Long-standing history of emphysema. Acute myocardial infarction 12 years ago. Randal Camus Age: 75 Weight: 100 kg Location: Emergency Department (ED) Background

Patient History

Past Medical History:

Had an upper respiratory infection about two weeks ago

Allergies:

Penicillin

Medications:

Takes “some heart medications” but does not know the names, nor can he describe the

pills due to his severe shortness of breath

Code Status:

Full code

Social/Family History:

Married with grown adult children. Wife did not arrive with him as she is waiting

for their son to pick her up and bring her to the hospital. Patient smokes at least two packs of non-

filtered cigarettes per day

Handoff Report

Situation:

The patient is a 75-year-old male who was brought into the emergency department (ED) from home

complaining that his breathing got worse the past few days. He uses oxygen at home, and he was

sitting in his recliner with the oxygen in place at a flow rate of 2 liters per minute by nasal cannula and

smoking when the paramedics arrived. He reports he also takes “some heart medications” but does not

know the names, nor can he describe the pills due to his severe shortness of breath.

Background:

Long-standing history of emphysema and a previous acute myocardial infarction 12 years ago. States he

had an upper respiratory infection about two weeks ago. Despite his long-standing COPD, he continues

to smoke two packs of nonfiltered cigarettes per day at a minimum.

Handoff Report Continued

Assessment:

Vital signs: HR 90, BP 140/66, RR 32 and labored, SpO

has been 88% on room air, Temperature 37.6C

General Appearance: Appears fatigued and older than stated age

Cardiovascular: Sinus rhythm

Respiratory: Wheezing in both lobes

GI: Hypoactive bowel sounds

GU: Has not voided

Extremities: Movement is weak in all four extremities (3+)

Skin: Cool and dry. Circumoral and peripheral cyanosis present

Neurological: Alert and oriented to person, place, and time. Anxious. Pupils are equal and round,

reactive to light. No neurological deficits

IVs: 20-gauge IV in the right forearm with normal saline infusing at 150 mL/hour. Site patent and non-

reddened

Labs: Ordered and need to be drawn

Fall Risk: High-risk

Pain: Denies pain

Recommendations:

Implement initial orders and monitor cardiopulmonary status.

Orders

Initial Healthcare Provider’s Orders:

Diagnosis: COPD Exacerbation

Full code

Admit to med/surg

Continuous cardiac and SpO2 monitoring

Oxygen at 2 LPM via nasal cannula titrate for sats>88

IV of NS at 150 mL/hour

PredniSONE 40 mg PO daily

Pneumococcal vaccine upon hospital discharge

CBC, Electrolytes, BUN, Creatinine, Glucose, BNP, ABG STAT

Chest x-ray STAT

12 lead EKG STAT

I & O

Levalbuterol 1.25 mg by nebulizer every 6 hours and PRN

Morphine sulfate 2 mg IV push every 4 hours PRN for anxiety

Vital signs every hour

 

1. Explain the assessment findings that are outside of normal, provide rationale.

 

2. Which findings are most important and should be addressed first? Provide rationale (Requires more insights than Airway/Breathing first. etc.)

 

3. Based on your priorities listed above, what therapies should be implemented first and why?

 

4. Based on your interventions listed above, what post-intervention assessment findings would you expect to see, indicating that the therapies you selected were effective?

A client asks the nurse why erectile dysfunction drugs cannot be taken with nitroglycerin. What is the correct response by the nurse?*

1 point

 

 

Nitroglycerin and ED drugs are hepatotoxic which can result in liver damage.

 

 

ED drugs and nitroglycerin cause vasoconstriction and increase blood pressure.

 

 

Nitroglycerin and ED drugs cause vasodilation dropping blood pressure.

 

 

ED drugs and nitroglycerin cause a drop in heart rate causing bradycardia.

After viewing the videos, use the flow chart in the Iowa EBP Model to Promote Quality Care found in the Grove, Gray, and Burns text, to discuss how closely the EBP project did or did not follow each step in this model. In what ways do you think the project would have benefited from implementing any step(s) that were not used?

The article is question is about Legionnaires’ Disease Outbreaks and Cooling Towers, New York City, New York, USA’, by Robert Fitzhenry,1 Don Weiss,1 Dan Cimini, Sharon Balter, Christopher Boyd, Lisa Alleyne, Renee Stewart, Natasha McIntosh, Andrea Econome, Ying Lin, Inessa Rubinstein, Teresa Passaretti, Anna Kidney, Pascal Lapierre, Daniel Kass,2 Jay K. Varma

DOI: https://doi.org/10.3201/eid2311.161584

I uploaded a copy of the article. Thank you.

Based on the article uploaded/listed, please answer the following questions:

 

1. Describe the event.

1. Which individuals experienced the event?
2. When did they experience the event?
3. Where are the individuals who have experienced the event?
4. What environmental factors are associated with the event?
5. Given the differences in resources, how well were available resources used?
6. Evaluate the process; describe how you would have done things differently given the location, resources, and particular event.
7. Going forward, what screening mechanisms should be put in place to detect these conditions early?  Please provide references and be as detailed as possible. Thank you.