You are now ready to meet your patient for this clinical experience. CASE SCENARIO: Mr. M.J. is a 78-year old from Sudipen, La Union. He is accompanied in the room by his adult son. The son stated that his father had a long history of cardiopulmonary problems with chronic productive cough and had been diagnosed as having COPD about 15 years ago. Over the past 10 years, Mr. M.J. has been admitted to this hospital on several occasions due to COPD exacerbations. Bedside spirometry showed an FEV1/FVC ratio of 45% and an FEV1 of 25% of predicted. He had three exacerbations during the past 12 months. Based on the Combined Assessment of COPD Rubric Scoring System, the patient was placed in Group D (High Risk, More Symptoms). At the time of his last hospital discharge (7 months ago), Mr. M.J.'s records showed that his baseline FEV1/FVC ratio was 55% and his FEV1 was 35% of predicted. It was noted that he was experiencing his second exacerbation within the past year. On a 1LPM oxygen cannula, his baseline ABG values at his previous hospital discharge had been as follows: pH 7.37, PaCO2 93 mmHg, HCO3- 52 mEq/L, PaO2 63 mmHg, and SaO2 90%. Mr. M.J. had a long history of cigarette smoking, as well as working many long hours in smoke-filled rhythm- and-blues clubs for over 55 years. He stated that although he no longer worked in smoke-filled bars, he still ks of cigarettes per day. His son stated that when he had checked in on his father earlier that day, he realized that his father was very confused and disoriented. The son immediately transported Mr. M.J. to the ER. Mr. M.J. had "run out" of previously prescribed medications about 2 months earlier. He also smoked two to three stated that he "could not afford" most of them. On examination, the patient appeared to be in moderate to severe respiratory distress. He was anxious, confused, and disoriented. He stated that he could not take a deep enough breath. His vital signs were as follows: RR 35 breaths/min, HR 145 breaths/min, BP 140/90, and temperature 37°C. He was moderately overweight and had a barrel chest. His skin appeared cyanotic. He had a frequent weak cough. He produced a moderate amount of purulent, gray-yellow sputum with each cough. In an upright position, he used accessory muscles of inspiration. Exhalations were prolonged with pursed-lip breathing. He had 3+ pitting edema of his legs, ankles, and feet. His neck veins were distended. He has clubbing of his fingers and toes. Palpation revealed decreased chest expansion. Hyperresonant percussion notes were present over both lung fields. Auscultation revealed diminished heart and breath sounds, with bilateral wheezes and coarse crackles heard over all lung fields. An X-ray taken in the emergency room with a portable film showed lung hyperinflation, depressed diaphragms, increased bronchial vascular markings, and an apparent enlargement of the heart. Bedside spirometry was attempted, but the patient was too weak and confused to generate a good expiratory maneuver. ABG values on a 35% venturi mask were pH 7.31, PaCO2 92 mmHg, HCO3- 46 mEg/L, Pa02 52 mmHg, Sa02 82%. Laboratory results reveal a hemoglobin level of 13g%.
You are now ready to meet your patient for this clinical experience. CASE SCENARIO: Mr. M.J. is a 78-year old from Sudipen, La Union. He is accompanied in the room by his adult son. The son stated that his father had a long history of cardiopulmonary problems with chronic productive cough and had been diagnosed as having COPD about 15 years ago. Over the past 10 years, Mr. M.J. has been admitted to this hospital on several occasions due to COPD exacerbations. Bedside spirometry showed an FEV1/FVC ratio of 45% and an FEV1 of 25% of predicted. He had three exacerbations during the past 12 months. Based on the Combined Assessment of COPD Rubric Scoring System, the patient was placed in Group D (High Risk, More Symptoms). At the time of his last hospital discharge (7 months ago), Mr. M.J.'s records showed that his baseline FEV1/FVC ratio was 55% and his FEV1 was 35% of predicted. It was noted that he was experiencing his second exacerbation within the past year. On a 1LPM oxygen cannula, his baseline ABG values at his previous hospital discharge had been as follows: pH 7.37, PaCO2 93 mmHg, HCO3- 52 mEq/L, PaO2 63 mmHg, and SaO2 90%. Mr. M.J. had a long history of cigarette smoking, as well as working many long hours in smoke-filled rhythm- and-blues clubs for over 55 years. He stated that although he no longer worked in smoke-filled bars, he still ks of cigarettes per day. His son stated that when he had checked in on his father earlier that day, he realized that his father was very confused and disoriented. The son immediately transported Mr. M.J. to the ER. Mr. M.J. had "run out" of previously prescribed medications about 2 months earlier. He also smoked two to three stated that he "could not afford" most of them. On examination, the patient appeared to be in moderate to severe respiratory distress. He was anxious, confused, and disoriented. He stated that he could not take a deep enough breath. His vital signs were as follows: RR 35 breaths/min, HR 145 breaths/min, BP 140/90, and temperature 37°C. He was moderately overweight and had a barrel chest. His skin appeared cyanotic. He had a frequent weak cough. He produced a moderate amount of purulent, gray-yellow sputum with each cough. In an upright position, he used accessory muscles of inspiration. Exhalations were prolonged with pursed-lip breathing. He had 3+ pitting edema of his legs, ankles, and feet. His neck veins were distended. He has clubbing of his fingers and toes. Palpation revealed decreased chest expansion. Hyperresonant percussion notes were present over both lung fields. Auscultation revealed diminished heart and breath sounds, with bilateral wheezes and coarse crackles heard over all lung fields. An X-ray taken in the emergency room with a portable film showed lung hyperinflation, depressed diaphragms, increased bronchial vascular markings, and an apparent enlargement of the heart. Bedside spirometry was attempted, but the patient was too weak and confused to generate a good expiratory maneuver. ABG values on a 35% venturi mask were pH 7.31, PaCO2 92 mmHg, HCO3- 46 mEg/L, Pa02 52 mmHg, Sa02 82%. Laboratory results reveal a hemoglobin level of 13g%.
Phlebotomy Essentials
6th Edition
ISBN:9781451194524
Author:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Publisher:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Chapter1: Phlebotomy: Past And Present And The Healthcare Setting
Section: Chapter Questions
Problem 1SRQ
Related questions
Question
Kardex, medical sheet and IV sheet
![21:46
76%
NCM-112-RLE-LEA...
COLLEGE
Prepared by:
RELATED LEARNING EXPERIENCE ROTATION
E
NURSING
Jesther Rowen B. Bautista
COLLEGE O
MEDICAL-SURGICAL NURSING
CLINICAL INSTRUCTOR
OLLEC
THE BIG LEAP
You are now ready to meet your patient for this clinical experience.
M
CASE SCENARIO: Mr. M.J. is a 78-year old from Sudipen, La Union. He is accompanied in the room by his adult
son. The son stated that his father had a long history of cardiopulmonary problems with chronic productive
cough and had been diagnosed as having COPD about 15 years ago. Over the past 10 years, Mr. M.J. has been
admitted to this hospital on several occasions due to COPD exacerbations.
Bedside spirometry showed an FEV1/FVC ratio of 45% and an FEV1 of 25% of predicted. He had three
exacerbations during the past 12 months. Based on the Combined Assessment of COPD Rubric Scoring System,
the patient was placed in Group D (High Risk, More Symptoms).
At the time of his last hospital discharge (7 months ago), Mr. M.J.'s records showed that his baseline FEV1/FVC
ratio was 55% and his FEV1 was 35% of predicted. It was noted that he was experiencing his second
exacerbation within the past year. On a 1LPM oxygen cannula, his baseline ABG values at his previous hospital
discharge had been as follows: pH 7.37, PaCO2 93 mmHg, HCO3- 52 mEq/L, PaO2 63 mmHg, and SaO2 90%.
Mr. M.J. had a long history of cigarette smoking, as well as working many long hours in smoke-filled rhythm-
and-blues clubs for over 55 years. He stated that although he no longer worked in smoke-filled bars, he still
smoked two to three packs of cigarettes per day. His son stated that when he had checked in on his father
earlier that day, he realized that his father was very confused and disoriented. The son immediately transported
Mr. M.J. to the ER. Mr. M.J. had “run out" of previously prescribed medications about 2 months earlier. He also
stated that he "could not afford" most of them.
On examination, the patient appeared to be in moderate to severe respiratory distress. He was anxious,
confused, and disoriented. He stated that he could not take a deep enough breath. His vital signs were as
follows: RR 35 breaths/min, HR 145 breaths/min, BP 140/90, and temperature 37°C. He was moderately
overweight and had a barrel chest. His skin appeared cyanotic. He had a frequent weak cough. He produced a
moderate amount of purulent, gray-yellow sputum with each cough. In an upright position, he used accessory
muscles of inspiration. Exhalations were prolonged with pursed-lip breathing. He had 3+ pitting edema of his
legs, ankles, and feet. His neck veins were distended. He has clubbing of his fingers and toes.
Palpation revealed decreased chest expansion. Hyperresonant percussion notes were present over both lung
fields. Auscultation revealed diminished heart and breath sounds, with bilateral wheezes and coarse crackles
heard over all lung fields.
An X-ray taken in the emergency room with a portable film showed lung hyperinflation, depressed diaphragms,
increased bronchial vascular markings, and an apparent enlargement of the heart. Bedside spirometry was
attempted, but the patient was too weak and confused to generate a good expiratory maneuver. ABG values
on a 35% venturi mask were pH 7.31, PaCO2 92 mmHg, HCO3- 46 mEq/L, PaO2 52 mmHg, SaO2 82%.
Laboratory results reveal a hemoglobin level of 13g%.
COLLEGE
Prepared by:
RELATED LEARNING EXPERIENCE ROTATION
Jesther Rowen B. Bautista
MEDICAL-SURGICAL NURSING
CLINICAL INSTRUCTOR
OF
You are the receiving NOD of the Medical Ward and the ER NOD will endorse the patient to you. Use the
physician's orders, VS monitoring sheet, and lab results as vour guide in preparing the necessary
GES
ONISHAN
LORMA
NURSING
COLLEGE](/v2/_next/image?url=https%3A%2F%2Fcontent.bartleby.com%2Fqna-images%2Fquestion%2F9dd6eee9-ee27-4c55-b87f-f06dd3f02fb9%2F7e185813-32ea-439a-986b-06e3ef8d19ab%2F2qr8c8b_processed.jpeg&w=3840&q=75)
Transcribed Image Text:21:46
76%
NCM-112-RLE-LEA...
COLLEGE
Prepared by:
RELATED LEARNING EXPERIENCE ROTATION
E
NURSING
Jesther Rowen B. Bautista
COLLEGE O
MEDICAL-SURGICAL NURSING
CLINICAL INSTRUCTOR
OLLEC
THE BIG LEAP
You are now ready to meet your patient for this clinical experience.
M
CASE SCENARIO: Mr. M.J. is a 78-year old from Sudipen, La Union. He is accompanied in the room by his adult
son. The son stated that his father had a long history of cardiopulmonary problems with chronic productive
cough and had been diagnosed as having COPD about 15 years ago. Over the past 10 years, Mr. M.J. has been
admitted to this hospital on several occasions due to COPD exacerbations.
Bedside spirometry showed an FEV1/FVC ratio of 45% and an FEV1 of 25% of predicted. He had three
exacerbations during the past 12 months. Based on the Combined Assessment of COPD Rubric Scoring System,
the patient was placed in Group D (High Risk, More Symptoms).
At the time of his last hospital discharge (7 months ago), Mr. M.J.'s records showed that his baseline FEV1/FVC
ratio was 55% and his FEV1 was 35% of predicted. It was noted that he was experiencing his second
exacerbation within the past year. On a 1LPM oxygen cannula, his baseline ABG values at his previous hospital
discharge had been as follows: pH 7.37, PaCO2 93 mmHg, HCO3- 52 mEq/L, PaO2 63 mmHg, and SaO2 90%.
Mr. M.J. had a long history of cigarette smoking, as well as working many long hours in smoke-filled rhythm-
and-blues clubs for over 55 years. He stated that although he no longer worked in smoke-filled bars, he still
smoked two to three packs of cigarettes per day. His son stated that when he had checked in on his father
earlier that day, he realized that his father was very confused and disoriented. The son immediately transported
Mr. M.J. to the ER. Mr. M.J. had “run out" of previously prescribed medications about 2 months earlier. He also
stated that he "could not afford" most of them.
On examination, the patient appeared to be in moderate to severe respiratory distress. He was anxious,
confused, and disoriented. He stated that he could not take a deep enough breath. His vital signs were as
follows: RR 35 breaths/min, HR 145 breaths/min, BP 140/90, and temperature 37°C. He was moderately
overweight and had a barrel chest. His skin appeared cyanotic. He had a frequent weak cough. He produced a
moderate amount of purulent, gray-yellow sputum with each cough. In an upright position, he used accessory
muscles of inspiration. Exhalations were prolonged with pursed-lip breathing. He had 3+ pitting edema of his
legs, ankles, and feet. His neck veins were distended. He has clubbing of his fingers and toes.
Palpation revealed decreased chest expansion. Hyperresonant percussion notes were present over both lung
fields. Auscultation revealed diminished heart and breath sounds, with bilateral wheezes and coarse crackles
heard over all lung fields.
An X-ray taken in the emergency room with a portable film showed lung hyperinflation, depressed diaphragms,
increased bronchial vascular markings, and an apparent enlargement of the heart. Bedside spirometry was
attempted, but the patient was too weak and confused to generate a good expiratory maneuver. ABG values
on a 35% venturi mask were pH 7.31, PaCO2 92 mmHg, HCO3- 46 mEq/L, PaO2 52 mmHg, SaO2 82%.
Laboratory results reveal a hemoglobin level of 13g%.
COLLEGE
Prepared by:
RELATED LEARNING EXPERIENCE ROTATION
Jesther Rowen B. Bautista
MEDICAL-SURGICAL NURSING
CLINICAL INSTRUCTOR
OF
You are the receiving NOD of the Medical Ward and the ER NOD will endorse the patient to you. Use the
physician's orders, VS monitoring sheet, and lab results as vour guide in preparing the necessary
GES
ONISHAN
LORMA
NURSING
COLLEGE
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