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Kim Uddo

Formation

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Its is one of the project assigned to us in Rural Marketing!!! Mine topic was Generic Medicine and its future prospects in India keeping in mind the High Expenditure an average Indian has capacity to bear. Hope its liked and appreciated by people. I will be also sharing a slide with a small online survey I did in this context which will provide a bit more insight in this aspect to everyone. Hope people will find this useful and informative..

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Case Study COPD Exacerbation Difficulty: Advanced Setting: Hospital Index Words: chronic obstructive pulmonary disease (COPD), medications, nutrition, patient education, assessment, coping Giddens Concepts: Clinical Judgment, Collaboration, Gas Exchange, Nutrition, Oxygenation, Safety HESI Concepts: Assessment, Clinical Decision Making—Clinical Judgment, Collaboration/Managing Care, Gas Exchange, Nursing Interventions, Nutrition, Oxygenation, Safety D.Z., a 68-year-old man, is admitted at 1600 to a medical floor with a diagnosis of acute exacerbation of chronic obstructive pulmonary disease (COPD). His other past medical history includes hypertension and type 2 diabetes. He has had pneumonia yearly for the past 3 years and has been a two-pack-a-day smoker for 38 years. His current medications include enalapril (Vasotec), hydrochlorothiazide (HCTZ), metformin (Glucophage), and fluticasone/salmeterol (Advair). He appears a cachectic man who is experiencing difficulty breathing at rest. D.Z. seems irritable and anxious; he complains of sleeping poorly and states that lately he feels tired most of the time. He reports cough productive of thick yellow-green sputum. You aus- cultate decreased breath sounds, expiratory wheezes, and coarse crackles in both lower lobes anteriorly and posteriorly. His vital signs (VS) are 162/84, 124, 36, 102° F (38.9° C), and Spo2 88%. · Scenario Physician's Orders Diet as tolerated Out of bed with assistance 2 IV of D5W at 50 mL/hr ECG monitoring Oxygen (O ) to maintain Spo of 90% 2 Arterial blood gases (ABGs) in am CBC with differential now Basic metabolic panel (BMP) now Chest x-ray (CXR) daily Sputum culture Albuterol 2.5 mg plus ipratropium 250 mcg nebulizer treatment STAT Chart View 1. Are D.Z.'s VS and Spo2 acceptable? If not, explain why. 2. Describe a plan for implementing these physician's orders. 3. What is the primary nursing goal at this time? 4. Based on this priority, identify three independent nursing actions you would implement. 5. Identify three expected outcomes for D.Z. as a result of your interventions. Chart View Medication Administration Record Methylprednisolone (Solu-Medrol) 125 mg IVP every 8 hours Azithromycin (Zithromax) 500 mg IVPB q24h  2 days then 500 mg PO  7 days Fluticasone/salmeterol (Advair) 100/50 mcg 2 puffs twice daily Heparin 4000 units subcut every 12 hours Enalapril (Vasotec) 10 mg PO daily Albuterol 2.5 mg/ipratropium 250 mcg nebulizer treatment every 6 hours Metformin (Glucophage) 500 mg PO twice daily 6. Indicate the expected outcome for D.Z. that is associated with each medication he is receiving. 0.2 0.4 0.6 0.8 1 mL 7. Because D.Z. is on azithromycin (Zithromax), what interventions need to be included in his plan of care? Select all that apply. a. Monitor intravenous (IV) site for inflammation or extravasation. b. A.

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