Author Question: The nurse is caring for a patient who developed a pulmonary embolism after surgery. Which goal ... (Read 45 times)

Charlie · **on:** Jul 23, 2018

The nurse is caring for a patient who developed a pulmonary embolism after surgery.

Which goal statement is the highest priority for the nurse to include in the patient's care plan for the diagnosis Impaired gas exchange r/t impaired pulmonary blood flow from embolus?
a.
The patient will maintain pulse oximetry values of at least 95 on room air.
b.
The patient will verbalize understanding of ordered anticoagulants.
c.
The patient will report chest pain of no greater than 3 on a 1-10 scale.
d.
The patient will ambulate 50 feet in hallway without shortness of breath.

Question 2

The nurse is caring for a patient who has been intubated with an oral endotracheal tube for several weeks. The physicians predict that the patient will need to remain on a ventilator for at least several more weeks before

he will be able to maintain his airway and breathe on his own. What procedure does the nurse anticipate will be planned for the patient to facilitate his recovery?
a.
Placement of a tracheostomy tube
b.
Diagnostic thoracentesis
c.
Pulmonary angiogram
d.
Lung transplantation surgery

rachel · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

ANS: A
Oxygenation is the most important human need, so adequate oxygenation of tissues as evidenced by pulse oximetry values of at least 95 on room air is the highest priority goal. The other goals may be addressed once the oxygenation goal has been met.

Answer to Question 2

ANS: A
Placement of a tracheostomy tube will secure the patient's airway directly through the trachea, eliminating the need for the endotracheal tube. This will make the patient more comfortable and may allow him to eat while minimizing damage to the oropharynx from the endotracheal tube.