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What nursing diagnosis is the priority for this patient and why?

CASE STUDY: Respiratory

#1 Patient Profile:

A 62-year-old female client with a history of COPD has been admitted to the hospital with acute exacerbation and left-sided pneumonia.

The nurse observes increased anterior-posterior diameter of the chest, reddish-blue skin tone, and prolonged expiratory phase when breathing.

Admission vital signs: temperature 101.5 F (oral), blood pressure 154/92, heart rate 110, and respiratory rate 26 breaths/minute.

Critical Thinking Questions:

Answer each question thoroughly and with details

1) What nursing diagnosis is the priority for this patient and why?

2) During the initial physical assessment of the patient, the patient exhibits a frequent cough with copious purulent secretions expectorated.

This assessment finding is compatible with which etiology of pneumonia?

What type of nursing care would you then provide?

3) What should the nutritional plan for this patient include? Explain why?

Case Study: Burn/Trauma

You are caring for Mr. Stevenson a 26 year male patient who is an employee in a chemical plant on the assembly line. There was a unusual event and two explosive chemicals combined and caused a chemical explosion in the plant. Mr. Stevenson was near to the explosion and sustained severe burns from the accident.

He is now a patient in the Burn/Trauma ICU receiving life saving care. Mr. Stevenson received 3rd degree burns to his entire chest and back and his entire right leg front and back. He sustained second degree burns to his entire face. He is intubated, sedated and on a ventilator at the moment.

Please answer the following questions.

1) According to the Rule of Nines, what percentage of his body received burns? Please explain your answer in details.

2) Explain in details what is meant by treating the ABCDE’s of Burn Injuries?

3) What would be his fluid resuscitation goals for the first 24 hours? How about after that?

4) According to the American Burn Association, name at last 5 findings that would necessitate a referral to a burn center?

5) Explain the process of skin grafting for burn management.

GI CASE STUDY:

#1 Patient Profile: A 56-year-ld male patient tells you that he has been having abdominal pain about 3 hours after he eats. It feels like burning and is mostly in the upper abdomen. He gets some relief with over-the-counter antacids.

Critical Thinking Questions: Answer each question completely and thoroughly.

1) What is the differential diagnosis?

2) An endoscopy is ordered on this patient, and he is found to have multiple scattered duodenal ulcers. Now what do you think?

3) Suppose the serum gastrin is high. How can a diagnosis of Zollinger-Ellison syndrome be confirmed?

4) What are the signs and symptoms of Zollinger-Ellison and how would you educate your patient?

#2 Patient Profile:

A 46-year-old patient tells you he’s been vomiting blood, but he does not bring any in for you to see.

Critical Thinking Questions: Answer each question completely and thoroughly.

1) What is the differential diagnosis and what priority question should you ask?

2) What lab tests would you expect the physician to order?

3) What is an appropriate nursing diagnosis and what education would you provide?