Pat is an 83 y/o patient admitted from the Primary Care Physician’s office with complaints of shortn

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Asked by neverforgotten886

Pat is an 83 y/o patient admitted from the Primary Care Physician’s office with complaints of shortness of breath, blood-tinged phlegm, and fatigue over the last month. Pat initially contributed these symptoms to smoking and worsening COPD.

Preview Medical History: Smoker (65 pack year), emphysema, hypertension, hyperlipidemia, bilateral cataracts (surgical repair completed in 2014 for both eyes), and PVD

Code Status: Full Code

Allergies: Iodine

Ht/Wt: 5’6″/117 lbs. (client/patient reports a 20 lb. weight loss over the last month)

Last set of vital signs: Temp 98.2 F, HR 120 bpm, RR 28, O2 sats 79% room air (89% 2LNC), BP 128/68 mm Hg

Pain assessment: 3/10

Neuro: Alert and oriented x 4, and is withdrawn

Cardiac: Regular rate, S1 and S2 auscultated

Respiratory: Diminished breath sounds to right lower lobe, dyspnea on exertion.

Gastrointestinal assessment findings: Normoactive x 4. LBM yesterday (hard and brown).

Genitourinary: Voiding concentrated urine.

Integumentary: Clean, warm, dry, and intact.

Intravenous access: 18 gauge to the left forearm, IV fluids infusing at 75 mL/hour

1.  Pat was asked if he had an advanced directive. Name 3 different types of Advance Directives and explain the difference. Be sure to include the state when each one is used.

Pat had a CXR that showed a mass. He is scheduled for a lung biopsy.

2. How would you prepare the patient for the procedure? Include pre-procedure teaching.


3. Pat was informed that the biopsy revealed a moderately differentiated stage III adenocarcinoma of the lung. The physician discusses surgery, radiation, and chemotherapy. What do you need to include as part of a collaborative approach to care?

Pat had an uneventful recovery from surgery, begins chemotherapy and radiation. Unfortunately, Pat develops difficulty swallowing a few months into treatment. A follow up CT and PET scan reveals enlargement of the lung cancer with metastasis to the liver. Pat opts to stop all treatment and just wants to be home with his family. Hospice has been set up for Pat.


4. Define hospice vs palliative care.


5. State 6 physical signs of approaching death.



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