SOLVED. Question
Answered step-by-step
Asked by Lammy1986
Mr. Tao is a 56-year-old man being transferred from the ED to your medical surgical unit. Report is called to you from the ED nurse – the following initial data is collected.
Interview Data
“Mr. Tao states that he does not know when he first started having difficulty breathing but says that it has gotten noticeably worse the last couple of days. Pt. states he usually plays golf twice a week but complains of recent fatigue – states he is ‘too tired to do anything’. He also complains of difficulty sleeping and has been napping in his lazy boy chair with the head up. Denies taking any prescription or OTC medications. Denies history of smoking or alcohol use.
Examination Data
Alert, anxious, cooperative, well-groomed male. Appears stated age. Breathing labored.
VS: B/P 142/112 R arm, 144/110 L arm; P 120; R 26; T 98.8 F
Pulses: All pulses palpable 2+. No carotid bruits bilaterally
Neck: JVD and pulsation noted with pt. in supine position
LE: skin warm and dry; without cyanosis. Even hair distribution. 2+ pitting edema noted bilaterally from knees to feet. No lesions noted.
1.      Identify abnormal data from normal data in report.
Abnormal                                                           Normal
              Â
Â
Â
Â
Â
Â
Â
Upon arrival from the ED, you transfer Mr. Tao to his bed, take VS and check physician’s orders. You transfer the O2 at 2 L and take a new set of VS. From the examination data already received what elements of the VS are missing?
2.      You begin your physical assessment by opening the pt. gown to assess the chest and work of breathing. Putting your stethoscope on, explain how you will proceed to auscultate the lung fields. Identify and diagram placement (anterior, posterior, lateral) and expected normal lung sounds.
Anterior                                              Posterior           Â
Do you expect to auscultate abnormal lungs sounds with Mr. Tao? If so, explain.
3.      Describe how you will proceed with the cardiac exam.
Identify points of auscultation. What structure are you listening to at each position?
Where will you position the stethoscope to listen for murmurs?
What other elements of the cardiovascular exam would you perform at this time?
4.      Mr. Tao’s presentation makes you suspect of what medical diagnosis?
Write brief summary of the medical diagnosis and identify signs and symptoms that support your suspicion?
What signs and symptoms support your suspicion?
              Â
5.      Identify three priority nursing diagnoses appropriate for Mr. Tao at this time?
SCIENCE
HEALTH SCIENCE
NURSING
HLTH 3371B
