Case Scenario: The Client with COPD and

Case Scenario: The Client with COPD and pneumonia The client is a 72-year-old male who was admitted from the emergency room to the medical surgical unit. The nurse gives you report and states the client reported a four-day history of increased sputum production, a change in the character of the sputum and increased shortness of breath. The client complains of pain with inspiration. History: Pt is a 2 pack a day smoker for 40 years, diabetes type 2, chronic COPD, 2L NC 02. Pt has several recent admissions for pneumonia. Allergies: PCN Medications at home: albuterol HFA (high flow aerosol) PRN 1 puff, tiotropium bromide 1 puff Q am, combination inhaler of fluticasone furoate/vilanterol 1 puff Q am, metformin 500 mg daily The admission VS in the ED were as follows: BP 120/70 HR 103 Resp 25 Temp 101.3 O2 sat on 2L 91% Pain 3/10 numeric pain scale The physician orders the following tests: Glucose AC/HS accucheck WBC RBC Sputum culture C&S Blood culture C&S CXR ABG Hgb A1C O2 2L NC Diet as tolerated IV fluid of 0.9 NS at 100 mL/hr Continuous pulse ox monitoring What is the rationale for the following tests? WBC: RBC: Sputum Cx: Blood Cx C&S: CXR: ABG: The ABG’s were obtained with the following results: pH 7.25 pCO2 58 HCO3 26 pO2 87 2) These ABG results indicate that the client is experiencing which acid base imbalance? The health care provider orders the following meds: levofloxacin 500mg IVPB every 24 hours. Nebulizer treatments with saline and albuterol every 4 hours and PRN tiotropium bromide 1 puff Q am combination inhaler of fluticasone furoate/vilanterol 1 puff Q am metformin 500 mg daily Identify the classification of the levofloxacin and the purpose for this client. Classification: Purpose: What is the nursing responsibility before administering the levofloxacin? The levofloxacin 500 mg IVPB is supplied in 100 mL in normal saline to be delivered over 60 minutes. The drop factor is 15 gtt/mL. The nurse should set the IVPB to infuse at how many gtt/minute? (must show calculation – you cannot just post the final answer) Regarding the clients smoking history, how can the nurse advocate for the client while in the hospital? The nurse is monitoring the pulse ox for the last 2 days. The trend has been 96% on 2LNC. This morning the pulse ox is registering 90% on 2LNC. Name 2 nursing actions that will help this client increase their o2 sat without a provider order. The nurse is doing discharge teaching regarding the use of the client’s inhaler. Identify one important teaching item necessary regarding the combination inhaler of fluticasone furoate/vilanterol.

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