Engage Fundamentals: Gas Exchange Clinical Judgment Case Study with Concept Map
Case Study
The nurse is caring for Oliva Jamison, 77 years old, and was admitted to the medical unit with exacerbation of COPD. Vital signs upon admission to the unit is: Blood Pressure 156/88, Pulse 101; Respiratory Rate 28, Temperature 97.8°F. The client reports worsening shortness of breath, extreme fatigue, decreased appetite, and a weight loss of 15 pounds over the past three months. The nurse notices the client is lying flat in bed and currently on 2L O2 via nasal canula with an oxygen saturation level of 88%. Other symptoms include a dry cough, inspiratory and expiratory wheezes upon auscultation of breath sounds. Respiratory treatments (albuterol) are ordered every 4 hr as needed. The client reports having little or no family support.
Assessment Questions
1. Identify the relevant subjective and objective assessment information related to the client’s condition and place the findings in the assessment data box below. (Recognizing cues; Assessment)
2. Based upon assessment information, identify and prioritize the top 3 client problems. Write one client problem in each of the Client Problem boxes below. (Analyze Cues; Analysis and Prioritize Hypothesis; Planning)
3. Below each client problem, determine and enter the relevant assessment information that supports the identified client problem. (Analyze Cues; Analysis and Prioritize Hypothesis; Planning)
4. Identify important nursing interventions that should be taken to address each client problem and enter them in the related intervention box for the associated client problem. (Take Action; Implementation)
Discussion Questions
1. Discuss special considerations to be made for clients from diverse backgrounds. (Recognize Cues; Assessment)
a. Elderly client with no family support.
b. Clients from diverse backgrounds (i.e. age, culture, socioeconomic status).
2. Identify potential client problems. (Analyze Cues; Analysis)
a. Instruct students to provide a rationale for their choices.
3. Discuss nursing interventions to address the identified potential client problems. (Generate Solutions; Planning)
a. Instruct students to provide a rationale for their choices.
4. Discuss the desired client outcomes related to the performed interventions identified in the concept map as well as for potential client problems. (Generate Solutions; Planning)
a. Discuss client responses that demonstrate an improvement of the client problem.
b. Identify client responses that indicate worsening of the client condition. (Generate Solutions; Planning)
5. Discuss safety considerations that should be included when planning care for this client (i.e. fall risk). (Generate Solutions; Planning)
6. Identify client education the nurse should provide for this client (i.e. diet, activity, ADLs). (Take Action; Implementation) Discuss client outcomes you would anticipate based on the performed nursing interventions (i.e. improved SPO2 with raising head of bed, increasing amount of oxygen being delivered). Identify how achievement of client outcomes would be evaluated. (Evaluate Outcomes; Evaluation)
7. Discuss ways to modify or revise the plan of care when client outcomes are not met. (Evaluate Outcomes; Evaluation)
