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Respiratory Case scenario Michael Ross is a 72-year-old male admitted to the hospital with severe chronic obstructive pulmonary disease. He has a 40-year history of smoking two packs per day and quit 10 years ago and he has a history of hyperlipidemia. His vital signs are temperature 36.7*Cor 98*F, pulse 98 and regular, respiratory is 26 and labored. Blood pressure 144/73, pulse oximetry reading of 90% at rest while on 2 L of oxygen per nasal cannula. The patient has a productive cough with thick secretions but has no hemoptysis. Heart sounds are distant. Respirations are diminished with inspiratory and expiratory wheezes and a prolonged expiratory phase. He denies pain or complains of difficulty breathing. The chest.is barrel shaped, and the abdomen is protruding without acute changes. He is on a regular diet but can only eat 25% of his breakfast. Labs White blood cells 10.7 Glucose 122 Arterial blood gas pH 7.73, CO2 57, PO 265, HCO3 32. Chest x-ray shows density increased in the right lower lobe Treatment orders are as follows Physical therapy to help with conservation of energy and activity Respiratory therapy for breathing treatments Blood glucose level before meals and at bedtime Titrate oxygen up to 3 L per minute to keep SPO2 at 92% or greater Treatment orders are as follows Albuterol nebulizer six times daily Simvastatin 5 mg PO daily Methylprednisolone sodium succinate 125 mg IVQ6 hours 1. List the focused assessments that need to be performed and why 2. List 2 nursing diagnosis that are appropriate 3. Which medications can elevate the patient’s blood glucose levels? 4. Provide at least four nursing interventions with rationales that can help relieve some of the patient’s respiratory distress
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