Reference no: EM133397145

Case study: Mr. Pavlidis' right leg was amputated following a motor vehicle accident (MVA) that occurred 20 years ago. He uses a wheelchair to get around his apartment and outside. Mr. Pavlidis is on 2 litres of oxygen by nasal cannulae, but he often forgets to use his oxygen at home. He would keep the head of the bed up for most of the day and night to help with his breathing which resulted in lower back pain. He uses extra strength Tylenol for pain, but he informs you (the student nurse) that this is not working anymore. He requires someone to help him push his wheelchair because he often experiences fatigue, lower back pain, and shortness of breath. During physical assessment, his capillary refill is 5 seconds, and he has slight clubbing of his fingers. Moderate pitting is observed on his left ankle. There is a raised nevus on the patient's back. When you asked him about it, he replied "oh that looks different from the last time Ophelia told me about it". During auscultation, there is a decrease in breath sounds and continuous highpitched squeaking sounds during expiration. Ophelia informs you (in private) that her husband has been experiencing insomnia at home and in the hospital since his admission. She also noticed that while in the hospital, he stays in bed for most of the day and rarely changes position. While she was helping him get dressed one evening, she noticed some redness on his tailbone, which was warm to the touch compared to surrounding areas. Mr. Pavlidis describes this area as either "itchy" or "mild burning". Finally, Ophelia informs you that her husband smoke cigarettes inside their apartment, and this has been a source of conflict between the two.

Medical History: COPD (emphysema) Type 2 diabetes Generalized anxiety disorder Hypertension Hyperlipidemia Below-the-knee amputation (right leg) after MVA 20 years ago Family History: Hodgkin's lymphoma (patient's father and younger sister) Type 2 diabetes (patient's father) Bipolar II disorder (patient's mother) Substance Use: Alcohol (about 6 beers / week) Cigarettes (about 1 pack per day for the past 30 years) Vital Signs: T: 37.3 oC P: 98 R: 25 (use of accessory muscles to aid respiration) BP: 156 / 84 SP02 : 93% on 2 litres / min via nasal cannulae Height: 5'6 (170.6 cm) Weight: 405 lbs (183.7 kg) BMI: 65.4.

Questions:

1. Identify 3 priority health issues.

2. Provide 2 actual and 1 potential nursing diagnoses.

3. Provide 2 Short term and 1 long-term SMART goals.

4. Describe health teaching (at least 3 topics) you would provide for this family