Question

Spring 2020 NRS 160

Case Study

Joe Ritter, a 74-year-old retired bricklayer, has a 40-pack-year tobacco history and a history of chronic obstructive pulmonary disease (COPD). Today, he presents to the emergency department in respiratory distress with shortness of breath, retracting respirations of 26 breaths/min, BP is 154/76 mm Hg, pulse is 140 beats/min, rapid and irregular and temperature is 37°C.  He also complains of chest discomfort and left leg pain (8 on 0-to-10 scale). His skin color is pale gray, his chest is barrel-shaped, and he uses accessory muscles to breathe; he appears anxious and is sitting in a tripod position. His nail beds are bluish in color; his oxygen saturation by pulse oximetry is 86%.  Chest auscultation reveals wheezes and decreased-to-absent breath sounds in bilateral bases. Hyperresonance is noted upon chest wall percussion. Chest x-ray showed atelectasis bilaterally in the bases. Mr. Ritter coughs with minimal amounts of clear sputum.  A 12-lead ECG recorded his heart rate as 140 beats/min, rapid, and irregular with an interpretation by the physician as atrial fibrillation.  Upon further exam the left lower extremity is edematous warm and tender to touch.

1. What subjective and objective data can the nurse gather from the information available about Mr. Ritter in the given scenario?
2. What questions would you ask Mr. Ritter during the interview portion of the health assessment related to his symptoms, SOB, chest pain, cardiac rate and rhythm?
3. What findings from the given scenario represent abnormal objective data?
4. What are your priorities in care? What could be causing his symptoms?
5. Why is the shortness of breath problematic?

Answer 1

Subjective	objective
Respiratory distress Shirtness of breath Chest discomfort Left leg pain Pale grey skin	Bp:154/76mmHg PR: 140bpm Spo2-86% Huperressonance noted upon chest wall percussion Minimal amount of clear sputum Atrial fibrillation

2. Do you have similar complints before and what is the treatment you have used.

3. Spo2 level, blodd pressure, hear rate and irregular ECG.

4. Long term tobacco usage was the main cause for his symptoms. He should stop tobacco using and roaming in cold whether.

5. The shortness of breath was due to high blood pressure as it is clearly represented in the ECG. And it is grade-4type.