Author Question: M.S., a 72-year-old white woman, comes to your clinic for a complete physical examination. She has ... (Read 47 times)

jace · **on:** Jun 25, 2018

M.S., a 72-year-old white woman, comes to your clinic for a complete physical examination. She has not been to a provider for 11 years because I don't like doctors. Her only complaint today is pain in my upper back.

She describes the pain as sharp and knifelike. The pain began approximately 3 weeks ago
when she was getting out of bed in the morning and hasn't changed at all. M.S. rates her pain as 6 on a
0- to 10-point pain scale and says the pain decreases to 3 or 4 after taking a couple of ibuprofen. She
denies recent falls or trauma.
M.S. admits she needs to quit smoking and start exercising but states, I don't have the energy to
exercise, and besides, I've always been thin. She has smoked one to two packs of cigarettes per day since
she was 17 years old. Her last blood work was 11 years ago, and she can't remember the results. She went
through menopause at the age of 47 and has never taken hormone replacement therapy. The physical
examination findings are unremarkable other than moderate tenderness to deep palpation over the spinous
process at T7. No masses or tenderness to the tissue surround the tender spot. No visible masses,
skin changes, or erythema are noted. Her neurologic findings are intact, and no muscle wasting is noted.

An x-ray examination of the thoracic spine reveals a collapsed vertebra at T7 and bone
density changes in the spine. What could this result indicate?

The physician suspects osteoporosis. List seven risk factors associated with osteoporosis.

Place a star or asterisk next to those risk factors specific to M.S.

Question 2

You assess B.T. and find that he has diminished lung sounds with inspiratory and expiratory wheezes in all lung fields with a nonproductive cough and accessory muscle use. His skin is pale, warm and dry.

The electrocardiogram (ECG) shows sinus tachycardia without ectopy. He is alert and oriented 4 spheres.
He appears anxious and is sitting upright, leaning over the bedside table, and continuing to complain of shortness of breath.

What is your primary nursing goal at this time?

Describe six actions you must implement based on this priority.

You will need to monitor B.T. closely for the next few hours. What is the most serious complication to anticipate?

Identify four signs and symptoms of this complication you will assess for in B.T.

When combination inhalation aerosols are prescribed without specific instructions for the
sequence of administration, you need to be aware of the recommendations for safe drug
administration. Describe the correct sequence for administering B.T.'s treatments.

What are your responsibilities while administering aerosol therapy?

xthemafja · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

These results could indicate osteoporosis, which is a decrease in bone density at a level that can be
diagnosed by conventional x-rays. In this case, the patient reports pain in the area at the bottom of
her shoulder blades; the pain is caused by the collapsed vertebra. Note that bone loss is not detected
by conventional x-rays until bone loss is in the 25 to 40 range. Many patients do not realize they
have osteoporosis until a bone fracture occurs.

The risk factors for osteoporosis are:
Cigarette smoking
Female gender
White or Asian ethnicity
Lack of adequate exercise
Lifelong insufficient calcium and vitamin D intake
Low body weight (less than 128 pounds)
Postmenopausal status (estrogen deficiency)
Alcoholism
History of fractures in a first-degree relative
Advanced age (65 years and older in women; older than age 75 in men)
Long-term use of specific medications that can lead to loss of bone density, such as glucocorticoids
and certain antiepileptic drugs

Cigarette smoking, female gender, low body weight, white or Asian ethnicity, lack of adequate
exercise, postmenopausal status, advanced age

Answer to Question 2

The nursing priority right now is to improve B.T.'s respiratory status.

Administer respiratory medications as prescribed.
Maintain oxygen therapy.
Frequently measure vital signs with continuous pulse oximetry and ECG monitoring.
Perform respiratory assessment, auscultating lung sounds and observing chest movements, at
least every hour.
Maintain IV therapy.
Place him in a minimum of a semi-Fowler's position.
Coach B.T. in relaxation and breathing techniques.

Respiratory failure.

Breathlessness at rest
Muteness
Respiratory rate greater than 30 breaths/min
Paradoxical thoracoabdominal movement
Few or absent breath sounds
Relative bradycardia
Absent pulsus paradoxus

Whenever a beta agonist (Alupent) is prescribed, the beta agonist is always administered first, with
a 5-minute wait before administration of the second drug. Therefore the fluticasone (Flovent) should
be given 5 minutes after the albuterol (Ventolin). Do not administer separate aerosols in rapid
sequence because there is the possibility of inducing fluorocarbon toxicity, and there is a decreased
effectiveness of both drugs.

Major nursing responsibilities during aerosol therapy are to assess the effectiveness of the
treatment, the patient's tolerance of the procedure, and the patient's ability to perform the
procedure and to use equipment correctly. Assess breath sounds, work of breathing, and pulse
oximetry readings and heart rate before and after treatments. After breathing treatments, you need
to assist the patient with performing oral hygiene.