Katherine Bowen Part 2
NUR 130 AY 2023-24
Part 2 – Inpatient Care – 5 Points (see points)
Ms. Bowen has been admitted to the Medical Unit with a diagnosis of Acute COPD exacerbation most likely caused by pneumonia. You are about to start your shift.
You receive the following SBAR report.
S
Ms. Katherine Bowen presents to the Emergency Department (ED) complaining of a productive cough of green phlegm that started three days ago being admitted for Acute COPD exacerbation most likely caused by pneumonia.
B
PAST MEDICAL HISTORY:
Ms. Bowen has diagnosed Chronic Obstructive Pulmonary Disease and Anxiety. She has an allergy to sulfa medication.
PERSONAL/SOCIAL HISTORY:
Katherine, or Kate as she likes to be called, lives at home with her husband of 64 years Xander. They live alone independently though their two adult children live less than 30 minutes away. She is a retired elementary school teacher.
A- Assessment:
NEURO & PAIN
Alert & oriented to person, place, time and situation (x4)
Appears anxious and in distress
CARDIO
Pale
hot & dry
no edema
heart sounds regular – S1 S2
pulses strong, equal with palpation at radial/pedal/post-tibial landmarks
P: 113 (regular)
B/P: 154/89
Normal Saline (0.9% NS) running at 75 milliliters and hour
RESPIRATORY
Dyspnea with use of accessory muscles,
breath sounds very diminished bilaterally anterior and posterior with scattered expiratory wheezing
barrel chest present
RR: 28 (labored)
Sats: 89% on 6 liters N/C
GI
Abdomen soft/non-tender,
bowel sounds audible per auscultation in all 4 quadrants
Unknown when last BM or when last ate
GU
Voiding without difficulty, urine clear / yellow
ID
(Infectious Disease)
101.2 F / 38.4 C (oral)
Antibiotics have not been given.
Was on home antibiotics
INTEGUMENTARY & MUSCULOSKELETAL
(Skin/Drains/Mobility)
Skin integrity intact
skin turgor elastic
no tenting
20 ga IV in her left forearm
ENDO
Not diabetic
·
MENTAL HEALTH
· Feelings of hopelessness
· Religious and close to her pastor that has visited
R- Review &
Recommendation
(“What’s the plan?”) .
· Goals
· Patient Education
· Discharge/Transfer Status
Next Page
Answer the following questions.
1. Look at the interpretation of both the EKG and the Chest X-ray and answer the questions below. (1 point)
EKG
A graph of a heart beat Description automatically generated with medium confidence
Interpretation: Sinus Tachycardia
Chest X-ray =
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Interpretation: Left lower lobe infiltrate. Hypoventilation is present in both lung fields.
a) Why would the HCP order an EKG?
b) What is a lobe infiltrate?
What does hypoventilation in the Chest X-ray mean?
2. Using the medication and procedure orders below, fill out the chart regarding each order, rationale for the order and the expected outcome would be. (2 points)
Order
Analyze Cues – Why is it being used?
Evaluated / Expected Outcome:
Albuterol-ipratropium 2.5 mg neb
Establish peripheral IV
Lorazepam 1 mg IV push every 6 hours as needed (PRN) for anxiety
Methylprednisolone 125 mg IV push
Levofloxacin 750 mg IVPB
Acetaminophen 1000 mg oral
Obtain blood cultures
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3. Prioritize the medications and orders in descending order. (Use the assumption that you are acting as the nurse alone without additional assistance) (2 points)
· Acetaminophen 1000 mg oral
· Albuterol-ipratropium 2.5 mg neb
· Establish peripheral IV
· Levofloxacin 750 mg IVPB
· Lorazepam 1 mg IV push every 6 hours as needed (PRN) for anxiety
· Methylprednisolone 125 mg IV push
· Obtain blood cultures
Order / Medication
Prioritized Order
Why is this order / medication being given in this order?
Why did you prioritize it this way?
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