Question

History of Present Problem: B.A is a 69-year-old resident at Concordia Rehabilitation Facility. His primary medical diagnosis is chronic obstructive pulmonary disease (COPD). He is 5 ft., 10 inches tall and weighs 150 lbs. B.A had a 40-pack-per-year history of cigarettes and quit smoking one year ago. He is usually short of breath upon exertion of ambulation more than 50 feet. He often eats about 30% of his meals because he says that he is too short of breath and too tired to finish. His medications include ipratropium (Atrovent) and albuterol (Proventil) metered-dose inhalers for control of his symptoms.

Subjective Data

• He states that he is just “out of shape.”
• Reports his chest hurts when he “coughs up yellow stuff”
• Feels anxious and jittery at times
• Sleeps with “a lot” of pillows at night

Visual assessment

• Speaks in short sentences
• Leans over on the bedside table to catch his breath
• Barrel chest

Develop two priority nursing diagnoses.

Priority Nursing Diagnoses	Goals (at least one goal per diagnosis)	Interventions (list 3 interventions)	Evaluation (write what you imagine can happen)
		.

What psychosocial/holistic care PRIORITIES need to be addressed for this patient?

How can you engage and show this patient matters to you?

What are 5 possible nursing diagnoses?

What educational/discharge priorities need to be addressed to promote health and wellness for this patient and/or family?

Answer 1

Nursing Diagnosis

Priority nursing diagnosis	Goals	Intervention	Evaluation
Impaired gas exchange related in inflammatory process,secretion as evidenced by shortness of breath, cough	to maintain normal gaseous exchange	Monitor vital signs with saturation to get baseline information Administer oxygen to meet oxygen demand Provide propped up position to improve lung capacity Provide nebulization, steam inhalation to remove secretion	The patient is able to breath normally
Imbalanced nutrition less than body requirement as evidenced by decreased food intake	to maintain adequate intake	Provide food of preferred choice Encourage to have small and frequent feeds Nutritional supplements as per order	The patient is able to eat food adequately

●The psychosocial/holistic care to be addressed here are

• Providing psychological support
• Enhancing spiritual life
• Providing support to establish good relationships in the society

●Some of the way to engage and show that the patient matters to you are

• Establishing a good communication and trying to make patient express their requirements
• Meeting all, their basic needs
• Providing a comfort zone

●The five possible nursing diagnosis are

• Ineffective breathing pattern related to inflammatory process as evidenced by short of breath ,elevated sleep posture during sleep, inability to mobilize
• Risk for nutritional deficiency related to decre as ed food intake as evidenced by lack of interest to consume
• Anxiety related to the disease condition as evidenced by verbalisation
• Impaired sleep pattern related to obstruction in respiratory pathway as evidenced by using many pillows to sleep
• Body image disturbance related to barrel chest as evidenced by verbalisation

●The discharge advice required are

• Take medication as prescribed
• To practice breathing exercises
• Avoid triggers
• Good dietary intake
• Maintain oxygen saturation