hello im a new nursing student working on a case study and i need help

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The change of shift report tells you that Ms. Brenda Paisley, a 35years old homeless woman was admitted with acute asthma and cellulitis of her right foot . She had a very restless night. She is still dyspneic at 28 breaths/min and still demonstrating inspiratory and expiratory wheezes and complains of shortness of breath. She is maintaining an oxygen saturation of 90 to 92 % on oxygen at 2L/min via nasal cannula. On examination, she is restless but oriented to person, place and time. Her skin is cool and moist. She states, I don't feel so good and my foot is really hurting me. I don't feel like much breakfast because of the pain and the difficulty breathing”. She further states, I don't know what is happening to me. I can't make it to the bathroom and so I just wet myself and the bed. I feel so embarrassed”

.V/S BP: 149/88, P:98, R:28, O2 Sat: 90%, T: 99.1

INSTRUCTIONS:

1. From the above case, identify the five priority needs for the patient giving rationale for each need indicated. (5 marks)

2. Write 5 appropriate assessment from the case based on the need selected (one per need). (5 marks)

3. Select an appropriate NANDA label for each assessment you have written from the 2015-2017 copy (find this document uploaded in the learning resources). (5 marks)

4. Write a client related goal (short/ long term) for each Nanda label. ( 5 marks)

5. In your own words state five (5) interventions for each goal. ( 12.5 marks)

6. APA referencing, Times New Roman, size 12, double spacing. (2.5 marks)

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Specializes in Nephrology, Cardiology, ER, ICU.

Hi there. Can you show us what you have so far?

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The change of shift report tells you that Ms. Brenda Paisley, a 35years old homeless woman was admitted with acute asthma and cellulitis of her right foot. She had a very restless night. She is still dyspneic at 28 breaths/min and still demonstrating inspiratory and expiratory wheezes and complains of shortness of breath. She is maintaining an oxygen saturation of 90 to 92 % on oxygen at 2L/min via nasal cannula. On examination, she is restless but oriented to person, place and time. Her skin is cool and moist. She states, I don't feel so good and my foot is really hurting me. I don't feel like much breakfast because of the pain and the difficulty breathing”. She further states, I don't know what is happening to me. I can't make it to the bathroom and so I just wet myself and the bed. I feel so embarrassed”.

V/S BP: 149/88, P:98, R:28, O2 Sat: 90%, T: 99.1

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Specializes in Education, FP, LNC, Forensics, ED, OB.

What the Admin was talking about is what have you come up with in regards to the Instructions given?

INSTRUCTIONS:

1. From the above case, identify the five priority needs for the patient giving rationale for each need indicated. (5 marks)

2. Write 5 appropriate assessment from the case based on the need selected (one per need). (5 marks)

3. Select an appropriate NANDA label for each assessment you have written from the 2015-2017 copy (find this document uploaded in the learning resources). (5 marks)

4. Write a client related goal (short/ long term) for each Nanda label. ( 5 marks)

5. In your own words state five (5) interventions for each goal. ( 12.5 marks)

6. APA referencing, Times New Roman, size 12, double spacing. (2.5 marks)

We do not mind helping you with your Case Study homework, but you will need to show your work first.

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for each priority I came up with a diagnosis and also a rationale.

For ineffective airway clearance r\t asthma aeb sob wheezing etc

for my rationale I would encourage the client to take deep breath as it would promote oxygenation

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for the tissue perfusion i would elevate the affected foot with a pillow this would promote good circulation.

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Specializes in Pediatrics Telemetry CCU ICU.

Priority One: Breathing

Nursing Diagnosis: Alteration in respiratory status due to ineffective breathing pattern/ restrictive airway clearance

a. Acute asthma

b. Anxiety/ restlessness

Interventions:

a.Provide respiratory medications and O2 as per physician's orders. Rationale: Respiratory medications reduce inflammation thus enhancing airway clearance as well as liquifying secretions to aid patient to expectorate excess secretions. Supplemental oxygen helps reduce hypoxemia and relieve respiratory distress.

b. Monitor vital signs and O2 Sats. Rationale: Vital Signs and Oxygen Saturations will alert personnel to changing respiratory status.

c. Assess ABG's as prescribed. Rationale: Blood gas monitoring will allow a view of the oxygenation of arterial flow.

d. Auscultate breath sounds, rate, and rhythm. Rationale: frequent monitoring of breath sounds, rate and rhythm will alert personnel to changes in mechanical respiratory status.

e. Assess skin color and mucous membranes for signs of cyanosis or pallor. Rationale: Changes in skin tone, color, and turgor may indicate circulatory changes due to respiratory status.

f.Encourage slow, pursed lip breathing and calming exercises. Rationale: Allows patient to participate in maintaining respiratory status and improve ventilation.

g. Provide anti-anxiety medications as prescribed. Rationale: Providing prescribed anti-anxiety medications aids in patient relaxation and calming techniques to slow patient's breathing.

h. Maintain at least a semi-Fowlers (45 degrees or more) head of bed position. Rationale: Promotes comfort, chest expansion, and ventilation of lung fields.

i. Provide Chest Physiotherapy (and Pulmonary Toilet if appropriate) to enhance secretion expectoration. Rationale: Chest Physiotherapy, suctioning and assisted ventilation aid in clearing airway of trapped mucous.

Expected Outcomes:

a. Patient's respiratory rate remains within established limits.

b. Patient's Vital signs return to within normal limits

c. Patient's O2 Sats stay above 94% without supplemental oxygen.

d. Patient's O2 will titrate down to room air.

e. Patient's breath sounds will be clear and symmetrical without wheezes, rales or rhonchi

f. Patient's skin color and mucous membranes will return to pink .

g. Patient's ABG levels return to and remain within established limits.

h. Patient indicates, either verbally or through behavior, feeling comfortable when breathing.

i. Patient reports feeling rested each day.

j. Patient performs deep, pursed-lip breathing.

k. Patient demonstrates good lung expansion with adequate ventilation.

Patient Goals:

Patient will maintain asthma control by:

a. Patient and family will learn about asthma (chronic inflammatory), purpose and action of medications, triggers to avoid and how to do so, and proper inhalation technique.

b. The patient will learn how to implement an action plan and how and when to seek assistance.

c. The nurse will obtain current educational materials for the patient based on the patient's diagnosis, causative factors, educational level, and cultural background.

d. The patient will understand that good asthma control includes an adherence to prescribed therapy, preventive measures, and the need for follow-up appointments.

e. The patient will be referred to home health nurse as indicated and/ or appropriate.

f. Patient and family will understand that a Home visit to assess for allergens may be indicated (with recurrent exacerbations).

g. The patient will attend and be referred to a community support group.

h. Patient and families will understand the importance of health promotion strategies and recommended health screening.

Priority Two: Circulation

Nursing Diagnosis: Risk for ineffective peripheral tissue perfusion.

a. Cellulitis of the right foot.

Annndddd so on………..

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Prority # 3

Imbalance nutrition less than body requirements

discuss with the client basic food grouos that are required for improvement

rationale- It will determine the clients basic knowlege and undersatnding

dicusss foods like/dislike

#4

Insomina

determine the clients sleep and activity pattern

rationale the amt of sleep the client need will result or varies with their age

#5 ineffctive coping

encourage the pt to identify their strenght and weakness

rationale- pt will develop strategies for their coping mechanism

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What's your rationale for elevating the foot? If you think she has arterial disease, elevating it will decrease circulation. If you think she has venous disease or lymphedema, elevating it will decrease edema by increasing venous and lymphatic drainage, but this is not the same thing as increasing circulation. Think about that.

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Specializes in Pediatrics Telemetry CCU ICU.

Well looking at just words on a page is easy and from the limited knowledge of the patient it would be hard to tell if there is PAD or PVD. From just the description, I would elevate the extremity. She is 35 years old and homeless. Many homeless get athletes foot, which oftentimes causes cellulitis in a small cut or break in skin. A history of Asthma doesn't necessarily cause PVD or PAD. The cellulitis is the inflammation of the subcutaneous areas of the skin and so it is not a circulatory problem (well technically circulation problems will hinder healing but....). Elevation (higher than hip area) will aid in both arterial and venous return. If she indeed had a cardiac or circulatory history, I would rethink that.

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Well looking at just words on a page is easy and from the limited knowledge of the patient it would be hard to tell if there is PAD or PVD. (cut text) Elevation (higher than hip area) will aid in both arterial and venous return. If she indeed had a cardiac or circulatory history, I would rethink that.

No, the original description says specifically "cellulitis," and neither venous or arterial disease. There is no such thing as "arterial return," and elevating an extremity with inadequate arterial flow will decrease its perfusion, not usually a desirable state of affairs, LOL. Never, ever elevate an extremity with arterial insufficiency.

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