Case Study R. W. You are a

Case Study R. W. You are a nurse working in a primary care clinic. One of the first clients coming into the clinic is R. W. R.W. is a 70-year-old female who has a 50-pack year history of smoking and was diagnosed with chronic obstructive pulmonary disease (COPD) chronic bronchitis two years ago. When you enter the room, you immediately notice that R. W. is using accessory muscles in work of breathing. She has a heavy cough and says she expels thick and yellow colored sputum. She looks thin and poorly nourished. She is well-kept and is appropriate in her affect despite her shortness of breath. When asking what brought her into the clinic today, R. W. provides her concerns: She is finding it difficult to eat hard foods like meat and is sticking to softer foods. She has a lot of pain in her mouth. She has not visited a dentist in five years since she retired as she no longer has dental insurance, and it is too expensive to see a dentist. She is having to prop herself up on pillows to sleep at night. She is finding her sleep is of poor quality and finds herself waking up “just as tired as when I went to bed.” She is having a lot of pain in her hands and knees. Previously worked as a cashier and has osteoarthritis bilaterally in hands and feet. She wants to know what she can take for the pain so she can work in her garden. When looking in her chart, you notice that she has had her annual influenza vaccination and received her first pneumococcal immunization at age 60. When inquiring R. W. about insurance, she states that she could not afford to purchase the Medicare Part D. Her most recent labs have some concerning values: Lab Result Normal Hbg 10.8 g/dL 12.0-15.5 g/dL Hct 47% 36% – 48% Na 147 mEq/L 135-145 mEq/L Albumin 3.0 g/dL 3.4 – 5.4 g/dL Serum Transferrin 180 mg/dL 170 – 370 mg/dl Iron 65 mcg/dL 60 – 170 mcg/dL O 2 90% 95% – 100% CO 2 34 mEq/L 23-29 mEq/L On your assessment of R. W., you notice that her skin is dry and flaky, and tissue thin. She has a wound on her elbow that does not appear to be healing well. She stated she had a bug bite two weeks ago and scratched it as it was itchy. On examination of the oral cavity, you notice multiple caries and several missing teeth from previous extractions. R. W. said she could not afford dentures. Using your knowledge of pathophysiology of COPD and osteoarthritis, and the subjective, objective, and assessment information, create a nursing care plan that incorporates primary, secondary, and tertiary interventions for this client. Address the client’s concerns and requests in your plan, immunizations, nutritional needs, and the necessary client education to address findings and prevent further disease progression.

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