Discussion 8.1 – Case
Study One

The nurse is caring for a frail, older patient in the
hospital after surgery to repair a bowel obstruction. The patient has a
nasogastric NG tube, through which all her scheduled drugs are given, oxygen at
1 liter/nasal cannula at night, an indwelling urinary caterer, and a saline
lock. The patient is weak and fatigued, has pain not relieved by IV opioids,
and is reluctant to participate in any activities.

What risk factors does this patient have for developing
pneumonia?

What actions does the nurse take to decrease the patient’s
risk for pneumonia?

Two days later, the NG tube is removed and the patient is
started on ice chips and other clear liquids. The patient swallows repeatedly
when given sips of water. What action does the nurse perform?

The nurse does hourly rounds on the patient, and the
patient’s daughter states, “Something is just not right with mom” What action
should the nurse take first? What other actions should the nurse perform?

The physician orders a chest x-ray, and the results show
pneumonia. What actions by the nurse are most important?

Discussion 8.2 – Case
Study Two

A 50 year old patient is admitted to the medical-surgical
floor from the emergency department with severe abdominal pain thought to be
from acute pancreatitis. He case a history of drinking at least a case of beer
a day. He also smokes and appears cachectic. His old chart indicates a history
of COPD, but he does not take drugs for this. He does have a new productive
cough. At chage of shift, the nurse finds the patient dyspneic and slight
confused. Lung sounds have wheezes, and he is mildly febrile. Pulse is 120
beats per minute, respirations are 32 breaths per minute, and blood pressure is
118/64. Oximetry shows a SpO2 of 91%.

What risk factors for ARDS does this patient have?

Explain the relationship between the lung sounds and the
oximetry reading

What diagnostic testing should you be prepared to obtain?
Two hours after applying oxygen at 3 liters/nasal cannula, the patient’s Spo2
is now 89%4. What additional measures do you anticipate for this patient?