pulmonary disorder case study

I can't figure out how to update my post....

Here's what else I've come up with:

1. the orders seem fine to me... a little curious about the KCL. I'd want to know Potassium levels before I actually gave it, right??

6. Respiratory distress due to the collapsed alveoli

7. Immobility increases the risk for atelectasis.

Still very unsure of #8. I do have

Posistion pt on ?? side (not sure if I use affected side or not) or maybe semi-fowlers??

Admin 02

Notify doctor

that's only 3... I need 5!

9. change posistion freq. Encourage early Ambulation. Encourage Deep brathing and coughing. Teach/reinforce appropriate technique for IS

10. I don't know 3 outcomes... only 1?

Improved lung expansion.

Would decreased respirations and decreased pulse rate be an outcome??

12. I'm not sure what I'd do differently?

obtain culture to ID cause

dr. would prescribe antibiotics???

I'll address a few of your questions.

#1. Why would you put potassium in the fluids? What causes low potassium?

#8. How can you tell what's going on with her (ie, are there any other means of looking to see if she's developing atelectasis or pneumonia)? What assessment questions can you ask her? I agree that positioning her with HOB elevated and notifying the physician are good--why would you apply O2? How do you know what her sats are? What questions do you think the physician will ask you?

#9. How can you implement those? What are some barriers to the implementation of TB&C and ambulation that you could address?

#10 Think simple on the outcomes as well.

#12 What are you going to culture? How does one treat pneumonia vs atelectasis? Think meds, think types of RT tx.

You're doing well, keep going!

Thanks Bluegrass. I put that all orders were appropriate, however, I would need to check the K blood levels before administering the KCL.

#8. I suggested placing the patient in semi-fowlers to allow for greatest oxygenation. Assess for respitory distress by taking vitals, auscultating and monitoring SPO2. Start 02 if indicated. Notify MD. I'm still missting 2 actions though

#9. Pain is a barrier to TCDB and ambulating. I would premedicate. ??

10. These interventions will promote lung expansion, clear breath sounds and allow patient to remain free from respiratory distress.

12. Sputum culture to determine type of pneumonia. I would anticipate the MD to order antibiotics. Rocephin or levaquin if the pneumonia is bacterial.

Am I missing anything??

I just had a classmate catch something... Morphine should be given IV, not IM.

#8, as well as medically monitoring the patient via objective numerical results like vital signs - look at your patient! What colour is her skin (is it blue, is it cold/pale/clammy, is she cyanotic?) Are her respirations laboured? Can you see her chest significantly rising and falling? How is she breathing (mouth breathing etc)? Has she thrown all the blankets off because she's overheating from the physical effort of attempting to breathe and therefore oxygenate her system (my gran has respiratory failure and this is one I see all the time in her.) Ask her how she feels she's breathing - does she feel short of breath?

The machines are brilliant tools, but they don't mean anything unless you're actually looking at your patient and observing what it really happening to them, as opposed to what they machines are telling you might be happening.

#1. I suggest you look up the causes of low potassium; I think you'll find your answer there. Potassium in IV fluids is standard with one of the issues your patient has.

#8. You've got repositioning, check vitals, notify MD, start O2 if indicated. Rachael mentioned a complete, thorough respiratory assessment. How does she look? Is she short of breath? Does she have a cough, and if so, is it productive? What are her respirs like--shallow, fast, slow (could she be over sedated, or could she not be breathing deeply because of the pain? Has she been sleeping hard?) How does she appear after repositioning--did her sats/respirs improve? How does she feel--does she feel short of breath, ill, fatigued; or is she feeling pretty good? What do her tests say? Didn't she have a CXR this morning? What about labs, did they do a CBC?

#9 Absolutely you are going to premedicate if necessary. What else can you do to relieve her pain--how about a splint pillow for when she coughs or repositions? You should also educate her and her family on the potential for post-surgery lung complications, and you are going to educate her on the use that ISP and encourage her to do it at least every two hours while she's awake. ISP is VERY important. Maybe you could get her up to a chair for meals TID after she has successfully dangled, in addition to making sure she ambulates. Educate, educate, educate, reinforce education, provide written info if possible, support, and educate!!!

#12. The only thing I would add is that with pneumonia, they often order RT tx. With atelectasis, unless the pt is having a hard time, we typically do more ISP, TDB&C, and increased activity.

You're doing well!