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University of Santo Tomas
THE GRADUATE SCHOOL
ADVANCED MEDICAL-SURGICAL NURSING I
CASE SCENARIO
NURSING CARE OF CLIENTS WITH RESPIRATORY PROBLEMS
Prepared by: John Henry O. Valencia, RN, RM
Master of Arts in Nursing Student
M.C. a 65-year-old man is admitted to your medical unit for exacerbation of his emphysema
(COPD). He has a history of atopic asthma during his childhood and hypertension which has been well
controlled by Enalopril for the last six years. He presents as a poorly nourished man who is experiencing
difficulty breathing. He complains of coughing spells productive of thick yellow sputum. M.C. seems
irritable and anxious when he tells you that he has been a two-pack-a-day smoker for 38 years. He tells
you he has been sleeping poorly and lately feels very tired most of the time even when he has not done
any physical activity. His VS are 162/84, 124, 36, 102 F, SaO2 88%. His admitting diagnosis is chronic
emphysema with an acute exacerbation.
His admitting orders are as follows:
Diet as tolerated
Out of bed with assistance
O2 at 2L/nc
IV Plain NSSS 1L at 50 ml/hr
Sputum C & S
ABGs in AM
CBC with WBC differential
CXR followed by Pulmonary Function test in AM
ECG
1. What are the significant data that you have gathered? What other relevant questions do you
need to ask M.C.?
2. What physical assessment findings do you expect to find? What specific changes in the
respiratory system do you expect to find indicative of emphysema?
3. What is the most common cause of emphysema? Based on this information, what question will
you ask about his health behaviors? What do you believe are the major cause/s of M.C’s
emphysema?
4. Are M.C.’s VS and SaO2 appropriate? If not, explain why.
5. Is your patient with chronic hypoxia? Is he compensating for his chronic hypoxia?
6. Why is the O2 inhalation at 2LPM inspite of the SaO2 at 88%? How do we explain the “hypoxic
drive” in a pt. with emphysema? What important considerations do you have to remember
regarding O2 administration in a pt. with COPD like M.C.?
7. Make an integrated pathophysiologic flowchart of MC’s disease condition.
8. Given M.C.’s history and your knowledge of pathophysiologic processes, explain the
pathophysiologic basis of the assessment findings in M.C?
9. What are the possible complications of Emphysema and their manifestations?

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10. Make a tabular comparison of the pathogenesis and pathophysiologic changes of Emphysema,
Bronchitis and asthma.
11. Based on the assessment findings, identify five priority problems that M.C. may be experiencing.
The laboratory sends the ff. report several hours after admission: RBC 3.8thou/cmm, WBC- 13,000
thou/cmm, Hgb 12g/dL, ABGs: pH- 7.28, pO2 80 mmHg, pCO2 65 mmHg, HCO3 22.
12. Interpret the above results. How do the results relate to the pathophysiologic changes of
emphysema?
13. With the ABG result, can you say that M.C. is in respiratory failure or respiratory insufficiency?
Explain the scientific basis of your answer.
14. What are the major hallmarks of respiratory failure? What do you believe are the principal causes
of this problem in M.C.?Explain your answer.
Five days after admission, M.C.’s condition has remarkably improved. The MD wants all medications
continued and has shifted the antibiotics to oral preparations.
15. What made the MD say MC’s condition has improved? Give the assessment findings that
supports the MD’s observation.
16. Summary of journal readings (3) related to the case. Use the table below.
Directions:
1. This scenario is to be accomplished individually and to be submitted on Tuesday,Sept 16, 2014
This must be typewritten in A4 bond paper using Arial Narrow font 11.
Late submission will have demerit rating. Please comply!
2. Discussion of the case will be done on Tuesday. Please come prepared for the discussion
3. Grading rubric is attached. Kindly attach a copy of this on the paper you will submit
ISTIONKO/USTGS/2014

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University of Santo Tomas THE GRADUATE SCHOOL ADVANCED MEDICAL-SURGICAL NURSING I CASE SCENARIO NURSING CARE OF CLIENTS WITH RESPIRATORY PROBLEMS Prepared by: John Henry O. Valencia, RN, RM Master of Arts in Nursing Student M.C. a 65-year-old man is admitted to your medical unit for exacerbation of his emphysema (COPD). He has a history of atopic asthma during his childhood and hypertension which has been well controlled by Enalopril for the last six years. He presents as a poorly nourished man who is experiencing difficulty breathing. He complains of coughing spells productive of thick yellow sputum. M.C. seems irritable and anxious when he tells you that he has been a two-pack-a-day smoker for 38 years. He tells you he has been sleeping poorly and lately feels very tired most of the time even when he has not done any physical activity. His VS are 162/84, 124, 36, 102 F, SaO2 88%. His admitting diagnosis is chronic emphysema with an acute exacerbation. His admitting orders are as follows: Diet as tolerated Out of bed with assistance O2 at 2L/nc IV Plain NSSS 1L at 50 ml/hr Sputum C & S ABGs in AM CBC with WBC differential CXR followed by Pulmonary Function test in AM ECG 1. What are the significant data that you have gathered? What other relevant questions do you need to ask M.C.? 2. What physical assessment findings do you expect to find? What specific changes in the respiratory system do you expect to find indicative of emphysema? 3. What is the most common ca ...
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I was struggling with this subject, and this helped me a ton!

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