Profile number 3
Christopher Lando
School of Nursing, Liberty University
031-001: Strategies for Adult Health Care I Clinical
Mrs. Ranson
10/09-10/2020
1
PATIENT PROFILE WORKSHEET
Clinical Date: _ 10_ / _ 9-10_ / _ 20_
A. Personal Information
Room # _ 444_ Gender _ F_ Ethnicity _ White_ Age if <90 _ 73_
Place of Residence: _ home_ MD _ Madala Sushma_
Emergency Contact: _ Husband_ Marital Status _ Married_
Admitting Diagnosis: _ Pneumothorax_
Co-Morbidities: _ Arthritis, COPD, Diverticulosis, Hypercholesterolemia, HTN, Menopause,
Osteoporosis, Thyroid disease_
Date of Admission: _ 10/06/20_ Date of Surgery: _10/06/20_ Allergies: Morphine, Nickel,
Aleve__
Code Status: _ Full_ Mental Status: _ A&Ox4_
B. Activity and Nutrition
Diet order: _ Liquid_ Route/Rate: _ NL_ Last Wt: _ 34.5 kg (76 lbs)_
Level of Activity (bedrest, up ad lib, BRP, turning): _ up ad lib_
Level of self-care: ambulate w/ assist x1__
C. Nursing Care
Drainage devices (foley, NGT, JPs, T-tube, etc.): _ chest tube right side_ NGT Flushes:
_ no_
Wound care/Dressing (be specific): _ for chest tube, posterior right lower lobe_
IV access (peripheral, central, location, care): _ peripheral right AC, right anterior wrist, left
posterior wrist_
IVF: _ no_ @ _ n/a_ mL/hr Saline Lock? _ yes_ TPN? _ no_
Frequency of vital signs (including pulse oximetry): _ Q 4 hrs_
2
Frequency of Glucometer: _ none_ Supplemental oxygen: _ 4 lpm via NC_ OSA _ no_
Falls Risk _ High_
Precautions: _ None_
3
Most Recent Labs
Lab Normal range Patient value Date/time Out of range?
CBC
WBC 4500-11000 nL 7600 10/09/20 @
0258
WNL
RBC 4000000-5200000 nL 3630000 10/09/20 @
0258
Low
Hb 12.5-16.0 g/dl 11.2 10/09/20 @
0258
Low
Hct 36-46% 34.9 10/09/20 @
0258
Low
MCV 80-100 nm^3 96.1 10/09/20 @
0258
WNL
MCH 26-34 pg/cell 30.9 10/09/20 @
0258
WNL
MCHC 31-37 g/dl 32.1 10/09/20 @
0258
WNL
RDW 11.5-14.5% 13.8 10/09/20 @
0258
WNL
Plts 165000-415000 /ml 256000 10/09/20 @
0258
WNL
CHEM 12
Na+ 133-143 mEq/dl 146 10/09/20 @
0258
High
K+ 3.5-5.1 mEq/dl 2.6 10/09/20 @
0258
Low
Cl- 98-107 mEq/dl 107 10/09/20 @
0258
WNL
TCO2 22-28 mEq/dl 35 10/09/20 @
0258
High
Anion Gap 7-16 mEq/dl 4 10/09/20 @
0258
Low
Glucose 70-100 mEq/dl 152 10/09/20 @
0258
High
BUN 7-20 mg/dl 17 10/09/20 @
0258
WNL
Cr 0.6-1.2 mg/dl 0.55 10/09/20 @
0258
WNL
Calcium 9.0-10.5 mg/dl 7.6 10/09/20 @
0258
Low
Total protein 6.3-8.2 g/dl NL N/A N/A
Albumin 3.5-5.5 g/dl NL N/A N/A
AST 0-35 IU/L NL N/A N/A
4
ALK 38-126 IU/L NL N/A N/A
Total bilirubin 0.3-1.0 mg/dl NL N/A N/A
ALT 0-35 IU/L NL N/A N/A
GFR >60 mOm/Kg >60 10/09/20 @
0258
WNL
Osmolality 275-295 mOm/Kg NL N/A N/A
OTHER LABS
Neutrophils 2.0-6.8 6.8 10/09/20 @
0258
WNL
lymphocytes 1.5-3.5 0.2 10/09/20 @
0258
Low
Monocytes 0.3-1.0 0.5 10/09/20 @
0258
WNL
Eosinophils 0.0-0.6 0.0 10/09/20 @
0258
WNL
Basophils 0.0-0.2 0.0 10/09/20 @
0258
WNL
[CITATION RHm10 \l 1033 ]
Other Diagnostic Tests
Diagnostic Study Date & Time Results
EKG
RADIOLOGY EXAMS 10/06/20 @ 1803 (Chest X-ray) Pneumothorax; admission
Vital Signs
Date/Tim
e
Temp HR RR BP SpO2
10/09/20 97.3 103 19 145/94 98% on
4lpm
via NC
10/10/20
@ 0745
98.2 95 18 129/66 97%
3lpm
via NC
10/10/20
@ 1150
98.0 94 15 129/59 96%
3lpm
via NC
PATIENT HISTORY WORKSHEET
5
Chief complaint:
Shortness of breath
History of Present Illness:
Presented to ER with expiratory wheezing, intercostal contractions while breathing, labored
breathing, and feeling of distress
Past Medical History:
Arthritis, bladder cancer, COPD, Diverticulitis, Hypercholesterolemia, HTN, Lung cancer x2,
Menopause, osteoporosis, smoker for 52 years, stroke, thromboembolism, thyroid disease.
Past Surgical History:
Colonoscopy, chest surgery (tumor removal), C-section, lobectomy x2, tonsillectomy, bypass
Family History:
HTN, Macular Degen, stroke, pancreatic cancer, lung cancer, breast cancer
Tobacco _ 52 year history_ Alcohol _ yes, infrequent_ Illegal Drugs _ no_
Occupational Status _ retired_
Religious Preference _ NL_
Cultural Support Needs _ NL_
PHYSICAL ASSESSMENT
GENERAL: (overall assessment)
Sickly appearance, poor respiratory status. Very sweet lady, not in poor spirits. Hopefully for
recovery
HEENT: (ED only)
Click or tap here to enter text.
CARDIAC: (heart sounds, rate, rhythm, pulses, circulation, etc)
6
95 bpm, NSR, present and equal pulses in the extremities (pedal and radial), only sounds heard
were S1 and S2
RESPIRATORY: (lung sounds, work of breathing, O2 sat)
96% 3lpm via NC, not on home O2. Just quit smoking last month after 52 years. Clear lung
sounds, nonlabored, tachypneic. Chest tube in place
ABDOMEN/GI: (bowel sounds, overall assessment)
Normal, flat stomach, non-distended
GU: (urinary output, catheters, etc.)
Straw/yellow, clear, no scent
MUSCULOSKELETAL: (strength, gait, mobility status)
Equal strength, needs assistance ambulating
INTEGUMENT: (list any wounds, dressings, other issues)
3 IV’s in place (peripheral right AC, right anterior wrist, left posterior wrist) Chest tube posterior
right side.
NEURO: (A&O x 4, pupils, etc.)
A&Ox4, PERLA, desire for speedy recovery.
7
PATHOPHYSIOLOGY
The patient, seventy three year old female presented to the emergency room after
experiencing a few days of progressively worsening respiration status. The patient had audible
expiratory wheezing in the emergency department, she had shortness of breath, tachypnea,
labored breathing with intercoastal contractions, and an overall feeling of distress and
unwellness. Quickly a chest X-ray was obtained and discovered a spontaneous pneumothorax,
the patient was admitted and prepared for an insertion of a chest tube. Fluid was also present in
the pleural space, but the main concern was the tracking air up the patient’s chest and into her
throat. Patient was admitted to allow for drain to work over the next few days and slowly build
the patient back up into a functional state. She has the desire and determination to heal, this just
takes some time. Her past medical history is Arthritis, Chronic Obstructive Pulmonary Disease
(COPD), Diverticulosis, Hypercholesterolemia, Hypertension (HTN), Menopause, Osteoporosis,
Thyroid disease, stroke, smoker for 52 years, lung cancer twice, thromboembolism, and a
bypass.
A pneumothorax is the presence of air inside the pleural space of the lungs. This is caused
by a rupture bleb or alveolar sac; which air then seeps through. The increased amount of air
flowing into the empty space will cause a backwards pressure onto the lung itself which can if
left untreated cause a collapsed lung. Once trapped inside the pleural space the air is slow to
dissipate, so the more that leaked the bigger the issue will be. In the case of this patient her
pneumothorax was large enough to allow for interstitial fluid to build up inside the base and the
body swelled in an immune response. There are two types, primary and secondary. Primary being
8
in a healthy person which the spontaneous event is truly spontaneous. And the secondary in a
person with risk factors such as smoking, asthma, COPD, etc. [ CITATION McC19 \l 1033 ]
In the instance of this patient she has a secondary pneumothorax based on her history of
smoking and COPD. Secondary is worse because the injury is the same as in primary but with
the additive underlying injury that provoked the bleb rupture. COPD risks airway
hyperresponsiveness and when subjected to a pollutant will have an inflammatory response. The
inflammation will trigger the bronchial wall to constrict in size, because a tube under pressure of
edema will collapse on itself verses expanding outwards. COPD also increases the amount of
mucus that gets secreted both resting and in the inflammatory response of an allergen. The
continual stretching will eventually lead to loss of elastic potential of the elastic fibers inside the
bronchioles themselves. [ CITATION Hea19 \l 1033 ]
Smoking is another risk factor for a pneumothorax due to the introduction of nicotine.
Which bind to the catecholamine receptors acting as a beta cell agonist. Meaning that
Epinephrine effects in the sympathetic nervous system response are heightened, which in turn
causes bronchial dilation, vasoconstriction, shunting of blood to skeletal muscles, and an
increased heart rate. Nicotine in the sense of bronchial constriction will act to wear out the elastic
fibers inside the bronchial cell wall lining. Over time the stretch will reduce until the response is
almost zero. Not to mention that smoking induces tobacco into the lungs, which are a pollutant,
which further exacerbates the lungs into extra secretion of mucus. Extra mucus blocks the ability
for the gas exchange in the little bronchioles leading to the alveolar sacs. These sacs are where
carbon dioxide from the blood is exchanged for oxygen from the atmosphere, when this process
is messed up the response is tachypnea to increase amount of potential air into the lungs. Another
issue is when the carbon dioxide is to high the pH levels in the blood are thrown off, which will
9
result in the compensatory change is the bicarbonate to help balance the blood pH.[ CITATION
McC19 \l 1033 ]
Smoking can cause a secondary pneumothorax, COPD can cause a secondary
pneumothorax, and smoking can cause COPD. So, the history of smoking most likely led to the
current history of COPD, COPD is the likely culprit here considering the patient states she quit
smoking last month but after 52 years the damage has been done. The heat from smoking burns
the mucus elevator in the lungs. The mucus elevator is the process by which micro villa will
slowly pull anything from inside the lungs up to the esophagus to be swallowed (or coughed
along route). Smoking burns and destroys these micro villas and prevent the constant movement
of mucus. This causes stasis of mucus in the lungs, which over time leads to an increase in
carbon dioxide remaining inside the deep alveolar sacs and ineffective perfusion. Which
overtime will become COPD, the risk for COPD is stasis mucus has an increased risk for
infection and pneumonia inside the lungs as well as the already mentioned change in gas
exchange and thus perfusion. In COPD a patient’s drive to breath is actually flipped, meaning
that rather than a normal patient who feels the need to breath in order exhale carbon dioxide and
exchange for oxygen. A patient with COPD will have the desire to breath come from the lack of
oxygen in their blood stream, so giving high flow oxygen to a patient with COPD can be
contraindicated in a long-term setting because this could cause a respiratory depression.
[ CITATION Dug19 \l 1033 ]
Smoking in conjunction with COPD acts as an increased risk for a pneumothorax, then
consequently a plural effusion. The smoking is adding a pollute to the lung which then reacts
because of the COPD by constricting, which reduces the exchange of gases. Emphysema is the
effect of COPD, which smoking exacerbates it through a process called proteolysis-
10
antiproteolysis. Smoking causes a decrease in the alpha one antitrypsin activity while
simultaneously causing the attraction of inflammatory cells. Which then causes the release of
elastase. Elastase causes the alpha one antitrypsin activity to decrease, an inherited deficiency in
alpha one antitrypsin, and the action of alpha one antitrypsin to become inhibited. Which will
lead to the destruction of elastic fibers in the bronchiole walls over extended time of being
subjected to this process. And no elastic fibers will reduce the capability to move gases, and for
the micro villa to work to clear the lungs. So the dirty the lungs get the dirtier they stay. This
entire process will result in mucus accumulation known as emphysema which causes a host of
issues.[ CITATION Dug19 \l 1033 ]
The patient also has a history of lung cancer, which depending on the type will cause a
physical alteration to the anatomical make up. Whether a tumor was removed and with it part of
a lobe. Or worse, if the entirety of a lobe is gone. For this patient she hasn’t lost a lobe rather just
had tumors removed (twice). In these areas the lungs have lost a portion of its alveolar sacs and
with that a percentage of its maximum potential to ventilate and exchange gas. So, adding COPD
and smoking all just increases the risk of her pneumothorax. Furthermore, the added potential for
complications in her healing process such as pneumonia, effusion, or secondary bleb pop.
[ CITATION McC19 \l 1033 ]
The patient’s signs and symptoms are self-expressed shortness of breath, tachycardia,
tachypneic, an increased blood pressure, a decreased vital capacity of the lungs, and audible
expiratory wheezing. These signs and symptoms were in the emergency room and were the
initial findings. The most recent has shown a decrease in the blood pressure (still elevated) and a
return to normal in all other categories except for vital capacity. However, this too is on the rise
back towards baseline and will continue to improve so long as the patient keeps doing her deep
11
breathing, spirometer, and ambulating a few times per nurses’ shift. Her most recent blood
pressure was 129/59. Her most recent set of labs show a decrease in the hemoglobin and the
hematocrit, as a result of the bleeding from the surgery and her natural state is probably slightly
anemic due to being underweight. Her body increased its blood pressure to maintain perfusion
while the patient felt pain and was unable to get all the oxygen, she normal would have been able
to. This led to the natural response to hold water, which means the sodium was held in and
calcium/ potassium were allowed to be excreted in small quantities. Her potassium was
immensely low originally at 2.6 which is dangerously low, resulting in prescription of a pill and a
bicarb drink both of which to increase the potassium. When potassium gets to low, it can and will
cause cardiac dysthymias. And with her history of clots and a stroke it is not a risk that should be
taken. Sodium was only slightly high at 146 and calcium was at 7.6 and her carbon dioxide
values were also elevated at 35 which is indicative of a gas exchange problem..[ CITATION
RHm10 \l 1033 ]
The patient was prescribed Albuterol to initially assist with perfusion. She was also
prescribed Albuterol-Ipratropium (Atrovent) to administer with Albuterol in the form of a duo
nebulizer. The patient has a history of arthritis and was prescribed Amlodipine to reduce the free
calcium from being taken away from the blood and delivered to the bones. She wears an
extended release nicotine patch to assist her as she is still going through cessation of smoking
measures. She was given potassium bicarbonate in the form of a drink mix to help boost her
potassium levels to maintain a healthy heart function. Ascorbic acid in the form of vitamins to
help her as her immune system is working hard and using resources. Aspirin to prevent blood
clotting that could be lethal given her history. Azithromycin which is prophylactically given to
prevent the development of pneumonia from sprouting up inside of her due to the fluid.
12
Pravastatin to reduce the levels of lipids which are normally elevated due to her history of
Hypercholesterolemia. But these values were in normal range on her last set of vitals.
Ceftriaxone also serves to prevent an infection from occurring in this patient whom is at a big
risk for one. Heparin is given to reduce the chance of a thrombus forming (also a reason to
regularly ambulate with the patient). Hydrochlorothiazide is given to secrete sodium and retain
potassium and calcium. Methylprednisolone is given to reduce the inflammatory response and
allowing for healing to occur much faster.[ CITATION Val19 \l 1033 ]
The patient is retired and thus needs to rely on Medicare or other insurance to help pay
for her hospital visit. The stay is most likely going to be around a week since she had to have ac
chest tube. Without insurance the average cost per stay is just over 4,000$ per day/night (24-hour
period). Hopefully this patient has insurance r can apply for a program to relieve the cost because
a week would be around 28,000$ plus cost for the chest tube insertion and paying the surgeon
whom inserted if it was through a private practice as opposed to the hospitalist.[ CITATION
Fay18 \l 1033 ]
The patient was admitted with a clinical diagnosis of pneumothorax. She was then given
a chest tube to allow for drainage of air and any accumulating fluid related to her history of
COPD and 52-year history of smoking. Her labs, vitals, and complaints are all on the return to
baseline four days post-surgery and is pointing towards a speedy recovery. Her attitude has a
large part to play, she is willing to work had at her treatment plan. She should be discharged
within the week, if no complications occur. Nursing care plan is to monitor for worsening
conditions pointing to another ruptured bleb or infection.
13
14
MEDICATION LIST
Medication
Generic & Trade Route Dosage &
Frequency
Category/
Mechanism of Action
Contraindications /
Cautions
Side Effects Use for this
patient
Trade
(Generic)
Albuterol
Accuneb,
Airomir,
Proair HFA,
Proair
Respiclick,
Proventil
HFA, Salbu
tamol,
Ventolin
HFA, Vento
lin Diskus,
Ventolin
Nebules,
VoSpire ER
Neb 2.5 mg
Single dose
Binds to beta2-
adrenergic receptors
in airway smooth
muscle, leading to
activation of adenyl
cyclase and increased
levels of cyclic-3′, 5′-
adenosine
monophosphate
(cAMP). Increases in
cAMP activate kinases,
which inhibit the
phosphorylation of
myosin and decrease
intracellular calcium.
Decreased
intracellular calcium
relaxes smooth muscle
airways. Relaxation of
airway smooth muscle
with subsequent
bronchodilation.
Relatively selective for
beta2(pulmonary)
receptors.
Contraindicated
in: Hypersensitivity to
adrenergic amines.
CNS: nervousness,
restlessness, trem
or, headache,
insomnia
(Pediatric: occurs
more frequently in
young children than
adults), hyperactivity
in
children. Resp: para
doxical
bronchospasm (exce
ssive use of
inhalers). CV: chest
pain, palpitations,
angina, arrhythmias,
hypertension. GI: n
ausea,
vomiting. Endo: hy
perglycemia. F and
E: hypokalemia. Ne
uro: tremor.
To combat the
COPD and
allow for good
oxygen intake
by the action
of
bronchodilatio
n. Which also
acts to help
reopen the
lung since the
pneumothorax
closed the
lower alveoli
Albuterol-
Ipratropium
Atrovent,
Atrovent HFA
Neb 2.5mg-
0.5/3ml
PRN Q 4 hr
Inhalation: Inhibits
cholinergic receptors
in bronchial smooth
muscle, resulting in
decreased
concentrations of
cyclic guanosine
Contraindicated
in: Hypersensitivity
to ipratropium, atropine,
belladonna alkaloids, or
bromide; Avoid use during
acute bronchospasm; Note:
Atrovent HFA has
CNS: dizziness,
headache,
nervousness.. EENT
: blurred vision, sore
throat; nasal
only- epistaxis, nasal
dryness/irritation. R
To combat the
COPD and
allow for good
oxygen intake
by the action
of
bronchodilatio
15
monophosphate
(cGMP). Decreased
levels of cGMP
produce local
bronchodilation. Local
application inhibits
secretions from glands
lining the nasal
mucosa.
replaced the discontinued
Atrovent CFC
(chlorofluorocarbon). Soy
and CFC-allergic patients
can now safely use the
Atrovent HFA formulation.
However, Combivent
(ipratropium/albuterol
combination) MDI does
contain soya lecithin and
is contraindicated in
patients with a history of
hypersensitivity to soy
and peanuts.
esp: bronchospasm,
cough. CV: hypoten
sion,
palpitations. GI: GI
irritation,
nausea. Derm: rash
. Misc: allergic
reactions.
n. Which also
acts to help
reopen the
lung since the
pneumothorax
closed the
lower alveoli.
Taken in
conjunction
with albuterol.
Amlodipine
Norvasc
PO 10 mg
daily
Inhibits the transport
of calcium into
myocardial and
vascular smooth
muscle cells, resulting
in inhibition of
excitation-contraction
coupling and
subsequent
contraction
Contraindicated
in: Hypersensitivity; Systolic
BP <90 mm Hg.
CNS: dizziness,
fatigue. CV: periph
eral edema,
angina, bradycardia,
hypotension,
palpitations. Derm:
flushing. GI: gingiva
l hyperplasia,
nausea.
Helping
reduce the
amount of
calcium being
transported
away from the
blood and help
raise the
patients
calcium levels.
Ascorbic acid
] Apo-C,
Ascor,
Ascorbicap,
Cebid, Cecon,
Cecore-500,
Cemill,
Cenolate,
Cetane,
Cevalin, Cevi-
Bid,
Flavorcee,
Mega-C/A
Plus,
Ortho/CS,
PO 500 mg
daily
Necessary for collagen
formation and tissue
repair. Involved in
oxidation reduction
reactions; tyrosine,
folic acid, iron, and
carbohydrate
metabolism; lipid and
protein synthesis;
cellular respiration;
and resistance to
infection.
Contraindicated
in: Tartrazine
hypersensitivity (some oral
products contain tartrazine—
FDC yellow dye #5).
CNS: drowsiness,
fatigue, headache,
insomnia. Derm: flu
shing. GI: cramps,
diarrhea, heartburn,
nausea,
vomiting. GU: oxala
te nephropathy,
nephrolithiasis. Hem
at: deep vein
thrombosis,
hemolysis (in G6PD
deficiency). Local:
pain at subcut, IM, or
IV sites.
Given a boost
to help the
patient heal
from her tube
placement,
also helping
aid against
infection.
16
Sunkist
Aspirin (delayed
release)
Acuprin, A
saphen,
Aspergum,
Aspir-Low,
Aspirtab,
Bayer Aspiri
n, Bayer
Timed-
Release
Arthritic Pain
Formula,
Easprin,
Ecotrin, 8-
Hour Bayer
Timed-
Release,
Empirin, E
ntrophen,
Halfprin,
Healthprin,
Lowprin,
Norwich Aspi
rin, Novas
en, Rivasa,
Sloprin, St.
Joseph Adult
Chewable As
pirin,
Therapy
Bayer,
Vazalore,
ZORprin
PO 162 mg
Daily
Produce analgesia and
reduce inflammation
and fever by inhibiting
the production of
prostaglandins.
Decreases platelet
aggregation.
Contraindicated
in: Hypersensitivity
to aspirin or other
salicylates; Cross-sensitivity
with other NSAIDs may exist
(less with nonaspirin
salicylates); Bleeding
disorders or
thrombocytopenia; Pediatri
c: May increase risk of
Reye’s syndrome in children
or adolescents with viral
infections.
Derm: rash,
urticaria. EENT: tinn
itus. GI: gi
bleeding, dyspepsia
, epigastric
distress, nausea,
abdominal pain,
anorexia,
hepatotoxicity,
vomiting. Hemat: a
nemia,
hemolysis. Misc: hy
persensitivity
reactions (including
anaphylaxis and laryngeal
edema).
History of
cardiovascular
issues with
HTN,
hyperlipidemia
, and throwing
clots have all
led to aspirin
to prevent a
clot from
being thrown.
Azithromycin IV 500 mg in 250 Inhibits protein
synthesis at the level
Contraindicated
in: Hypersensitivity
CNS: dizziness,
seizures, drowsiness,
Good for
killing any
17
Zithromax,
Zmax
ml per Hr
daily
of the 50S bacterial
ribosome.
to azithromycin,
erythromycin, or other
macrolide anti-infectives;
History of cholestatic
jaundice or hepatic
dysfunction with prior use
of azithromycin; QT interval
prolongation, hypokalemia,
hypomagnesemia, or
bradycardia; Concurrent use
of quinidine, procainamide,
dofetilide, amiodarone, or
sotalol.
fatigue,
headache. CV: torsa
des de pointes,
chest pain,
hypotension,
palpitations, QT
interval
prolongation. Derm
: acute generalized
exanthematous
pustulosis, drug
reaction with
eosinophilia and
systemic symptoms
(dress), stevens-
johnson
syndrome, toxic
epidermal necrolysis,
photosensitivity,
rash. EENT: ototoxi
city. F and
E: hyperkalemia. GI
: hepatotoxicity, clos
tridioides difficile-
associated diarrhea
(CDAD), abdominal
pain, diarrhea, nau
sea, cholestatic
jaundice, ↑ liver
enzymes, dyspepsia,
flatulence, melena,
oral candidiasis,
pyloric
stenosis. GU: nephri
tis,
vaginitis. Hemat: a
nemia, leukopenia,
thrombocytopenia.
Misc: hypersensitivit
y
reactions (including
anaphylaxis and
angioedema).
bacteria that
may be trying
to infect the
patient, will
help prevent a
super infection
and or a
hospital
infection.
Pneumonia is
common after
a
pneumothorax
18
Ceftriaxone
Rocephin
IV 1g in 100/ml
daily
Binds to the bacterial
cell wall membrane,
causing cell death
Contraindicated
in: Hypersensitivity to
cephalosporins; Serious
hypersensitivity to
penicillins; Pediatric: Prema
ture neonates up to a
postmenstrual age of 41
wk; Pediatric: Hyperbilirubi
nemic neonates (may lead to
bilirubin
encephalopathy). Pediatric:
Neonates ≤28 days requiring
calcium-containing IV
solutions (↑ risk of
precipitation formation).
CNS: seizures (high
doses). GI: Clostridi
um difficile-
associated diarrhea,
diarrhea,
cholelithiasis,
gallbladder sludging,
pancreatitis. Derm:
rash,
urticaria. GU: acute
renal failure,
urolithiasis. Hemat:
bleeding,
eosinophilia,
hemolytic anemia,
leukopenia,
thrombocytosis. Loc
al: pain at IM
site, phlebitis at IV
site. Misc: allergic
reactions
including anaphylaxi
s, superinfection.
Used in
conjunction
with the
aforementione
d drug to kill
of bacteria.
Heparin
Hepalean,
Hep-Lock,
Hep-Lock U/P
SubQ 5,000 units Q
8 hrs
Potentiates the
inhibitory effect of
antithrombin on factor
Xa and thrombin. In
low doses, prevents
the conversion of
prothrombin to
thrombin by its effects
on factor Xa. Higher
doses neutralize
thrombin, preventing
the conversion of
fibrinogen to fibrin.
Contraindicated
in: Hypersensitivity;
Uncontrolled bleeding;
History of heparin-induced
thrombocytopenia; Severe
thrombocytopenia; Open
wounds (full
dose); Pediatric: Avoid use
of products containing benzyl
alcohol in premature infants.
Derm: alopecia
(long-term use),
rash,
urticaria. GI: drug-
induced
hepatitis. Hemat: bl
eeding, heparin-
induced
thrombocytopenia
(hit) (with or without
thrombosis), anemi
a. Local: pain at
injection
site. MS: osteoporo
sis (long-term
use). Misc: fever,
hypersensitivity
reactions.
Similar to the
use for aspirin
in this patient.
Heparin is
helping the
patient to not
through a clot
19
Hydrochlorothia
zide
Microzide,
Urozide
PO 12.5 mg
daily
Increases excretion of
sodium and water by
inhibiting sodium
reabsorption in the
distal tubule. Promotes
excretion of chloride,
potassium, hydrogen,
magnesium,
phosphate, calcium
and bicarbonate. May
produce arteriolar
dilation.
Contraindicated
in: Hypersensitivity (cross-
sensitivity with other
thiazides or sulfonamides
may exist); Some products
contain tartrazine and should
be avoided in patients with
known intolerance;
Anuria; Lactation: Lactation
.
CNS: dizziness,
drowsiness, lethargy,
weakness. CV: hypo
tension. Derm: stev
ens johnson
syndrome,
photosensitivity,
rash. EENT: acute
angle-closure
glaucoma, acute
myopia. Endo: hype
rglycemia. F and
E: hypokalemia,
dehydration,
hypercalcemia,
hypochloremic
alkalosis,
hypomagnesemia,
hyponatremia,
hypophosphatemia,
hypovolemia. GI: pa
ncreatitis, anorexia,
cramping, hepatitis,
nausea,
vomiting. Hemat: b
lood
dyscrasias. Metab:
hyperuricemia,
hypercholesterolemi
a. MS: muscle
cramps.
Helps excrete
the sodium
that the patient
is holding
onto, while
preserving the
potassium and
calcium
Methylprednisol
one
DEPO-Medrol,
Medrol, SOLU-
Medrol
IV 40 mg
Q 8 hr
Suppresses
inflammation and the
normal immune
response. Has
numerous intense
metabolic effects (see
Adverse Reactions and
Side Effects).
Suppresses adrenal
function at chronic
doses of 4 mg/day. Has
negligible
Contraindicated in: Active
untreated infections (may be
used in patients being
treated for tuberculous
meningitis); Epidural use
(may result in serious
neurological injury or death);
Known alcohol, bisulfite,
cow's milk, or tartrazine
hypersensitivity or
intolerance (some products
contain these and should be
Adverse
reactions/side
effects are much
more common with
high-dose/long-term
therapy
CNS: depression, e
uphoria, headache,
↑ intracranial
pressure (children
only), personality
changes, psychoses,
Inflammatory
suppressant to
allow for
healing at the
surgical
wound site
20
mineralocorticoid
activity.
avoided in susceptible
patients); Administration of
live virus
vaccines; Lactation: Lactati
on.
restlessness. CV: hy
pertension. Derm:
acne, ↓ wound
healing, ecchymos
es, fragility, hirsut
ism, petechiae. EE
NT: cataracts, ↑
intraocular
pressure. Endo: ad
renal suppression,
hyperglycemia. F
and E: fluid
retention (long-term
high doses),
hypokalemia,
hypokalemic
alkalosis. GI: peptic
ulceration, anorexia
, nausea,
vomiting. Hemat: t
hromboembolism,
leukocytosis,
thrombophlebitis. M
etab: weight gain,
weight
loss. MS: muscle
wasting, osteopor
osis, avascular
necrosis of joints,
muscle
pain. Misc: cushing
oid
appearance (moon
face, buffalo hump),
infection.
Nicotine
nicotine che
wing gum
Nicorette,
Thrive
nicotine inh
Transd
ermal
14 mg/ 24 hrs
daily
Provides a source
of nicotine during
controlled withdrawal
from cigarette
smoking.
Contraindicated
in: Hypersensitivity; Recent
history of MI (inhaler or nasal
spray); Arrhythmias (inhaler
or nasal spray); Severe or
worsening angina (inhaler or
nasal spray); Severe
cardiovascular
CNS: headache, in
somnia, abnormal
dreams, dizziness,
drowsiness, impaired
concentration,
nervousness,
seizures,
weakness.. CV: tac
To assist the
patient in her
journey to
cessation of
smoking
21
aler
Nicotrol
nicotine loz
enge
Nicorette
nicotine nas
al spray
Nicotrol NS
nicotine tra
nsdermal
patch
Nicoderm CQ
disease; Obstetric: Effects
on fetus unknown;
spontaneous abortion has
been reported. Encourage
behavioral approaches to
smoking
cessation. Lactation: Excret
ed in breast milk; weigh risks
of nicotine product use
against risk of continued
smoking.Pediatric: Safety
not established.
hycardia, chest
pain,
hypertension. Derm
: transdermal- burni
ng at patch
site, erythema, pr
uritus, cutaneous
hypersensitivity,
rash,
sweating. EENT: sin
usitis; gum- pharyn
gitis; nasal
spray- nasopharyn
geal
irritation, sneezin
g, watering eyes,
change in smell,
earache, epistaxis,
eye irritation,
hoarseness; inhaler-
local mouth/throat
irritation. Endo: d
ysmenorrhea. GI: a
bdominal pain,
abnormal taste,
constipation,
diarrhea, dry mouth,
dyspepsia, hiccups,
nausea,
vomiting; gum- belc
hing, ↑ appetite, ↑
salivation, oral
injury, sore
mouth. MS: arthral
gia, back pain,
myalgia; gum- jaw
muscle
ache. Neuro: pares
thesia. Resp: Nasal
spray,
inhaler- cough,
dyspnea.
Potassium Po 40 mEq Maintain acid-base Contraindicated CNS: confusion, To help boost
22
Bicarb
potassium
bicarbonate
K+Care ET, K-
Electrolyte, K-
Ide, Klor-
Con/EF, K-
Lyte, K-
Vescent
potassium
bicarbonate/
potassium
chloride
Klorvess,
Klorvess
Effervescent
Granules, K-
Lyte/Cl, Ne
o-K,
Potassium
Sandoz
potassium
bicarbonate/
potassium
citrate
Effer-K, K-Lyte
DS
potassium
chloride/pot
assium
bicarbonate/
potassium
citrate
Kaochlor Eff
trikates
(potassium
acetate/pot
assium
bicarbonate/
Q 4 hr balance, isotonicity,
and electrophysiologic
balance of the cell.
Activator in many
enzymatic reactions;
essential to
transmission of nerve
impulses; contraction
of cardiac, skeletal,
and smooth muscle;
gastric secretion; renal
function; tissue
synthesis; and
carbohydrate
metabolism.
in: Hyperkalemia; Severe
renal impairment; Untreated
Addison’s disease; Some
products may contain
tartrazine (FDC yellow dye
#5) or alcohol; avoid using in
patients with known
hypersensitivity or
intolerance; Hyperkalemic
familial periodic paralysis.
restlessness,
weakness. CV: arrh
ythmias, ECG
changes. GI: abdo
minal
pain, diarrhea, flat
ulence, nausea, vo
miting; tablets,
capsules only- GI
ulceration, stenotic
lesions. Neuro: par
alysis, paresthesia.
the potassium
levels in the
patient by
giving her
potassium
loaded drinks
23
potassium
citrate)
Tri-K
Classificatio
n
Therapeutic:
mineral and
electrolyte
replacements
/supplements
Pravastatin
Pravachol
PO 40 mg (before
bed)
daily
Inhibits 3-hydroxy-3-
methylglutaryl-
coenzyme A (HMG-
CoA) reductase, an
enzyme which is
responsible for
catalyzing an early
step in the synthesis
of cholesterol
Contraindicated
in: Hypersensitivity; Active
liver disease or unexplained
persistent ↑ in AST and
ALT; Obstetric: Avoid use
during pregnancy (may
cause fetal
harm); Lactation: Avoid
breastfeeding if treatment is
necessary.
CNS: amnesia,
confusion, dizziness,
headache, insomnia,
memory loss,
weakness. EENT: rh
initis. Resp: bronchi
tis. CV: chest pain,
peripheral
edema. GI: abdomi
nal
cramps, constipati
on, diarrhea, flatus
, heartburn, altered
taste, drug-induced
hepatitis, dyspepsia,
↑ liver enzymes,
nausea,
pancreatitis. GU: ere
ctile
dysfunction. Derm:
rash,
pruritus. Endo: hyp
erglycemia. MS: rha
bdomyolysis,
arthralgia, arthritis,
immune-mediated
necrotizing
myopathy, myalgia,
myositis. Misc: hyp
ersensitivity
reactions.
Helping to
reduce the
cholesterol in
her blood by
acting to stop
the synthesis
of cholesterol
24
[ CITATION Val19 \l 1033 ]
25
CARE PLAN
Top Three Prioritized Medical and Nursing Diagnosis
1. Pneumothorax “Actual” impaired gas exchange r/t impaired alveolar perfusion AEB shortness of breath, Tachycardia,
Tachypnea, and 4lpm via NC.
2. Pneumothorax “Risk for” impaired vital capacity r/t increased air in peripheral space AEB X-ray, Shortness of Breath, labored
respirations, and diminished breath sounds.
3. Pneumothorax “Risk for” ineffective airway r/t collapsed lung AEB tachypnea, tachycardia, respiratory distress, unilateral
chest movement.
Medical & Nursing Dx Nursing Outcomes (NOC) Nursing Interventions (NIC) Evaluation
1. Pneumothorax “Actual”
impaired gas exchange r/t
impaired alveolar perfusion AEB
shortness of breath, Tachycardia,
Tachypnea, and 4lpm via NC.
1. Pt will improve
respiratory status NLT end
of shift AEB use of
inspiratory spirometer, deep
breathing exercises, clear
chest tube drainage, and
normal vital signs
2. Pt will return to normal
vital signs NLT tomorrow
AEB HR between 60-100
bpm, RR between 12-20,
1a. Nurse will ambulate the
patient before lunch IOT
increase mobility
1b. Nurse will watch the Pt use
the inspiratory spirometer IOT
ensure proper use.
1c. Nurse will check the
drainage quality and quantity
whenever vitals are checked
IOT not miss anything.
2a. Nurse will encourage.
meditation IOT reduce Pt HR
1. decreased from 4lpm to 3
lpm without drop from O2
saturation.
2. Vital signs are within
normal limits.
3. Pt. was only able to
ambulate 2/3 of the hallway.
26
O2% greater than 95% on
RA, and reduced symptoms.
3. Pt will ambulate the
entire hall NLT end of the
weekend AEB increased
mobility, higher level of
strength, improved lung
vital capacity, and lower
levels of drowsiness.
2b. Nurse will use teach back
with inspiratory spirometer
IOT ensure proper use and
goal.
2c. Nurse will slowly decrease
O2 in NC to see where the
patient is sitting near room air.
3a. Nurse will walk with Pt
twice a shift IOT promote
ambulation in the healing
process.
3b. Nurse will call for PT to
visit IOT give the Pt exercises
to promote strength building
up.
3c. Nurse will monitor vitals
IOT track them and ensure a
downwards trend towards
27
baseline.
[ CITATION Ack20 \l
1033 ]
28
References
Ackley, B., & Ladwig, G. (2020). Nursing Diagnosis Handbook. St. Louis: Elsevier.
AH, V., & CA, S. (2019, November 19). Davis's Drug Guide for Nurses. Retrieved from Nursing
Reference Center powered by EBSCOhost:
https://web.a.ebscohost.com/nrc/popsourcesbrowsefiltered?sid=313114ac-4dec-403f-b380-
2106f67d4061%40sdc-v-sessmgr01&vid=65&bk=1
Dugdale, D. M. (2019, October 1). Smoking and COPD. Retrieved from MedlinePlus:
https://medlineplus.gov/ency/patientinstructions/000696.htm
Fay, B. (2018). Hospital and Surgery Costs. Retrieved from debt.org:
https://www.debt.org/medical/hospital-surgery-costs/
Healthwise staff. (2019, June 9). Collapsed Lung (Pnuemothorax). Retrieved from Michigan Medicine
university of Michigan: https://www.uofmhealth.org/health-library/zr1018spec
McClinton, T., & Murray, E. (2019). Disorders of Ventilation and Gas Exchange. In T. Norris, porth's
Pathophysiology Concepts of ALtered Health States (pp. 926-940). Philadelphia: Wolter Kluwer.
RH med labs. (2020). RH medical labs. Retrieved from ResidentHelper:
http://residenthelper.com/Products/RHLabs/
29
