Please answer these discussion posts, with 3 references each and over 250 words each.
1. Mr. Z is a 63-year-old retired banker with a long history of chronic obstructive pulmonary disease (COPD). He is a longtime smoker, smoking four packs of cigarettes each day for 30 years. For the last week, Mr. Z has experienced a flulike illness with fever and chills. He also complains of nausea, exhaustion, anorexia, diarrhea, and a productive cough with thick, dark brownish yellow, purulent sputum.
Mr. Z is admitted to the telemetry unit with acute respiratory insufficiency. He is sitting up in a chair, leaning forward, with his elbows resting on the over-the-bed table. Mr. Z is breathing through his mouth, taking rapid shallow breaths, using his accessory muscles to ventilate. He appears anxious, angry, irritable and is barely having audible words between each breath. He is not very cooperative and is using profanity to express how he feels. Auscultation reveals crackles posteriorly over the lower right and left lung fields. When asked to inhale, his nostrils flare, and his intercostal muscles retract. On exhalation, he uses pursed-lip breathing, and his intercostal muscles bulge. Mr. Zs admission chest radiograph reveals infiltrates in bilateral lobes. Gram stain of Mr. Zs sputum shows numerous gram-positive diplococci.
Mr. Zs admission chest radiograph reveals infiltrates in bilateral lobes. Gram stain of Mr. Zs sputum shows numerous gram-positive diplococci. His baseline vital signs are as follows:
Blood pressure (BP): 100/50 mm Hg
Heart rate (HR): 110 beats/min (sinus tachycardia)
Respiratory rate (RR): 40 breaths/min
Temperature (T): 102.5 F
His baseline arterial blood gas (ABG) values on a 100% non-rebreather mask are:
Pao2: 68 mm Hg
Paco2: 30 mm Hg
pH: 7.55
HCO3 level: 28
O2 saturation: 86%
Community-acquired pneumococcal pneumonia is diagnosed.
QUESTIONS:
What major outcomes do you expect to achieve for this patient
What interventions must be initiated to monitor, prevent, manage, or eliminate the problems and risks identified?
What major outcomes do you expect to achieve for this patient?
What interventions should be initiated to promote optimal functioning, safety, and well-being of the patient?
What possible learning needs do you anticipate for this patient?
What cultural and age-related factors may have a bearing on the patients plan of care?
2.
A 24-year-old Asian woman comes to the clinic for physicals required for her job. She immigrated to the United States two months ago to work as a nurses aide until she finds a job as an RN. Her PPD is positive. She says she has latent TB.
Based on the case information provided, respond to the following in your initial post:
What cultural considerations are necessary?
How would you explain the causes of this positive reaction, appropriate diagnostics, and treatment plan?
What other skin tests are used to identify TB?
Last Completed Projects
| topic title | academic level | Writer | delivered |
|---|