Patient: Erin Johns Date of Birth: 09/09/19xx PERSONA Erin Johns is 74 years old. She is widowed with four children, one

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Patient: Erin Johns
Date of Birth: 09/09/19xx
PERSONA
Erin Johns is 74 years old. She is widowed with four children,
one of whom lives at home with her in their original family home in
a small city in northern British Columbia. Two of Erin’s children
live within a one-hour drive from her, and one lives a three-hour
flight away. She also has 10 grandchildren and one great
grandchild. Erin communicates with her grandchildren by telephone
and Skype using her iPad. Erin describes herself as a non-smoker,
but she smoked socially when she was in her early twenties for
about five years. She is a retired hairdresser. Erin also has a
small hairless Chihuahua named Trixie. Erin spends her time
socializing at her local community centre with her friends, and she
likes to play Bingo. At home, she enjoys watching Netflix and
playing “Solitaire and Scrabble with friends” on her iPad. Erin
tends to feel down when she thinks about her lower financial status
and her advancing age, and how she is becoming more forgetful and
less energetic. She often feels alone but is grateful to have
the company of Trixie and the few friends she has left who are
still alive. She worries about falling and not being able to alert
anyone to come to her rescue. Driving is becoming hard for her, and
she finds getting to the clinic and picking up her medications more
and more challenging, especially now that she doesn’t have her own
doctor anymore and she needs to go to the walk-in clinic.
“Trixie stop barking!” Erin calls. She gets up from the couch
slowly. “I can’t believe how tired I am.”
Taking a few steps towards the back door to let Trixie out, Erin
stops at the corner of the kitchen island and puts a hand out to
steady herself on the counter.
“Oh my. Can’t catch. My breath. Trixie. Stop barking.”
“I can’t. Catch. My. Breath. I think. I need. To go. To the.
Hospital.”
“Hi, my name is Jackie and I’m the triage nurse today. How can I
help you?”
Jackie pulls the blood pressure and pulse oximetry
machine close to Erin and wraps the cuff around her right arm.
She presses a button and the cuff inflates. On Erin’s left index
finger she places a pulse oximeter.
After about 30 seconds, the machine beeps and displays the
following vital signs:
Day: 0
Pulse Rate
Blood Pressure
Respiratory Rate
Temperature
O2 Saturation
Time: 18h00
96
180/90
28
36.5° C
85%
“I see, Mrs. Johns, that you were at a clinic last week. Is this
correct?”
Erin nods ‘yes’ “They changed her puffers and said to come back
if there was any problem.”
“Do you see anyone regularly at the clinic?” Erin,
“No. I see whoever is available. They change so often.”
“My name is Jason. I’ve just come on shift. I see the triage
nurse started your chart and that you have been admitted. What I
need to do now is listen to your chest and ask you some questions.
Is that ok?”
“When did you begin to feel short of breath?”
“About a week. Ago. I went. Clinic. Gave me new puffers. Seemed
to help. Today. Walking Trixie. Cold out. Really short of
breath.
“The clinic notes indicate you have COPD. Is this
correct?” “Yes.”
“Do you have any other conditions?” “No.” Erin smiles
weakly. “Otherwise. Healthy.”
“Ok, Mrs. Johns. Your blood pressure is higher than I would
expect. Is this normal for you?”
Erin leans forward and peers closely at the numbers. “I think
so. Top number. 150 to. 170. Normally.”
Day: 0
Pulse Rate
Blood Pressure
Respiratory Rate
Temperature
O2 Saturation
Time: 19h30
112
190/84
28
–
84% on RA
Jason nods. “Your oxygen saturation is a bit low, so
I’m going to put you on a little oxygen. Is that ok with
you?” “Yes.”
He pulls out a set of nasal prongs and attaches them to an
oxygen tank fitted at the back of the wheelchair. He thinks to
himself and then sets the flow at 2 LPM.
Jason then carefully slips his stethoscope between Erin’s
clothes and skin. Closing his eyes, he moves the
stethoscope systematically first to the anterior chest then
posterior chest. After listening, he quickly examines her abdomen
and extremities.
Mrs. Johns, 74 years old, in Hallway B. Exacerbation of COPD,
maybe pneumonia, no other medical history, quite short of
breath with low sats. I placed her on 2 LPM
prongs with some relief and better sats. Breath sounds are
quite to the lower fields and she has a slight wheeze in the upper
fields.
she’s stable right now, but with a big potential to deteriorate.
I, Dr. Singh will follow the COPD
protocol and write the orders for a chest X-ray, some
labs, Ventolin 2 puffs q4h and Atrovent 2 puffs q4h via aero
chamber overnight, spirometry, and an ABG.
Dr. Singh
wrote: CBC, lytes, BUN, creatinine, spirometry, and
a portable chest X-ray, and as per COPD protocol.
“I’m a respiratory therapist (RT) and a couple of tests have
been ordered for you. One is spirometry, which I think you
have had before, from the results in your chart, and the second one
is a blood gas.”
“Spirometry shows a decrease in vital capacity from what was
taken at the clinic a couple of months ago. That’s not surprising,
given that she’s back here. The ABG shows a rise in
CO2 and just normal PaO2 on 2 LPM
oxygen. She’s a bit compromised right now. I took a listen to her
chest a little while ago. She sounds typically COPD-like, with
nothing I didn’t expect.”
Dr. Singh sighs. “Ok, the X-ray shows a bit of infiltrates at
the bases and your typical COPD hyper-inflation. Nothing that I
would consider abnormal itself, but when we consider the ABG and
the spirometry all together. If it’s pneumonia, she will get worse
overnight and the next day. If it’s just the cool weather we’re
having and nothing infective, she should get a bit better with some
care and attention.
6. Why was blood/diagnostic tests ordered for this patient? What
would be a normal finding for this test? What would an abnormal
finding indicate? What nursing assessments/care would you complete
for this patient before and after the blood/diagnostic test?
7. What collaborative treatment(s) would the nurse expect for
this patient if not already ordered?
8. What would be an appropriate nursing diagnosis for this
patient based on the information provided? What would be an
expected patient outcome relevant for the nursing diagnosis you
have identified? Provide 3 nursing interventions. ETPC 43 Identify
nursing diagnosis related to case study
9. What health teaching (medications, treatments, tests,
pharmacological and non-pharmacological interventions,
self-monitoring) would you provide to this patient before they are
discharged home? What teaching strategies (consider patients
readiness to learn, learning style and various teaching/learning
methods) would you incorporate when completing health teaching with
this patient? How would you determine if your health teaching has
been effective for this patient?