Week 8 Lucy Lu Care Plan Chronic Bronchitis PDF

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Care plan for COPD, detailed. Oxygenation, nursing. Oxygen administration...

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Potter & Perry: Fundamentals of Nursing Multi-Media Enhanced Edition, 7th Edition Chapter 40: Oxygenation Case Study Lucy Lu is a 77-year-old Asian client who is admitted to the surgical unit after a colon resection this morning. She has not been in the hospital before and is accompanied by her 80-year-old husband and her two daughters. Mrs. Lu has been in the United States for 30 years and speaks fluent English. She still values her Asian heritage. Her health has been deteriorating lately because of chronic bronchitis and stable angina. She smokes 1½ packs of cigarettes per day. She is 10 pounds underweight for her height. Jim Stone is a 24-year-old senior nursing student and has been assigned to care for Mrs. Lu postoperatively. He takes her vital signs upon return from the postanesthesia unit: blood pressure is 110/58 mm Hg, temperature 99.8° F orally, pulse 112 beats/min, and respirations 26 breaths/min. He asks her to rate her pain, and she states that it is a 6 on a scale of 1 to 10. She has a patient-controlled analgesia pump. Her surgical dressing is dry and intact. 1. Jim decides to check with the primary nurse and see if he can start administering oxygen to Mrs. Lu. The nurse tells Jim that it would be good. What is the preferred method of oxygen administration for this client? A. Simple face mask B. Venturi mask C. Nasal cannula Answer: C Rationale: Nasal cannula oxygen delivery is comfortable and noninvasive. It provides a low concentration of oxygen and can be kept on while eating, drinking, and talking. 2. The primary nurse asks Jim to take Mrs. Lu an incentive spirometer and teach her what it is and how to use it properly. What should Jim include in his teaching plan? Answer: Jim should explain that an incentive spirometer is used to encourage deep breathing and prevent pulmonary complications after abdominal surgery. He should have her place her lips around the mouthpiece and inhale slowly with an even flow to elevate the balls and to keep them floating as long as possible. He should tell her to do this frequently while she is awake. Rationale: Deep breathing helps alveoli, the small air sacs deep in the lungs, to fully expand. After surgery, clients may not take deep breaths because of pain or drowsiness. The incentive spirometer forces deep breaths to help keep the lungs expanded.

Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

Case Study

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3. Mrs. Lu complains of being short of breath. Three hours after she was admitted to her room Jim assesses her temperature and it is 101.2° F orally. Jim takes her other vital signs: blood pressure is 100/70 mm Hg, pulse 112 beats/min, and respirations 30 breaths/min. Her pulse oximetry is 88%. What nursing actions should Jim initiate to treat these changes in Mrs. Lu’s condition? Answer: Jim should do a thorough respiratory assessment. He should place her in Fowler’s position, check that the oxygen is flowing through the nasal cannula, and encourage frequent coughing and deep breathing. Rationale: The changes indicate a problem that requires more oxygen to be supplied to the lungs. By positioning in Fowler’s position, maximal expansion is allowed, and the coughing and deep breathing will further expand the lungs to allow for deeper respirations. 4. Later, while Jim is listening to Mrs. Lu’s lung through the stethoscope, he hears a high-pitched musical sound. What does this indicate? A. Mrs. Lu is wheezing. B. Mrs. Lu has a pleural friction rub. C. Mrs. Lu has fine crackles. D. Mrs. Lu has course crackles. Answer: A Rationale: The abnormal breath sound is the result of air moving through a narrowed airway. This could be caused by smoking.

Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc....