Kardex, medical sheet and IV sheet 21:4676%NCM-112-RLE-LEA...COLLEGEPrepared by:RELATED LEARNING EXPERIENCE ROTATIONENURSINGJesther Rowen B. BautistaCOLLEGE OMEDICAL-SURGICAL NURSINGCLINICAL INSTRUCTOROLLECTHE BIG LEAPYou are now ready to meet your patient for this clinical experience.MCASE SCENARIO: Mr. M.J. is a 78-year old from Sudipen, La Union. He is accompanied in the room by his adultson. The son stated that his father had a long history of cardiopulmonary problems with chronic productivecough and had been diagnosed as having COPD about 15 years ago. Over the past 10 years, Mr. M.J. has beenadmitted 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 threeexacerbations 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/FVCratio was 55% and his FEV1 was 35% of predicted. It was noted that he was experiencing his secondexacerbation within the past year. On a 1LPM oxygen cannula, his baseline ABG values at his previous hospitaldischarge 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 stillsmoked two to three packs of cigarettes per day. His son stated that when he had checked in on his fatherearlier that day, he realized that his father was very confused and disoriented. The son immediately transportedMr. M.J. to the ER. Mr. M.J. had “run out" of previously prescribed medications about 2 months earlier. He alsostated 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 asfollows: RR 35 breaths/min, HR 145 breaths/min, BP 140/90, and temperature 37°C. He was moderatelyoverweight and had a barrel chest. His skin appeared cyanotic. He had a frequent weak cough. He produced amoderate amount of purulent, gray-yellow sputum with each cough. In an upright position, he used accessorymuscles of inspiration. Exhalations were prolonged with pursed-lip breathing. He had 3+ pitting edema of hislegs, 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 lungfields. Auscultation revealed diminished heart and breath sounds, with bilateral wheezes and coarse cracklesheard 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 wasattempted, but the patient was too weak and confused to generate a good expiratory maneuver. ABG valueson 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%.COLLEGEPrepared by:RELATED LEARNING EXPERIENCE ROTATIONJesther Rowen B. BautistaMEDICAL-SURGICAL NURSINGCLINICAL INSTRUCTOROFYou are the receiving NOD of the Medical Ward and the ER NOD will endorse the patient to you. Use thephysician's orders, VS monitoring sheet, and lab results as vour guide in preparing the necessaryGESONISHANLORMANURSINGCOLLEGE

Drugs, treatments, diagnoses, normal care measures, equipment, and specific needs are all summarized…

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%.