IHUMAN CASE STUDY - MedSurge - COPD w/ Pneumonia - Darrell Johnson EXAM COMPLETE QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) WITH RATIONALE|ALREADY GRADED A+||BRAND NEW VERSION!!

IHUMAN CASE STUDY - MedSurge - COPD w/
Pneumonia - Darrell Johnson EXAM
COMPLETE QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED ANSWERS)
WITH RATIONALE|ALREADY GRADED
A+||BRAND NEW VERSION!!
62M comes to ED w/a 4 day history of increased sputum
production, change in character of sputum, increased
SOB, and fever 101F. History of smoking 2packs/day
prior, beginning at age 14. He reports he had asthma as a
child and he's been treated with Albuterol inhalers as an
adult. Has been hospitalized 2x w/pneumonia; the most
recent was 2 years ago.
Physical exam:
VS: 101F, P 115, R 30, BP 120/80
Respirations shallow and labored, w/use of accessory
muscles
Increased AP diameter of chest
Skin dry and warm touch, inelastic skin turgor, fingernail
clubbing.
Which assessment is most important for nurse to
complete next? - ANSWER-Auscultate breath sounds
RATIONALE:
This is the highest priority because Mr. Johnson is clearly
exhibiting respiratory distress
Which assessment finding supports pt's diagnosis of
pneumonia - ANSWER-Pulse of 110-- tachycardia is most
consistent w/infectious process, in addition pt's fever
and rapid RR are also VS findings that indicate a problem-
-> infection
RATIONALE:
Tachycardia is consistent with an infectious process. In
addition, Mr. Johnson's fever and rapid respiratory rate
are also vital sign findings that indicate a problem, such
as an infection.
Crackles
ABG:
pH 7.28
pCO2 55
HCO3 25
pO2 89
These ABG results indicate that pt is experiencing which
acid-base imbalance - ANSWER-Respiratory acidosis--
RATIONALE:
The low pH indicates that acidosis is present. The
elevated pCO2 indicates that the problem is respiratory
in nature. Clients w/any condition that depresses
respirations are prone to the development of respiratory
acidosis. Even though pt has a rapid RR, his underlying
COPD causes retention of CO2
Which nursing diagnosis has the highest priority when
the nurse is planning care for pt? - ANSWER-Ineffective
airway clearance
RATIONALE:
There are adventitious breath sounds, tachypnea,
changes in depth of respirations, fever, and cough, all of
which support this as a priority diagnosis.
Pt admitted and HCP prescribes:
-Bedrest w/bedside commode
-O2 at 2L/min nasal cannula
-diet as tolerated
-continuous O2 sat monitoring via pulse oximeter
-IV fluid 5%Dextrose and 0.45% NS at 3L/day
-obtain sputum culture
Meds:
-ampicillin 1gm IVPB Q6H
-Neb Tx Q4H and prn saline & albuterol
- beclomethasone inhaler 2puffs 2x/day
-albuterol 2puffs 4x/day
methylprednisolone 125mg IVPB Q8H
Which nursing action should be implemented before
Ampicillin is administered? - ANSWER-Obtain sputum
culture--
RATIONALE:
the sputum culture will be compromised if broadspectrum is taken first. The sputum specimen should