Case Study Help!!

[EbonyLaShonda]

Hello Everyone,

I have to do a case study & concept map based on the scenario below:

Mr. Baldwin is a 45-year-old White male who complains of chronic cough, intermittent fever and night sweats. He's a long haul truck driver and travels quite frequently to Mexico. He has a 40-pack year history of cigarette smoking. He is complaining of cough for 3 weeks, which produces hemoptysis and is also dyspnic. He has lost 8 pounds in the last 3 months, has had a fever and is experiencing night sweats. Upon exam he has a fever of 100.2, HR of 94, labored respirations of 24/minute and lung sounds with fine crackling rales in both lung fields. He has mild enlargement of neck and groin lymph nodes. Labs: WBC 15,200, HGB 8.5, HCT 26.3. CXR-haziness and bilateral infiltrates both lungs. Sputum and blood cultures are pending. He states he has been taking Robitussin 2 tsp every 4-6 hours and Advil 800 mg for body aches. He has not seen a doctor for many years. He is here in the ED and is going to be admitted for further treatment and work-up.

He tells you he is worried because he does not live in this area and was just driving through when he became SOB and had to come to the ED. He has no family or friends close by. He is married but he and his wife are in the process of getting a divorce so he is also afraid he is going to lose his health insurance.

I have to come up with 8 NDX and a primary (priority) NDX- any suggestions???

So far I came up with Ineffective airway clearance r/t copious secretions as one of the possibilities. Any suggestions would greatly be appreciated!!

[registerednutrn, BSN, RN]

Well how about something psych social related to fear or loneliness. Ineffective tissue perfusion, you can figure out the related to for this one. Activity intolerance again you figure out the related to. Maybe this will help get you started thinking. Also think about possible pathos for the symptoms presented and that may help you.

[roser13, ASN, RN]

Pretend there is no internet. Then think your way through your homework.

That is how you build your critical thinking skills.

[firstinfamily, RN]

How about---Lack of support systems--this would touch on the lack of medical and family support due to his occupation. Discharge planning should include some type of follow-up placement for him. Sounds by the WBC count he will need some form of antibiotic treatment, so it will be important that he completes all of the treatment. Lack of knowledge would touch on his potential to not be willing to stay for a long hospitalization and to complete all of the antibiotic treatment. What other treatments would you do for ineffective breathing???

[EbonyLaShonda]

Thank you all for your suggestions!!!! I am building on my critical thinking skills, but I thought that a little feedback would be able to help me process the case study and point me in a decent direction.