Case study Saturday, 1340. A 26-year-old graduate student wi…
Case study Saturday, 1340. A 26-year-old graduate student with asthma arrives by ambulance after wheezing began 3 hours ago at a backyard bonfire. The client has taken 12 puffs of albuterol since then and took naproxen yesterday for a sprained ankle. History includes childhood eczema. The home controller, budesonide-formoterol twice daily, ran out 2 weeks ago. Assessment, 1340 Data Vital signs T 99.0°F (37.2°C), HR 128/min, RR 30/min, BP 150/90 mm Hg, SpO2 88% on room air Respiratory Pauses to breathe after 3–4 words, sits in tripod position, inspiratory and expiratory wheezes, intercostal and sternocleidomastoid retractions Peak expiratory flow (PEF) 42% of personal best Mental status Restless and oriented Which assessment data does the nurse flag for immediate action? Select all that apply.
Read DetailsPulmonary clinic follow-up. The client has severe COPD and t…
Pulmonary clinic follow-up. The client has severe COPD and takes tiotropium once daily, albuterol as needed and home oxygen at 2 L/min. The spouse reports the client has been sleeping more and using albuterol every 2 hours since a cold began 4 days ago. Finding 3 months ago Today pH 7.38 7.30 PaCO2 (mm Hg) 50 66 PaO2 (mm Hg) 60 51 HCO3− (mEq/L) 29 30 Hgb (g/dL) 18.1 18.3 Chest x-ray Flattened diaphragm, hyperinflation No change Which result should the nurse act on first?
Read DetailsDuring a home visit, the nurse finds a client pressing a tis…
During a home visit, the nurse finds a client pressing a tissue to a nosebleed from the front of the nose that began 10 minutes ago. The client takes warfarin for a history of deep vein thrombosis (INR goal 2–3). The medication log shows INR results of 2.2 in August and 2.9 in September, and today’s fingerstick INR is 4.1. Which direction should the nurse give first?
Read DetailsEmergency department. A client with untreated hypertension a…
Emergency department. A client with untreated hypertension arrives with blurred vision and confusion. BP is 220/124 mm Hg, the urine dipstick shows protein, and serum creatinine is 2.3 mg/dL (1.2 six months ago). The provider starts a sodium nitroprusside infusion and asks the nurse to titrate to the first-hour goal. Which MAP range should the nurse target?
Read Details