course material

1. [From 10$/Pg] 3 Pco2 68 Neutropils
[From 10$/Pg] 3 Pco2 68 Neutropils The Nursing situation is designed to help you to
improve critical thinking and clinical judgement for safe patient outcomes.You will
document answers to the discussion questions and upload them via the link below. Please
use the rubric as a guide as you answer the questions.NURSING SITUATIONTISSUE
PERFUSIONHistory of Present Illness Joan Walker is a 77 year old female that has a
productive cough of green phlegm which started 5 days ago. Three days ago, her primary
care physician prescribed prednisone 40 mg/QD and azithromycin 250mg x 5
days. Joan started the medication supervised by the nurse at her assisted living facility
and on the 3rd day she developed intermittent chills and a fever of 102.0F. She has been
having difficulty breathing causing her to use her albuterol inhaler every 1-2 hours with no
improvement. Her caregiver calls 911 and she is taken to the ED. Joan recently loss her
husband of 45 years 8 months ago. They had no children. Joan depends on her church family
and pastor for comfort and emotional support. She asks her caregiver before leaving for the
ED to contact them on her behalf. Joan later told the nurse in the ED, “I think this maybe the
end therefore when my church family arrive, please allow them to pray with me”. The nurse
assured her she would be encouraged Joan to relax and focus on getting better. “I don’t
understand why this continues to happen! My husband and I stopped smoking 10 years
ago!”Past Medical History COPD/Hypertension/Hyperlipidemia/Anxiety Disorder/1ppd
smoker for 40 years. Quit 10 years ago.Joan Walker’s Clinical Data upon AdmissionTemp
(102.0F) Pulse (110/Regular) RR(30/Labored/Use of Accessory Muscles) BP (178/96)
O2 Sat (86%/Pt. placed on 6L via N/C). Pain (2/Dull ache over chest).Lab
Results ABGsWBC 14.5
pH 7.25Hgb 13.3
pCO2 68 Neutropils 92 p0
2 52 Bands 5 HC03 36P
otassium 3.9 02 84%
CO2 35Glucose 112 (Patient is not Diabetic) Lactate Acid
3.2BUN 32Creatinine 1.2Discussion QuestionsBased on Ms. Walker’s presentation
to the ED, conduct a general head to toe assessment and document your findings.
(Remember to consider her PMH, age and psychosocial findings).Discuss the
pathophysiology of COPD. Utilizing the nursing process, what would your nursing care
include? What are some of the “Red Flags” related to COPD and this scenario?Discuss Ms.
Walker’s lab values. What do they tell you about your patient’s current condition?Discuss

2. Ms. Walker’s ABGs and Lactic Acid Levels. Prepare a brief SBAR you would give to the
attending physician in the ED along with your recommendations/orders.Based on Ms.
Walker’s PMH, what are some of the home medications you would expect her to be
on?Discuss her current oxygen therapy? Would you change or maintain it?What nursing
priorities will guide your plan of care for Ms. Walker?What can you do to engage yourself
with this patient’s experience and show that she matters to you as a person?What
educational/discharge priorities will be needed to assist Ms. Walker’s healing process? Who
would you like to collaborate with along with the patient?