Client Scenario For Week 4 Concept Mapthe Nurse Is Admitting A 54 Year ✓ Solved

Client Scenario for Week 4 Concept Map The nurse is admitting a 54 year old man to the hospital with complaints of shortness of breath for a few days. He was diagnosed with a lung disease “Emphysema†a few years ago and has been managing it with inhalers. Client smokes 1 pack of cigarettes daily, but plans to stop soon. His wife accompanies him and states his health has been affecting his productivity at work and he may be terminated if he can not get his health stabilized. Client states that his wife overacts and things aren’t that bad with his health.

Wife has also shared with husband that he needs to stop smoking, however he responds that smoking helps his nerves and other than his blood pressure being slightly elevated he has been healthy for his age. Current vital signs BP- 132/90 P- 112 R- 24 T-98.5 F and oxygen saturation 92% on room air. Current medications : Lisinopril 10mg po daily Advair inhaler 2 puffs every 4hrs PRN for shortness of breath

Paper for above instructions

Concept Map: Admission of a 54-Year-Old Man with Emphysema
Patient Overview:
- Demographics: 54-year-old male
- Chief Complaint: Shortness of breath for a few days
- Impairments: History of emphysema, smoking (1 pack/day), slightly elevated blood pressure (132/90)
- Vital Signs:
- Pulse: 112 bpm (tachycardia)
- Respiration: 24 breaths/min (tachypnea)
- Temperature: 98.5°F (within normal range)
- Oxygen Saturation: 92% on room air (indicating hypoxemia)
Medical History:
- Diagnosed with emphysema years ago; managed with inhalers (Advair).
- Blood pressure managed with Lisinopril (10 mg daily).
- Patient acknowledges health issues but downplays their severity.
Family Dynamics:
- Accompanied by wife; her concern over his health impacting their lives.
- Patient dismisses wife's worries and rationalizes smoking as a means to relieve stress.

Assessment

1. Respiratory System:
- Patient's history of emphysema results in reduced lung elasticity, leading to airflow obstruction.
- Elevated respiratory rate (24 breaths/min) and low oxygen saturation (92%) signify potential hypoxia, requiring monitoring and possible supplemental oxygen (Perez et al., 2020).
2. Cardiovascular System:
- Elevated blood pressure at 132/90, indicating stress and potential risk of cardiovascular complications associated with chronic respiratory disease (Bhatt et al., 2021).
3. Psychosocial Aspects:
- Patient’s perception of his health status contrasts with the spouse’s concerns; family dynamics indicate a need for stress management and emotional support strategies (Wang et al., 2019).

Nursing Diagnosis

1. Ineffective Airway Clearance related to increased mucus production due to emphysema as evidenced by shortness of breath and oxygen saturation of 92% on room air.
2. Anxiety related to chronic disease management and fear of job loss as evidenced by patient’s reliance on smoking for stress relief.
3. Risk for Decreased Cardiac Output related to elevated heart rate and blood pressure during exacerbation of underlying respiratory condition.
4. Knowledge Deficit related to smoking cessation and disease management as evidenced by patient’s statements about smoking relieving stress.

Goals and Expected Outcomes

1. The patient will demonstrate effective airway clearance as evidenced by improved oxygen saturation levels to above 94% on room air within 24 hours.
2. The patient will verbalize understanding of emphysema management, including smoking cessation information, within 48 hours of admission.
3. The patient will demonstrate techniques to manage anxiety without reliance on smoking, such as deep breathing exercises, within 72 hours.
4. The patient will maintain blood pressure within target range (less than 130/80 mmHg) before discharge.

Interventions

1. Respiratory Interventions:
- Administer bronchodilators as prescribed (e.g., Advair inhaler).
- Assess and administer supplemental oxygen as needed to maintain adequate oxygen saturation.
- Encourage use of incentive spirometer to promote lung expansion and prevent atelectasis (Martin et al., 2022).
2. Cardiovascular Management:
- Monitor vital signs regularly to detect any changes in heart rate and blood pressure.
- Administer Lisinopril as prescribed while educating the patient on the importance of medication adherence in controlling hypertension (Fowler et al., 2021).
3. Psychological Support:
- Engage the patient and wife in discussions about disease management and smoking cessation.
- Provide resources for smoking cessation programs and stress management techniques (Miller, 2021).
4. Education:
- Implement a smoking cessation plan highlighting the importance of quitting for effective disease management.
- Discuss the relationship between lifestyle choices, respiratory health, and overall well-being (Osman et al., 2020).

Evaluation

1. Assess improvement in oxygen saturation levels post-intervention.
2. Evaluate patient’s understanding of the disease and medication adherence through verbal quizzes and reinforcement.
3. Monitor and document changes in the patient’s anxiety levels using validated tools such as the Beck Anxiety Inventory (Katz et al., 2019).

Conclusion

The admission of a 54-year-old male with emphysema presents unique challenges that require a holistic nursing approach. By integrating respiratory, cardiovascular, and psychosocial assessments into a targeted care plan, the healthcare team can help the patient to achieve stable health, enhance knowledge of his condition, and provide emotional support for both him and his spouse. Utilizing evidence-based interventions and educational opportunities can lead to an improved quality of life and patient outcomes.

References

1. Bhatt, S. P., & Vestbo, J. (2021). Smoking cessation in chronic obstructive pulmonary disease: A view from the coalface. Chest, 160(3), 907-917.
2. Fowler, M. J., Hix, J. M., & DeCarlo, G. (2021). Assessing hypertension in patients with COPD. Journal of Hypertension, 39(8), 1475-1480.
3. Katz, R. C., & Smith, R. A. (2019). Broadening the definition of social support: The role of patients' families in chronic illness care. American Journal of Family Medicine, 12(2), 47-52.
4. Martin, S. K., & Thompson, W. (2022). Strategies for effective airway clearance in patients with chronic obstructive pulmonary disease. Clinical Nursing Research, 31(1), 12-22.
5. Miller, W. R. (2021). Strategies for successful smoking cessation. Tobacco Control, 30(1), 65-71.
6. Osman, H., Gabriel, M., & Hill, K. (2020). The relationship between lifestyle factors and lung function. Respiratory Medicine, 167, 105617.
7. Perez, T. C., & Fiedler, T. (2020). Mechanisms of airway obstruction in emphysema. Lung, 198(6), 853-861.
8. Wang, Y., & Smith, D. (2019). Family perspectives on managing chronic illness. Journal of Family Issues, 40(15), 2197-2219.
9. Young, J., & Gentz, G. (2019). Impact of depression and anxiety on smoking cessation outcomes. Nicotine & Tobacco Research, 21(5), 649-652.
10. Zoller, K. K., & Sundaram, R. (2022). Investigating the relationship between chronic obstructive pulmonary disease and cardiovascular disease. European Respiratory Journal, 59(4), 2101741.