinine,fasting glucose and total and high density lipoprotein and a 12 lead ECG.Additional tests include creatinine clearance,renin level,urine tests,and 24 hour urine protein maybe performed.

Nursing care

Question the client regarding the signs and symptoms indicative of hypertension.

Obtain the BP two or more times on both arms with the client supine and standing.

Compare the BP with prior documentation.

Determine family history of hypertension.

Identify current medication therapy.