Shortness of Breath And Productive Cough Assignment
To prepare:
- Review the interactive media under Required Media: Branching exercise. This is provided in the Learning Resources.
- Review the information provided in the case (patient presentation, vital signs, pmh, home meds, results of labs and diagnostics. With this information, critically think about what is happening with the patient.
- Use your critical thinking skills and current guidelines to develop orders. Include additional labs/diagnostics, what needs repeated and followed up on. Medications that need to be ordered or changed. Shortness of Breath And Productive Cough Assignment
PLACE YOUR ORDER HERE NOW
The Assignment:
- Using the required admission orders template found under the Learning Resources: Required Reading.
- Develop a set of orders as the admitting provider.
- Be sure to address each aspect of the order template
- Write the orders as you would in the patient’s chart. Be specific. Do not leave room for the nurse to interpret your orders.
- Do not assume anything has already been done/order. Use the information given. Example: If the case does not mention fluids were given, the patient did not receive fluids. You may have to start from scratch as if you are working in the ER. And you must provide orders if the patient needs to be admitted.
- Make sure the order is complete and applicable to the patient.
- Make sure you provide rationales for your labs and diagnostics and anything else you feel the need to explain. This should be done at the end of the order set – not included with the order.
- Please do not write per protocol. We do not know what your protocol is and you need to demonstrate what is the appropriate standard of care for this patient.
- A minimum of three current (within the last 5 years), evidenced based references are required.
Scenario #5 68 year old female (NRNP 6566F Week 9 Branching Exercise: Common Diseases and Disorders)
A 68-year-old female is brought to the hospital from the acute rehabilitation facility with complaints of shortness of breath and productive cough for 1 week. She was started on ciprofloxin 3 days ago, but her symptoms have continued to worsen. Her past medical history includes hypertension, hypothyroidism. She underwent a right knee replacement 2 weeks ago. Current medications include lisinopril 10mg, levothyroxine 75mcg, rivaroxaban 10mg daily and ciprofloxacin 500mg Q12. Her current symptoms include fever, chills, productive cough with purulent green sputum, and worsening shortness of breath. She is allergic to morphine. The patient is a full code. Shortness of Breath And Productive Cough Assignment
- Current vital signs T 102.6 HR 92. RR 22 BP 128/82. O2 saturation is 96% on 4L of O2
- Chest x-ray shows consolidation in the right lower lobe
- CBC and CMP are all within normal limits
The patient is requiring oxygen to maintain her O2 saturation at the low normal range. The safest option for the patient is to admit her to make sure her oxygen requirements do not need increasing with further intervention.
Admission Orders
Primary Diagnosis: (Shortness of breath and productive cough) Hospital Acquired Pneumonia
Status/Condition: Fair condition
Code Status: Full Code
Allergies: Allergic to morphine. No other known drug or food allergies
Admit to Unit: Female Medical Ward
Activity Level: Up with minimal assistance- Bed rest
Diet: Per oral. Tolerating fluids and solid foods
IV Fluids: Normal Saline 0.9% 2L in 24 hours
- Critical Drips (None)
Respiratory: Oxygen 1L/minute (60L per hour) via nasal cannula per hour when saturation falls below 92%, four hourly suctioning (Al-Otaibi, 2019)
Medications:
Lisinopril 10mg PO OD
Levothyroxine 75mcg per oral
Rivaroxaban 10mg OD
Ciprofloxacin 500mg Q12 NOCTE
Nursing Orders
Monitor Vitals every 4 hours
Propp patient in bed at 45 degrees to promote breathing (Fahlberg & Laramee, 2020)
Assistance with ambulation and other activities of daily living as tolerated
Daily grooming Shortness of Breath And Productive Cough Assignment
Daily knee assessment with weight bearing as tolerated
Provide warm drinks as needed
Follow-Up Lab Tests:
Arterial blood gas test
Complete blood count
Diagnostic testing: Sputum culture test, bronchoscopy, pulse oximetry, and blood culture (See & Lau, 2023)
Consults:
Consult cardiologist for cardiovascular evaluation for further assessment due to hypertension
Occupational therapist for follow-up on knee replacement therapy
Patient Education and Health Promotion :
Health education areas: patient condition
Treatment plans available
Coping skills- changes such as surgery
Fluid intake
Exercises
Diet conversant with underlying conditions
Medications used and their specifications
Discharge Planning and Required Follow-Up Care:
Discharge once patient symptoms are well-managed and the patient is stable, oxygen saturation above 94 on room air, and respiratory rate is below 20).
Follow-up clinic after two weeks for general assessment.
Notify the case manager and social workers about the patient’s discharge planning (Prusaczyk et al., 2019).
Follow-up with the physiotherapist
References
Al-Otaibi, H. M. (2019). Current practice of prescription and administration of oxygen therapy: an observational study at a single teaching hospital. Journal of Taibah University Medical Sciences, 14(4), 357-362. https://doi.org/10.1016/j.jtumed.2019.05.004
Fahlberg, B. B., & Laramee, A. S. (2023). 6 Reducing Episodic Dyspnea in Heart Failure. What Do I Do Now? Palliative Care, 49. https://doi.org/10.1093/med/9780190098896.001.0001
Prusaczyk, B., Kripalani, S., & Dhand, A. (2019). Networks of hospital discharge planning teams and readmissions. Journal of Interprofessional Care, 33(1), 85-92. https://doi.org/10.1080/13561820.2018.1515193
See, K. C., & Lau, Y. H. (2023). Acute management of pneumonia in adult patients. Singapore Medical Journal, 64(3), 209. https://doi.org/10.4103/singaporemedj.SMJ-2022-050 Shortness of Breath And Productive Cough Assignment
