62 y/o male presents to ED with

62 y/o male presents to ED with complaint of difficulty in breathing that started this morning “when the weather got so cold”. He normally wears 2L of O2 via nasal cannula at home but has had to turn it up this morning to 4L and still feels short of breath. He is a 2 pack-a-day smoker for the past 25 years and is allergic to penicillin. He recently retired from working in a factory that manufactures chlorine. Your assessment reveals: Lung sounds are diminished with expiratory wheezing throughout Nasal flaring Tripod position Accessory muscle use Tachypnea Barrel Chest BMI 15 Vitals ABG values Temp: 97.8 pH: 7.25 BP: 158/98 PaCO2: 74 HR: 114 HCO3: 28 RR: 42 PaO2: 65 1. What is going on with this patient? What condition(s) do you think he has? 2. What triggered this condition? 3. What evidence led you to this diagnosis? 4. What does his ABG results reveal? 5. What other test(s) might you want? 6. What risk factors does this patient have for the condition that developed? 7. Does this patient require immediate intervention? If so, why? 8. What treatments do you expect will be ordered for him? 9. What is your rationale for those treatments? 10. What are your top 3 nursing diagnoses for him?

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