Please ,this is a Case Scenario for

Please ,this is a Case Scenario for Mr. Lopez’s Sister Maria,Please do a nursing charting on care of Tracheostomy using this scenario.This is an NFDN2003 MED SURG Mr. Lopez’s sister has had a tracheostomy for 2 years. She has been requiring tracheal suctioning every 2-3 hours. In the past 24 hours, the secretions are becoming thicker and more tenacious. In the clinic, you enter the room to suction, you notice that Mrs. De León is sitting on a chair, and her respirations are tachypnic, with audible secretions heard from her tracheostomy. You note the following assessment:Patient is restless BP 147/89, HR 105, T. 36.8, R 22, Sp02 84% on RA, Pain 0/10 Audible secretions heard, accessory muscle use with inspiration, mild wheezes heard on auscultation in upper lobes, crackles heard throughout, decreased air entry to bilateral lower lobes. Height: 160cm Weight: 54kg Doctor’s Orders: Complete Vitals Suction Trach as needed Complete trach care – assessment, change ties, clean stoma, clean interior cannula Glycopyrrolate 0.2mg IM x1 dose now CBCD & Lytes Chest x-ray Contact/Droplet Isolation Precautions Describe the trach stoma using appropriate terminology. Complete a focused patient assessment, including a full set of vital signs. What are your abnormal assessment findings? Include abnormal objective and subjective findings. From your abnormal assessment findings, what is the client’s PRIORITY problem? Outline your nursing interventions based on your priority: What 3 things are you going to do for this patient, and why are those your 3 top interventions? What is your rationale? How will you evaluate the effectiveness of the nursing interventions? Know your medication: What is its purpose? Use laymen’s terms for the patient to understand Is it a safe dose? Y or N? How do you know this? What Nursing assessment (related to medication administration), needs to be complete prior to administration? Complete Nursing documentation on your focused assessment, your findings, your interventions, and your evaluation, and submit for feedback.

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