MR. COHEN EMPHYSEMA CASE STUDY
Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages To Order 5-10 Pages Description/Paper Instructions
CASE STUDY 3
Mr. Cohen
GENDER Male
AGE 75
SETTING Hospital
ETHNICITY Jewish American
CULTURAL CONSIDERATIONS Perception and expression of pain
PREEXISTING CONDITIONS Chronic obstructive pulmonary disease (COPD) (emphysema); hypertension (HTN) well controlled by enalapril (Vasotec)
COEXISTING CONDITION Lower back pain
COMMUNICATION
DISABILITY
SOCIOECONOMIC
SPIRITUAL/RELIGIOUS Judaism PHARMACOLOGIC
Acetaminophen (Tylenol); albuterol (AccuNeb, Proventil, Ventolin); enalapril (Vasotec); oxycodone/ acetaminophen (Percocet)
LEGAL
ETHICAL
ALTERNATIVE THERAPY
Nonpharmacologic interventions for respiratory distress and pain management
PRIORITIZATION
Difficulty breathing; pain management
DELEGATION
Needs assistance of one person while ambulating due to unsteady gait and dyspnea on exertion
Overview: This case requires that the nurse recognize the signs and symptoms of activity intolerance and respiratory distress and how symptoms differ in the client who has COPD. The nurse considers both pharmacologic and nonpharmacologic interventions to manage respiratory distress and pain. Cultural/spiritual perceptions of pain and pain management are discussed. The nurse must provide discharge teaching regarding safe use of oxygen in the home.
Client Profile
Mr. Cohen is a 75-year-old male admitted with an exacerbation of chronic obstructive pulmonary disease (emphysema). He has been keeping the head of the bed up for most of the day and night to facilitate his breathing which has resulted in lower back pain. Acetaminophen (Tylenol) was not effective in reducing his pain, so the health care provider has prescribed oxycodone/acetaminophen (Percocet) one to two tablets PO every four to six hours as needed for pain. Mr. Cohen is on 2 liters of oxygen by nasal cannula. He can receive respiratory treatments of albuterol (AccuNeb, Proventil, Ventolin) every six hours as needed. Mr. Cohen needs some-one to walk beside him when he ambulates because he has an unsteady gait and often needs to stop to catch his breath.
Case Study
The nurse enters the room and finds Mr. Cohen hunched over his bedside table watching television. He says this position helps his breathing. His lung sounds are clear but diminished bilaterally. Capillary refill is four seconds and slight clubbing of his fingers is noted. His oxygen saturation is being assessed every two hours to monitor for hypoxia. Each assessment reveals oxygen saturation at rest of 90% to 94% on 2 liters of oxygen by nasal cannula. After breakfast, Mr. Cohen complains of lower back pain that caused him in-creased discomfort while ambulating to the bathroom. He describes the pain as a dull ache and rates the pain a “6” on a 0–10 pain scale. He requests two Percocet tablets. The nurse assesses Mr. Cohen’s vital signs (blood pressure 150/78, pulse 90, respiratory rate 26) and gives the Percocet as prescribed. Forty-five minutes later, Mr. Cohen states the Percocet has helped relieve his back pain to a “2” on a 0–10 pain scale and he would like to take a walk in the hall. The nurse checks his oxygen saturation before they leave his room, and it is 92%. Using a portable oxygen tank, the nurse walks with Mr. Cohen from his room to the nurse’s station (approximately 60 feet). Mr. Cohen stops to rest at the nurse’s station because he is short of breath. His oxygen saturation at the nurse’s station is 86%. After a few deep breaths and rest, his oxygen saturation rises to 91%. Mr. Cohen walks back to his room where he sits in his recliner to wait for lunch. His oxygen saturation is initially 87% when he returns and then 91% after a few minutes of rest. Expiratory wheezes are heard bilaterally when the nurse assesses his lung sounds. While Mr. Cohen waits for lunch to arrive, the nurse calls respiratory therapy to give Mr. Cohen his albuterol treatment. The respiratory treatment and rest relieves his acute shortness of breath. His oxygen saturation is now 93%, and his lung sounds are clear but diminished bilaterally.
Questions
- Briefly define chronic obstructive pulmonary dis-ease (COPD). What pathophysiology is occurring in the lungs of a client with emphysema?
- What are five signs and symptoms of respiratory distress the nurse may observe in a client with COPD?
- Describe the physical appearance characteristics of a client with emphysema.
- Are Mr. Cohen’s oxygen saturation readings normal? Explain your answer.
- Explain the effects that acute pain can have on an individual’s respiratory pattern and cardiovascular system.
- List five nonpharmacologic interventions that the nurse could implement to help decrease Mr. Cohen’s difficulty breathing.
- How would the nurse measure the effectiveness of the interventions suggested in question number 6?
- Explain why the nurse did not increase Mr. Cohen’s oxygen to help ease his shortness of breath.
- Discuss the cultural/spiritual considerations the nurse should keep in mind while creating a plan of care for Mr. Cohen’s pain management.
- What are three nonpharmacologic nursing interventions to help manage Mr. Cohen’s pain?
- How would the nurse measure the effective-ness of the interventions suggested in question number 10?
- Should the nurse be concerned about the adverse effects of respiratory depression and hypotension when giving oxycodone/acetamino-phen (Percocet) to Mr. Cohen? Why or why not?
- What are three nursing diagnoses that address physical and/or physiological safety concerns for Mr. Cohen?
- Cohen will be returning home with oxygen. List at least five safety considerations the nurse should include in discharge teaching regarding the use of oxygen in the home.
RUBRIC
QUALITY OF RESPONSE NO RESPONSE POOR / UNSATISFACTORY SATISFACTORY GOOD EXCELLENT Content (worth a maximum of 50% of the total points) Zero points: Student failed to submit the final paper. 20 points out of 50: The essay illustrates poor understanding of the relevant material by failing to address or incorrectly addressing the relevant content; failing to identify or inaccurately explaining/defining key concepts/ideas; ignoring or incorrectly explaining key points/claims and the reasoning behind them; and/or incorrectly or inappropriately using terminology; and elements of the response are lacking. 30 points out of 50: The essay illustrates a rudimentary understanding of the relevant material by mentioning but not full explaining the relevant content; identifying some of the key concepts/ideas though failing to fully or accurately explain many of them; using terminology, though sometimes inaccurately or inappropriately; and/or incorporating some key claims/points but failing to explain the reasoning behind them or doing so inaccurately. Elements of the required response may also be lacking. 40 points out of 50: The essay illustrates solid understanding of the relevant material by correctly addressing most of the relevant content; identifying and explaining most of the key concepts/ideas; using correct terminology; explaining the reasoning behind most of the key points/claims; and/or where necessary or useful, substantiating some points with accurate examples. The answer is complete. 50 points: The essay illustrates exemplary understanding of the relevant material by thoroughly and correctly addressing the relevant content; identifying and explaining all of the key concepts/ideas; using correct terminology explaining the reasoning behind key points/claims and substantiating, as necessary/useful, points with several accurate and illuminating examples. No aspects of the required answer are missing. Use of Sources (worth a maximum of 20% of the total points). 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APA 6th Edition is used with only a few minor errors. There are minor errors in reference and/or citations. And/or there is some use of questionable sources. 20 points: Credible scholarly sources are used to give compelling evidence to support claims and are clearly and fairly represented. APA 6th Edition format is used accurately and consistently. The student uses above the maximum required references in the development of the assignment. 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