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Katherine Bowen Activity Part 1

NUR 130 AY 2023-24

Begin Part 1 – 5 Points – each question is worth 1 point

HEALTH CARE PROVIDER PRESCRIPTIONS/NOTES

September 15

CHIEF COMPLAINT:

“I’ve been sick for quite a while and I’m not getting any better.”

HISTORY OF PRESENTING ILLNESS (HPI):

Ms. Katherine Bowen presents to the Emergency Department (ED) complaining of a productive cough of green phlegm that started three days ago. Just previous to that, she was started ago on prednisone 40 mg PO daily and azithromycin (Zithromax) 250 mg PO x 5 days by her Health Care Practitioner. The diagnosis was Acute Tracheobronchitis. Though she has had intermittent chills over the last three days, she had a fever last night of 102.0 F/38.9 C. She has had more difficulty breathing during the night and has been using her albuterol inhaler every 1-2 hours with no improvement so she called 9-1-1 and is brought to the emergency department (ED) where you are the nurse who will be responsible for her care.

PAST MEDICAL HISTORY:

Ms. Bowen has diagnosed Chronic Obstructive Pulmonary Disease and Anxiety. She has an allergy to sulfa medication.

PERSONAL/SOCIAL HISTORY:

Katherine, or Kate as she likes to be called, lives at home with her husband of 64 years Xander. They live alone independently though their two adult children live less than 30 minutes away. She is a retired elementary school teacher. She called her pastor before coming to the ED and he has now arrived and came back with the patient. The nurse walked in the room when the pastor asked Kate if she would like to pray. The patient said to her pastor, “Yes please, I feel that this may be the beginning of the end for me!”

MEDICAL DIAGNOSIS:

Pneumonia

Dr. Andrea Larson, MD

1. Based on the history of presenting illness (HPI) what cues do you recognize from the histories is has clinical significance to the nurse? There are 4. Remember, the HPI is not her medical history, it is the signs and symptoms she presenting with and treatments already started. (1 pt)

Recognize Cues from Present Problem:

Analyze Cues - Why is it important?

1.

2.

3.

4.

Vital Signs in the ED:

VITAL SIGNS

Vitals / Date-Time

9/8/xx

9/15/xx

.

Temperature

98.6F / 36C (oral)

103.2F / 39.6C (oral)

Pulse

85 (regular)

110 (regular)

Resp.

22

30 (labored)

Blood Pressure

122/85

178/96

O2 Sat

93% RA

86% (6LNC)

Pain

0/10

3/10

Quality

n/a

Ache

Region / Radiation

n/a

Generalized over right side of chest with no radiation

Timing

n/a

Intermittent – lasting a few seconds

2. While reviewing Ms. Bowen’s vital signs taken in the Emergency Department, what about the cues n the vital signs are clinically significant (important)? There at least 6 (1 pt)

Recognize Cues from Vital Signs

Analyze Cues - Why is it important?

1.

2.

3.

4.

5.

6.

NEXT PAGE

LAB RESULTS

Lab Result

9/8/xx

9/15/xx

Normal Range

WBC

8.2 mm/dl

14.5 mm/dl

4.5-11 x 109/L

Hgb

12.8 g/Dl

13.3 g/Dl

12-16g/Dl

Hct

37.4%

39.9%

36-48%

Platelets

298 / L

277 / L

150-450x103/L

Neutrophil %

75

92

42-72

Band Forms %

1

5

3-5

Sodium

142 mEq/L

138 mEq/L

135-145 mEq/L

Potassium

3.8 mEq/L

3.9 mEq/L

3.5-5.0 mEq/L

Co2 (Bicarb)

31 mmol/L

35 mmol/L

21-31 mmol/L

Glucose

102 mg/Dl

112 mg/Dl

70-110 mg/Dl

BUN

28 mg/Dl

32 mg/Dl

7-25 mg/Dl

Creatinine

1.0 mg/Dl

1.2 mg/Dl

0.6-1.2 mg/Dl

Lactate

n/a

3.2 mmol/L

(0.5-2.2 mmol/L)

3. What 2 cues in the Complete Blood Count (CBC – is not highlighted) lab results are a priority that should be recognized when treating the client? There at least 2 (1 pt)

Recognize Cues from CBC

Analyze Cues - Why is it important?

1.

2.

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Lab Results:

4. What 5 lab results from the Basic Metabolic Panel (BMP are highlighted) lab results are a priority that should be recognized when treating the client? There are at least 5 (1 pt)

Recognize Cues from BMP

Analyze Cues - Why is it important?

1.

2.

3.

4.

5.

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LAB RESULTS

ABG

9/15/xx

Normal Range

pH

7.25

7.35-7.45

pCO2

68

35-45

PO2

52

80-100

Hco3

36

18-26

O2 Sats

34%

>92%

Interpretation: Respiratory Acidosis partially compensated

5. What 2 cues in the Arterial Blood Gas (ABG) lab results are a priority that should be recognized when treating the client? (1 pt)

Recognize Cues from ABG

Analyze Cues - Why is it important?

1.

2.

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BONUS QUESTIONS

6. Based on the additional personal and social history of presenting illness (HPI) what cues are important to note that are a priority that should be recognized when treating the client? There are at least 2 (Bonus) No points associated with this

Recognize Cues from Social History:

An analyze Cues - Why is it important?

1.

2.

BONUS – Math Practice. No points associated with this.

The Health Care Practitioner adds the following order:

Levofloxacin 750 Mg/150 ML In 5 % Dextrose Intravenous Piggyback

infuse at a rate of 150 mg an hour.

7. How many mL an hour to you set the infusion pump to run? ________ mL/hr

8. Ms. Bowen asks how long the antibiotic will be running for. Your answer ___________

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