1. M.C. is a 69-year-old man who presents to the outpatient office with a hacking, raspy cough. Subjective Data PMH: H

1. M.C. is a 69-year-old man who presents to the outpatient office with a hacking, raspy cough.

Subjective Data

PMH: HTN, DM

Cough is productive, bringing up green phlegm

Runny nose, sore throat

Denies fever

Sore throat pain when swallowing

No history of smoking or seasonal allergies

Complains of fatigue

Objective Data

Vital signs: T 37 P 72 R 14 BP 134/64

Lungs: + Rhonchi bilateral upper lobes, wheeze

O₂ Sat = 98%

Ears = TM bulging

Nose = + erythema, yellow discharge

Throat = + erythema, pustules

Medications: Metoprolol 12.5 mg per day, Glucophage 500 mg twice a day

Questions give rationales, also.

1.   What other questions should the nurse ask about the cough?

2.   Develop a problems list from the objective and subjective data.

3.   What nursing diagnoses can be derived from the problems list?

4.   What should be included in the plan of care?

5.   What risk factors are associated with this age group?

6.   Based on the readings, what is the most likely cause of this patient’s cough?

2. Cardiac Discussion

Consider five adult family members and list the lifestyle habits for each that might affect cardiac changes (no names, please; instead say something like: my 40 yo uncle.smokes 3 ppd, doesn’t exercise, etc.). Are there concerns that arise as you evaluate this information? Are there also cultural and genetic factors to consider? Give rationales.

3. Abdominal Case Study

J.P. is a 50-year-old man who presents to the gastroenterologist with cramping and diarrhea.

Subjective Data

Pain level is a 6/10 location = right and left lower abdomen

Works as a union construction worker, has missed 1 day of work

States he has been going to the bathroom about 8 to 10 times a day for past 2 days

Appetite is decreased

PMH: Crohn’s disease, depression, anxiety

Objective Data

Vital signs: T 37 P 80 R 14 BP 120/68

Bowel sounds hyperactive in all four quadrants

Medications: Infliximab (Remicade) infusions every 6 weeks, fluoxetine (Prozac) 25 mg per day

Weight = 145, last visit weight = 152

Questions

1.   What other assessments should be included for this patient?

2.   What questions should the nurse ask with regard to the abdominal pain?

3.   From the readings, subjective data, and objective data, what is the most probable cause of the abdominal pain?

4.   Develop a problems list from the subjective and objective findings.

5.   What should be included in the plan of care?

6.   What interventions should be included in the plan of care for this patient?

4. Peripheral Vascular Case Study

S.R. is a 65- year-old woman who presents to the emergency department complaining of shortness of breath, productive cough, and swelling in both legs. The patient has a past medical history of congestive heart failure (CHF), hypertension, and diabetes. Vital signs are T 97.5, P 85, R 16, and BP 160/90. Physical exam reveals +2 edema bilateral lower extremities, heart rate and rhythm regular, and lungs with rhonchi in the bases. The patient is started on a nebulizer treatment, and an electrocardiogram has been ordered.  Give rationales with answers.

1. What subjective information should the nurse obtain?  

2. The nurse is assessing the patient’s pulses. Which locations should the nurse check?

3. The nurse needs to evaluate the adequacy of the collateral circulation before obtaining an arterial blood gas (ABG) sample. How should the nurse proceed?

4. What is the most likely cause of this patient’s shortness of breath, productive cough, and swelling in both legs?

Choose one of the 4 to discuss. Jarvis Physical Examination & Health Assessment 8th ed. is required as a reference.