Medical Surgery

A , a 72 -year-old Hispanic male, arrives at the Emergency Department of the hospital complaining of shortness of breath, non-productive morning cough, and swelling in his lower extremities. He has had increased difficulty breathing when he walks short distances, such as to the bathroom for the last 3 days. He has gained 3 lbs this week and is 5feet 11 inches tall and weighs 280 lbs. He has a 50 year history of smoking, and quit 2 years ago after he was diagnosed with COPD.  He has a medical history of HTN, Type II diabetes, and GERD. He is a retired construction worker who lives with his wife in a 3^rd floor apartment.  He is currently taking the following medications: Esomeprazole (Nexium)40mg PO daily Hydrochlorothiazide (HCTZ) 50 mg PO twice daily Enalapril (Vasotec) 5 mg PO daily Fluticasone/vilanterol (Breo) 100mcg/25mcg Dry powder inhaler 1 puff daily Glipizide (Glucotrol XL) 10 mg daily K.G.’s vital signs are B/P 148/92, Pulse 109, Resp. Rate 26, Oxygen Saturation 90% on room air.  He has a non-productive cough and + diffuse crackles bilaterally, +3 bilateral lower extremity edema. He is alert and oriented x 3 and until recently was actively participating in church activities and is independent for all ADLS. He is admitted to the medical surgical unit with a diagnosis of COPD exacerbation and to rule out congestive heart failure. With each identified diagnosis/problem you will describe the pathophysiology of the patient’s condition and how this problem is affecting your patient.  Discuss how the patient’s diagnoses affect each other. Please list the appropriate lab tests and physical assessments needed for your patient’s diagnoses with results and meaning of the results. This activity will get you to think critically about the “whole” picture instead of just one problem or just one lab. You may use any peer-reviewed journals, texts or nursing practice resources you choose, however appropriate citations must be provided. This paper should be 8-10 pages long excluding references or cover page.  The paper should be in APA format and absent of any grammar or spelling errors with cover and reference pages. You will submit your paper via “Turnitin” by the assigned date.   Sections 1-4 are worth 5 points each

1. What are the patient’s age, gender and ethnicity? What disease risks do these non-modifiable factors create?
2. What is/are this patient’s primary medical diagnosis(es)?
3. How does the patient’s current presentation/physical findings confirm the admitting diagnosis?
4. Identify any vital signs that are out of normal range (high or low) and list the normal ranges based on this patient’s age and/or sex. Discuss the relation of the abnormal vitals to the Primary diagnosis. Is this consistent with or expected of a patient with this diagnosis?

Section 5 is worth 20 points

5. Discuss each of the patient’s medications. Include the dose, route and frequency. For each medication listed discuss the following:
6. Why this medication is prescribed?
7. How does this medication mediate or treat the patient’s condition?
8. What are the major side effects or precautions for the medication for this patient (consider patient’s demographics, diagnosis and any medication interactions)
9. What lab studies will need to be monitored in association with these medications

  Sections 6 and 7 are worth 25 points each

6. With each problem and medical diagnosis listed in question #2, explain the pathophysiology for each. Discuss how the diagnoses affect each other.  What labs or assessments are needed to monitor this condition? How do the patient’s diagnoses contribute to the potential for abnormal lab value(s).
7. Based on the information you have gathered about this patient, create a nursing care plan for the patient including a plan for patient education. Include and describe the use of and rationale for:
   1. Priority Nursing Diagnoses
   2. Patient Centered Goals
   3. Interventions for each Goal
   4. Evaluations

APA format, grammar, spelling and style are worth 10 pts