- Case Study 20 Marks List 20 Assessment Findings Under Subjective And Objective Headings Client X Is A 56 Year Old Fe 1 (448.54 KiB) Viewed 67 times
diagnosis for this patient? using RESPIRATORY
ASSESSMENT which would include subjective and
objective data in the above scenario.
Case Study: 20 marks. List 20 assessment findings under subjective and objective headings. Client X. is a 56-year-old female, Height 168 cm; Weight 85 kg who has a history of Diabetes, End stage Renal failure, and anaemia. She has been smoking two packs of cigarettes a day for 40 years and has refused to quit. Three days ago, she had an onset of coughing, fever, headache, and joint pains. She has not taken her medications or been to Dialysis for the past 6 days. Today, she has been admitted to the hospital with Covid 19. She is very anxious and asks whether she is going to die but denies pain but says she feels like she cannot get enough air. On further assessment you auscultate pulmonary crackles; decreased breath sounds auscultated in right lower lobe; coughing yellow sputum. On further assessment she says her heart feels like it is "running away." S1, S2 palpated, all peripheral pulses are 1+; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation. She reports that she is so exhausted she cannot eat or drink by herself. Vital signs: T 37.6 C, P 118 and irregular, RR 34, BP 90/58 SpO2 82% Chest xray shows infiltrates in right lobe. Blood results: Platelets 86, Hb 6.5, WBC 3.5, Creatinine 1284, K 3.5, BUN 38.6 Rapid Antigen: Positive